CALIFORNIA MEDI-CAL: FREQUENTLY ASKED QUESTIONS
HOW MUCH DOES SKILLED NURSING HOME CARE NORMALLY COST?
Without Medi-Cal, a skilled nursing home resident can expect to pay between $6,500.00 and $11,500.00
per month for standard care. (Residents receiving sub-acute or additional medical care can expect to pay
between $16,000 and $26,000 per month). Depending on location and level of care, skilled nursing home
costs range between $78,000 and $312,000.00 per year. A Medi-Cal recipient often pays only a small
fraction of their skilled nursing home care expenses.
WHEN SHOULD I BEGIN PLANNING FOR MEDI-CAL?
The sooner, the better. Early Medi-Cal qualification planning provides you with more options, including
creating estate planning documents with Medi-Cal planning language to ensure that your appointed
agent can carry out further Medi-Cal eligibility planning if you later become incapacitated. Proper estate
planning documents should also insure that your appointed agent has legal authority to implement an
appropriate Medi-Cal estate recovery minimization or avoidance plan.
Of course it is never too late for Medi-Cal planning and effective strategies can still be implemented in
emergency situations. To be honest, our typical client falls within this category of emergency Medi-Cal
planning because many do not realize that they (or their loved one) will not be covered indefinitely by
Medicare. Many are not even aware of the Medi-Cal program until they (or a loved one) are facing very
expensive private pay rates for skilled nursing home care. As such, our office is quite experienced in
preparing appropriate Medi-Cal plans for emergency situations and we are usually able to obtain
Medi-Cal eligibility for our clients effective the first day of the calendar month in which our services have
been retained. In some cases, pursuant to Medi-Cal regulations we are even able to obtain retroactive
Medi-Cal coverage for the three months prior to the date of application.
I AM ALREADY RECEIVING CALIFORNIA MEDI-CAL BENEFITS. CAN I STILL BENEFIT
FROM MEDI-CAL PLANNING?
Absolutely. Medi-Cal planning could potentially reduce or eliminate your “share of cost” co-payment and
protect your assets from Medi-Cal estate recovery. Various asset protection strategies are often even
available for mentally incapacitated Medi-Cal patients. A major concern of our clients is that their home
be protected from Medi-Cal estate recovery. Our office is experienced in preparing and implementing
innovative Medi-Cal estate recovery plans in order to protect a Medi-Cal recipients' home from Medi-Cal
estate recovery (even if the individual is mentally incapacitated).
CAN I MAKE A LARGE GIFT TO IMMEDIATELY QUALIFY FOR MEDI-CAL BENEFITS?
Medi-Cal has strict regulations concerning asset transfers. Improper transfers may result in a significant
“period of ineligibility” during which an individual cannot receive long term care Medi-Cal benefits.
Moreover, at some point in the future California is expected to implement the Deficit Reduction Act of
2005 which will introduce additional Medi-Cal gifting penalties. Transfers can also have negative estate
and capital gains tax ramifications. Legal advice from a knowledgeable Medi-Cal attorney should be
obtained before making any transfers of assets.
That said, carefully crafted Medi-Cal gifting strategies may still be an effective means for reducing
"countable" assets in order to qualify for Medi-Cal Long Term Care benefits. Of course, all gifts must be
documented and disclosed to Medi-Cal during the application process. An appropriate Medi-Cal gifting
strategy limits, or completely avoids potential "periods of ineligibility" for Medi-Cal Long Term Care
benefits. There are many factors to consider before implementing a Medi-Cal gifting spend down
strategy and legal advice from a knowledgeable Medi-Cal attorney should be obtained before making
any transfers of assets.
WILL I LOSE MY HOME IF I RECEIVE MEDI-CAL?
Medi-Cal will attempt to recover its expenses from the assets the Medi-Cal beneficiary owns at the time of
his or her death, including the beneficiary’s home. Your home can be protected with proper Medi-Cal
estate recovery planning. Asset protection is a crucial aspect of Medi-Cal planning.
