When it comes to Medi-Cal eligibility related to caregivers and nursing homes, some of the most frequently asked questions relate to the look-back period, transfer of assets or assuming one’s income is too high to receive benefits.
The Look-Back Period
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 otherwise. California’s Medi-Cal program never implemented the federal law, and it retains its 30-month “look-back” period.
Gifts 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 would 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 cost for this kind of care is $9,337 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.
For example, if there is a married couple and their total combined monthly income is less than $3,216 (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 $3,216, whatever the amount is over the $3,216 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 is no penalty for those who move assets properly and legally.
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 20 years, including denied claims. It’s our specialty.
We help families minimize their share of costs and avoid recovery claims by the state. Learn more about your rights. Call today for a free, fast consultation: 858-673-8448.