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”
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 $144.50 per day and is only available if the patient continues to show improvement in his or her
condition. The co-payment of $144.50 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 $6,850 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 2012) in “non-exempt” assets, while a
married applicant is allowed $113,640.00 (for 2012) 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
• Principal Residence • Certain Life Insurance
• One Vehicle • Household Goods
• Most Qualified Retirement Accounts • Burial Plots
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” $113,640.00 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
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 $113,640.00 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
• 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
• Preparation of estate planning documents (if applicable); and
• Preparation of all documents necessary to reduce or eliminate Medi-Cal estate recovery (if
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.
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
**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.
© 2012 Sean Ethington, All Rights Reserved
Medi-Cal Planning &
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