MY MOTHER HAS BEEN A RESIDENT AT A SKILLED NURSING HOME FOR THE PAST SIX
MONTHS. WILL SHE BE REIMBURSED FOR PAST NURSING HOME EXPENSES?
Medi-Cal benefits can be obtained retroactively for the three months immediately preceding your
application month as long as the eligibility requirements were met for those months. For example, if you
applied for Medi-Cal benefits in April but met the Medi-Cal eligibility requirements in January, Medi-Cal
benefits can be approved effective January. In such a case the nursing home would be required to
refund your payments above the “share of cost” amount determined by Medi-Cal from January forward.
Similarly, if the Medi-Cal eligibility limit is increased through a “3100 Court Petition” or “Administrative
Fair Hearing” procedure, the increased eligibility limit can be applied retroactively to cover the three
months immediately preceding the month of Medi-Cal application.
IN WHAT AMOUNT MAY MEDI-CAL MAKE A RECOVERY CLAIM AGAINST MY ESTATE?
Recovery is limited to the lesser of
1. The total amount of benefits a Medi-Cal beneficiary receive during his or her life
OR
2. The value of the Medi-Cal beneficiary’s estate at the time of their passing
If the Medi-Cal beneficiary dies with no remaining estate, there are no assets for Medi-Cal to recover
against. Transferring assets out of the Medi-Cal beneficiary's name should only be done under the
guidance of a qualified elder law attorney to avoid any potential Medi-Cal transfer penalties.
Contact our office today to schedule a FREE consultation in our office or at your home. Our law office
has three convenient office locations serving Los Angeles County and surrounding areas. We also
accept cases and can arrange for meetings in Ventura County, Orange County, Santa Barbara County,
Riverside County and San Bernardino County.
HOW MUCH DOES SKILLED NURSING HOME CARE NORMALLY COST?
Without Medi-Cal, a skilled nursing home resident can expect to pay between $6,500.00 and $11,500.00
per month for standard care. (Residents receiving sub-acute or additional medical care can expect to pay
between $16,000 and $26,000 per month). Depending on location and level of care, skilled nursing home
costs range between $78,000 and $312,000.00 per year. A Medi-Cal recipient often pays only a small
fraction of their skilled nursing home care expenses.
WHEN SHOULD I BEGIN PLANNING FOR MEDI-CAL?
The sooner, the better. Early Medi-Cal qualification planning provides you with more options, including
creating estate planning documents with Medi-Cal planning language to ensure that your appointed
agent can carry out further Medi-Cal eligibility planning if you later become incapacitated. Proper estate
planning documents should also insure that your appointed agent has legal authority to implement an
appropriate Medi-Cal estate recovery minimization or avoidance plan.
Of course it is never too late for Medi-Cal planning and effective strategies can still be implemented in
emergency situations. To be honest, our typical client falls within this category of emergency Medi-Cal
planning because many do not realize that they (or their loved one) will not be covered indefinitely by
Medicare. Many are not even aware of the Medi-Cal program until they (or a loved one) are facing very
expensive private pay rates for skilled nursing home care. As such, our office is quite experienced in
preparing appropriate Medi-Cal plans for emergency situations and we are usually able to obtain
Medi-Cal eligibility for our clients effective the first day of the calendar month in which our services have
been retained. In some cases, pursuant to Medi-Cal regulations we are even able to obtain retroactive
Medi-Cal coverage for the three months prior to the date of application.
I AM ALREADY RECEIVING CALIFORNIA MEDI-CAL BENEFITS. CAN I STILL BENEFIT
FROM MEDI-CAL PLANNING?
Absolutely. Medi-Cal planning could potentially reduce or eliminate your “share of cost” co-payment and
protect your assets from Medi-Cal estate recovery. Various asset protection strategies are often even
available for mentally incapacitated Medi-Cal patients. A major concern of our clients is that their home
be protected from Medi-Cal estate recovery. Our office is experienced in preparing and implementing
innovative Medi-Cal estate recovery plans in order to protect a Medi-Cal recipients' home from Medi-Cal
estate recovery (even if the individual is mentally incapacitated).
