How to Qualify for Medicaid / Medi-Cal
In order to receive benefits through Medicaid (called “Medi-Cal” in California) for caregivers and nursing homes, there are certain criteria needed to qualify.
We receive a lot of questions on becoming Medi-Cal eligible, transferring assets (and what they count as an asset), allowable income, and the look-back period. We know it all seems confusing, but we’re here to make it simple.
If you believe you’re over assets or have a high income, you can often still qualify for Medi-Cal eligibility with the proper planning.
If your total income is under the MMMNA (Minimum Monthly Maintenance Need Allowance) of $3,435 there would be no cost for your spouse to be in a Medi-Cal approved facility.
We will review how this works when we speak during your complimentary initial consultation.
Medi-Cal / Medicaid: The Look-Back Period
To determine eligibility for Medi-Cal, one thing that the County will do is check financial transactions for the last 30 months.
The Deficit Reduction Act (DRA) has now extended the “look-back period” to 60 months for all gift transfers, made by means of a trust or other methods. However, California’s Medi-Cal program never implemented the federal law, and it retains its 30-month “look-back” period.
Gift transfers are allowable under certain conditions and in certain amounts. This helps families legally qualify for financial assistance from the state, and is all disclosed to the County when applying for benefits.
Under existing law, if a person makes a gift transfer, the period of ineligibility begins with the month when the gift was made. Under the DRA, the penalty period starts when the applicant makes an application for long-term care benefits.
What this means is that under current regulations a person can make a transfer/gift for $34,000 and the period of ineligibility for Medi-Cal could be 4 months, not 30 months. This is something we explain during the initial consultation with families needing support.
We specialize in guiding our clients on how to reduce the period of ineligibility – in this example, the 4 month period of ineligibility to no period of ineligibility on a $34,000 transfer.
Medi-Cal eligibility for nursing home expenses is not an income based benefit.Tony Bevin, Financial Security Designs
Transfer of Assets
The Long Term Care Medi-Cal program pays for an elder loved one’s care in a skilled nursing facility. It helps provide Federal assistance for families paying for nursing care. The average private-pay rate for this kind of care is $10,933 per month.
Transfers/Gifts that start at the beginning of the month can total as much as $170,000 with no period of ineligibility for that month.
Most seem to be under the impression that if any assets have been transferred in the past 30 months they would be ineligible for Medi-Cal for 30 months. That is not the case.
Medi-Cal eligibility for nursing home expenses is not an income based benefit.
As mentioned above, if there is a married couple and their total combined monthly income is less than $3,435 (subject to change), there would be no cost (or zero share of cost) that would need to be paid to the facility.
If the total monthly income were over $3,435, whatever the amount is over the $3,435 would need to be paid to the facility, referred to as a share of cost. There is an allowable deduction for Health Insurance premiums and a $35 personal needs allowance.
If a person is single, all their income minus the deduction for health insurance and the $35 personal needs allowance would need to be paid to the facility.
Even if a Medi-Cal recipient or their spouse has a share of cost, it will be far less than the private pay rate for a nursing home.
Additionally, recipients do not need to spend down their assets to qualify, as is commonly believed. There may be no penalty for those who move assets properly and legally. If there is a penalty, we specialize in minimizing it!
There are other options available in terms of allowances and eldercare planning that many don’t know about. We’re grateful to be of service and help families receive the financial assistance they can really use during an emotionally difficult time.
We Can Help You Become Eligible for Federal Assistance
Financial Security Designs has been helping Californians qualify for Medi-Cal benefits for nursing homes and in-home care for over 28 years, including denied claims. It’s our specialty.
During our initial consultation, we’ll discuss your own unique situation and review your options on how to become eligible.
We will fill you in on many benefits that most don’t know are available. One program is called The Assisted Living Waiver Program (ALWP) and it helps seniors receive long term care assistance through Medi-Cal approved Assisted Living facilities. This has its own eligibility guidelines we will go over during your consultation.
The bottom line is that we help families minimize their share of costs through Medi-Cal – and avoid recovery claims by the state. Learn more about your rights. Call today for a free, fast consultation: 858-673-8448.