MEDI-CAL PLANNING AND QUALIFICATION ASSISTANCE


MEDI-CAL ELIGIBILITY PLANNING TO QUALIFY FOR MEDI-CAL BENEFITS

There are three very important areas to consider in developing a comprehensive Medi-Cal plan:

1.         
Eligibility Planning - to qualify for Medi-Cal benefits;

2.         
Income Planning - to reduce or eliminate a Medi-Cal beneficiary’s monthly “share of cost”
                                           
   co-payment; and

3.         
Medi-Cal Estate Recovery Planning - to reduce or completely eliminate Medi-Cal estate recovery
                                           
   against the beneficiary’s estate.   

Our office will carefully review your assets, income and estate planning documents to develop a
comprehensive Medi-Cal plan tailored to your specific situation. We typically offer our clients several
alternative strategies and thoroughly review each strategy with our clients so that they can make an
informed decision regarding how they would like to proceed.



WHAT IS MEDI-CAL?

Medi-Cal is the State of California’s version of the federal Medicaid program that provides additional health
insurance for qualified individuals who are at least 65 years of age, blind or disabled.  In addition to
offering In Home Supportive Services (IHSS), Medi-Cal is particularly helpful to individuals that reside in
skilled nursing facilities that have exhausted their Medicare skilled nursing home coverage.  While
Medicare often covers the first 20 days of skilled nursing home expenses, coverage for days 21 through
100 requires a co-payment of $15
7.50 per day and is only available if the patient continues to show
improvement in his or her condition.  The co-payment of $15
7.50 per day may or may not be covered by the
patients' secondary health insurance, depending upon their individual plan.  Upon receiving  a maximum of
100 days of Medicare coverage, the patient is then typically converted to "private pay" status where
monthly expenses average approximately $7,
628 per month.  On the other hand, Medi-Cal will continue
to pay for skilled nursing home expenses indefinitely, regardless of whether or not the patient continues
to show improvement.

Unfortunately, many people are misinformed about the eligibility criteria Medi-Cal uses to determine one's
eligibility for the Medi-Cal Long Term Care program.  Such misinformation is likely due to the ever
changing and complicated Medi-Cal regulations.  Despite what you might have heard, you do not have to
be destitute in order to qualify for Medi-Cal benefits.  With the guidance of a knowledgeable elder law
attorney, it is legal to implement various Medi-Cal eligibility planning techniques in order to qualify for
Medi-Cal benefits.  

Our law firm is experienced in developing and implementing various Medi-Cal planning techniques to
quickly qualify an individual for Medi-Cal benefits and to minimize or completely eliminate any estate
recovery for benefits received.  Medi-Cal planning is our passion and we take great pride in developing
sound planning options for our clients tailored to their unique circumstances.



STANDARD ELIGIBILITY LIMITS FOR  LONG TERM CARE MEDI-CAL BENEFITS

The applicant must be 65 years of age, blind or disabled in order to receive Medi-Cal Long Term Care
benefits. A single applicant may not have more than $2,000.00 (for 2015) in “non-exempt” assets, while a
married applicant is allowed $119,220 (for 2015) in “non-exempt” assets.

Medi-Cal classifies certain assets as “exempt” and their values are
not used in the determining an
applicant’s eligibility.  The following are the major assets considered “exempt” by Medi-Cal in determining
eligibility:

•  Principal Residence                                               
•  One Vehicle                                                               
•  Most Qualified Retirement Accounts                 
•  Certain Life Insurance
•  Burial Plots
•  Household Goods

It is important to understand that the above are “standard” Medi-Cal eligibility limits.  For married
applicants, it is possible to significantly increase the “standard” $119,220 limit through a “3100 Court
Petition” or “Administrative Fair Hearing.”

Again, a Medi-Cal eligibility plan should only be carried out under the guidance of a knowledgeable
California elder law attorney familiar with the complex Medi-Cal regulations.    



“SHARE OF COST”

Although an applicant’s income is not an eligibility factor, Medi-Cal does review an applicant’s income to
determine the applicant’s monthly co-payment (“share of cost”).  The formula used to determine an
applicant’s “share of cost” has many variables and often allows the applicant’s spouse to retain a large
portion of the applicant’s income.  With proper planning it may be possible to reduce one's "share of cost."



MEDI-CAL ESTATE RECOVERY

Medi-Cal keeps track of the total amount of benefits it pays out over the lifetime of a Medi-Cal beneficiary
and attempts to recover that amount from the beneficiary’s remaining estate.  Medi-Cal may only recover
from the assets that the Medi-Cal beneficiary has an ownership interest in at the time of their passing, and
only after the Medi-Cal beneficiary’s spouse also passes away.  Thus, the Medi-Cal beneficiary’s spouse
will have unrestricted use of the assets for the remainder of their life.  Our office will carefully review your
financial assets in order to minimize or completely avoid potential estate recovery.  A proper Medi-Cal
eligibility plan will not only qualify an individual for Medi-Cal benefits (thereby preserving assets), but
provide asset protection from potential Medi-Cal estate recovery (including protection of one's home).  
Our office is experienced in preparing and implementing effective asset protection plans for single or
married Medi-Cal recipients.  



COURT PROCEEDINGS AND ADMINISTRATIVE FAIR HEARINGS TO QUALIFY
FOR MEDI-CAL BENEFITS

For married couples, a “3100 Court Petition” or “Administrative Fair Hearing” are often valuable tools used
to significantly
increase the standard $119,220 Medi-Cal eligibility limit.  Additionally, a “3100 Court
Petition” may be used to reduce or possibly eliminate the “share of cost” co-payment and to transfer all
assets to the Medi-Cal beneficiary’s spouse thereby
eliminating potential Medi-Cal recovery.



MEDI-CAL SERVICES PROVIDED BY OUR LAW OFFICE

We understand that Medi-Cal planning can be an emotional undertaking for you and your family.  Our office
will make the Medi-Cal process as easy as possible by providing the following services:

•        Preparation and explanation of alternative Medi-Cal planning strategies available for your specific
      
    situation;
•        Implementation of the Medi-Cal qualification strategy of your choice;
•        Preparation of the Medi-Cal application forms;
•        Our office will deal directly with Medi-Cal on your behalf through completion of the application
      
    process;
•        Preparation of estate planning documents (if applicable); and
•        Preparation of all documents necessary to reduce or eliminate Medi-Cal estate  recovery (if
      
    applicable).



A WORD OF CAUTION

Medi-Cal regulations are constantly updated and changed. Medi-Cal planning should only be done under
the supervision of an elder law attorney familiar with Medi-Cal.  Certain transfers of property can have
significant tax ramifications that should be discussed with your attorney.  Furthermore, improper
transfers can disqualify a Medi-Cal beneficiary and result in a significant period of ineligibility for Medi-Cal
benefits.

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.  Please also take time to review our "Medi-Cal: Frequently Asked
Questions" for additional information.
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.

© 2015 Sean Ethington, All Rights Reserved
Medi-Cal Planning &
Qualification
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