CAN I MAKE A LARGE GIFT TO IMMEDIATELY QUALIFY FOR MEDI-CAL BENEFITS?
Medi-Cal has strict regulations concerning asset transfers. Improper transfers may result in a significant
“period of ineligibility” during which an individual cannot receive long term care Medi-Cal benefits.
Moreover, at some point in the future California is expected to implement the Deficit Reduction Act of
2005 which will introduce additional Medi-Cal gifting penalties. Transfers can also have negative estate
and capital gains tax ramifications. Legal advice from a knowledgeable Medi-Cal attorney should be
obtained before making any transfers of assets.
That said, carefully crafted Medi-Cal gifting strategies may still be an effective means for reducing
"countable" assets in order to qualify for Medi-Cal Long Term Care benefits. Of course, all gifts must be
documented and disclosed to Medi-Cal during the application process. An appropriate Medi-Cal gifting
strategy limits, or completely avoids potential "periods of ineligibility" for Medi-Cal Long Term Care
benefits. There are many factors to consider before implementing a Medi-Cal gifting spend down
strategy and legal advice from a knowledgeable Medi-Cal attorney should be obtained before making
any transfers of assets.
WILL I LOSE MY HOME IF I RECEIVE MEDI-CAL?
Medi-Cal will attempt to recover its expenses from the assets the Medi-Cal beneficiary owns at the time of
his or her death, including the beneficiary’s home. Your home can be protected with proper Medi-Cal
estate recovery planning. Asset protection is a crucial aspect of Medi-Cal planning.
MY MOTHER HAS BEEN A RESIDENT AT A SKILLED NURSING HOME FOR THE PAST SIX
MONTHS. WILL SHE BE REIMBURSED FOR PAST NURSING HOME EXPENSES?
Medi-Cal benefits can be obtained retroactively for the three months immediately preceding your
application month as long as the eligibility requirements were met for those months. For example, if you
applied for Medi-Cal benefits in April but met the Medi-Cal eligibility requirements in January, Medi-Cal
benefits can be approved effective January. In such a case the nursing home would be required to
refund your payments above the “share of cost” amount determined by Medi-Cal from January forward.
Similarly, if the Medi-Cal eligibility limit is increased through a “3100 Court Petition” or “Administrative
Fair Hearing” procedure, the increased eligibility limit can be applied retroactively to cover the three
months immediately preceding the month of Medi-Cal application.
IN WHAT AMOUNT MAY MEDI-CAL MAKE A RECOVERY CLAIM AGAINST MY ESTATE?
Recovery is limited to the lesser of
1. The total amount of benefits a Medi-Cal beneficiary receive during his or her life
OR
2. The value of the Medi-Cal beneficiary’s estate at the time of their passing
If the Medi-Cal beneficiary dies with no remaining estate, there are no assets for Medi-Cal to recover
against. Transferring assets out of the Medi-Cal beneficiary's name should only be done under the
guidance of a qualified elder law attorney to avoid any potential Medi-Cal transfer penalties.
Contact our office today to schedule a FREE consultation in our office or at your home. Our law office
has three convenient office locations serving Los Angeles County and surrounding areas. We also
accept cases and can arrange for meetings in Ventura County, Orange County, Santa Barbara County,
Riverside County and San Bernardino County.
| Sean Ethington Attorney at Law Phone: (800) 852-1239 or (661) 295-4604 FAX: (661) 295-4605 Our office serves Los Angeles County, Ventura County, Orange County, Santa Barbara County, Riverside County and San Bernardino County. |
**This information is designed to provide a general overview with regard to the subject matter. It is not intended, nor should it be interpreted as legal advice.
Use of this web site does not create an attorney-client relationship. You should consult an attorney for individual advice regarding your particular situation.
© 2018 Sean Ethington, All Rights Reserved
Use of this web site does not create an attorney-client relationship. You should consult an attorney for individual advice regarding your particular situation.
© 2018 Sean Ethington, All Rights Reserved
California Medi-Cal
Frequently Asked Questions
Frequently Asked Questions
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