Medi-Cal and Veterans Benefits FAQs

California’s Medicaid system is known as Medi-Cal.

This is a public health insurance program that offers essential medical services to people and families with kids, elders, people with disabilities, people in foster care, pregnant women, and those with certain conditions, including HIV/AIDS, breast cancer, or tuberculosis.

State and federal governments each contribute equally to the cost of Medi-Cal.

**  Because Medi-Cal Estate Recovery will come after assets if the proper planning is not done.

**  Because you’re busy and your time is valuable. And it’s not fun to sit on hold (for an average of an hour or more) when calling the Medi-Cal offices.

**  Because a large percentage of cases are denied initially until additional requirements are met. That feels defeating if you’re not familiar with the process.

**  Because if you do it incorrectly, the Medi-Cal Estate Recovery can come after you once your elder loved one (who received benefits) passes away.

**  Because Financial Security Designs has been handling Medi-Cal eligibility for over 25 years, has a 100% approval rate (assuming everything is disclosed and we accept your case), and the average cost (private pay rate) of a nursing home is $10,933.00 per month.

**  Because Financial Security Designs offers a Money Back Guarantee (see full Disclaimer for details) so there is nothing to lose.

You don’t have to do this on your own.

For a fraction of the cost of one month in a nursing home, your family can receive Medi-Cal financial support as long as you stay eligible. The Medi-Cal beneficiary’s income (minus $35 and a deduction for any health insurance premium) is called the “Share of Cost.”

If the institutionalized person is single, all their income (minus $35 for a personal needs allowance and a deduction for a health insurance premium) is what they would need to pay the facility – this is called the Share of Cost. 

If there is a well spouse at home (the healthy spouse), the well spouse can keep all their income if it is more than $3,435.00 – and all of the institutionalized spouse’s income would need to be paid to the facility.

If the income of the well spouse is not more than $3,435.00 (the amount at the time of this writing Jan. 2023, but verify, as this allowance amount changes yearly), the well spouse can keep whatever is needed from the institutionalized spouse to get their income up to $3,435.00. Referred to as the Community Spouse Resource Allowance (CSRA).

Don’t worry if this sounds confusing – these are all things we review in our consultations with families and help handle with our clients. We make everything simple – and we stay up-to-date on any changes.

The community spouse resource allowance (CSRA) is the amount of assets a spouse can keep when the other spouse applies for Medi-Cal to cover the cost of nursing home care.

The community spouse resource allowance ensures that the spouse not in the nursing home has sufficient resources to maintain their standard of living.

In California, as an example, the community spouse resource allowance is $128,640 as of 2021.

So in this example, if a married individual is applying for Medi-Cal to cover the cost of nursing home care, their spouse can keep up to $128,640 in assets. Any assets above this amount will be considered when determining the applicant’s Medi-Cal eligibility.

It’s important to note that the CSRA is subject to change, so it’s important to check with the California Department of Health Care Services, an elder care lawyer, or a Medi-Cal consultant for the most recent amount.

Yes. If we meet with you (via phone or in person), review your family’s situation, you disclose everything we ask related to eligibility, and we agree to accept your case, and you don’t become Medi-Cal eligible, then we will give a money-back guarantee concerning the funds paid for the Medi-Cal application process.

If we cannot obtain Medi-Cal eligibility, we will refund in full all funds paid to our firm for the application process. This guarantee is premised on the representations made to our office concerning the estate’s assets, the existence of any non-exempt transfers, other material factors that would impact the application process, and current rules and regulations concerning Medi-Cal laws.

The Money Back Guarantee does not apply should the Medi-Cal recipient pass away prior to the completion of the plan or should you decide not to continue with the planning.

In other words, our money-back guarantee is premised on the fact that all material facts have been disclosed to our office. If, as a result of the application process, the Department of Social Services uncovers assets that were not disclosed to us or other material facts are uncovered which cause the application to be denied, then the money-back guarantee would not apply.

In short, the only way the application would be denied is if we either do not understand the law or fail to appropriately apply for the benefits. In that event, we will be more than happy to make a full refund.Remember that denied cases are often part of this process, and filing an appeal is part of our work, which will only affect processing time.

As part of our guarantee, you must provide all requested documents within ten days (there are exceptions) – which includes: providing a schedule of transfers from the sale of the residence and disclosure to the county to maintain Medi-Cal eligibility after the period of ineligibility has expired.

See the Disclaimer for full details.

Yes, Medi-Cal (California’s Medicaid program) may cover the cost of elder care for eligible individuals.

Eligibility for Medi-Cal is based on your income, assets, and medical needs. 

Assuming you become Medi-Cal eligible, it can cover nursing home care for individuals who:

• Are 65 years of age or older
• Are blind or disabled
• Have low income and few assets

If you are not sure whether you are eligible for Medi-Cal, you can contact your local Medi-Cal office or a benefits counselor or consultant (like Financial Security Designs) to learn more. They can help you determine your eligibility and provide information on how to apply for Medi-Cal coverage.

To apply for Medi-Cal in California (Medicaid) to help pay for a nursing home or long term care, you will need to:

1. Gather the necessary documents. You will need to provide proof of your identity, income, assets, and any medical expenses you have.
2. Contact your local Medi-Cal office or look up Medi-Cal Benefit Consultants. Be sure to research their online reviews, how long they’ve been in business, and their success rate with Medi-Cal eligibility and denied cases.
3. If you decide to apply on your own, you can fill out an application online, by phone, or by visiting your local Medi-Cal office. If you hire a Benefits Consultant like Financial Security Designs, we will handle the entire process for you, including long hold times with the County.
4. Once your application has been completed, it needs to be submitted to your local Medi-Cal office for review.
5. Wait for a decision. It may take several weeks for your application to be processed and a decision to be made. If you are using a consultant or attorney, they will keep you updated on the status.

It is essential to apply as soon as possible to ensure that you can get the financial assistance you need to help pay for your nursing home care.

Medi-Cal may provide financial assistance to pay a family member who is a caregiver for an elderly or disabled individual. This financial assistance is known as “in-home supportive services” (IHSS).

To be eligible for IHSS, you must meet the following criteria:

• Be eligible for Medi-Cal
• Need help with activities of daily living, such as bathing, dressing, and eating
• Be unable to perform these activities without assistance
• Be at risk of being placed in a nursing home or other long-term care facility without in-home care

If you are eligible for IHSS, you may be able to hire a family member or other caregiver to provide in-home care services.

Every situation is different and the caregiver must be approved by the county IHSS office – and the services they provide must be medically necessary and authorized by a healthcare provider. This is another topic we discuss with families during our initial consultation.

If you are interested in receiving IHSS and hiring a family member as a caregiver, you should contact your local Medi-Cal office, Medi-Cal consultants like Financial Security Designs, or a benefits counselor for more information.

Yes, the income of the Medi-Cal recipient would be applied towards the bill – referred to as the “Share of Cost” (referenced above).

The categories of Medi-Cal long-term care programs have varying financial and medical (functional) eligibility criteria.

Eligibility for these programs is dependant upon changing financial criteria, marital status, and other pathways that California offers towards eligibility.

It’s important to note that Medi-Cal will look at both your assets and income when determining eligibility. All assets and income must be reported to the California Department of Health Care Services. By understanding the Medi-Cal eligibility requirements for single applicants for nursing home care, you can make sure you have the right information when applying.

A Single Applicant for Nursing Home Care – A California senior must be financially and medically eligible for long-term care Medicaid. They must have limited assets and a medical need for care.

Although there is no income limit, nearly all of one’s income must be paid towards the cost of nursing home care. 

A single California senior applying for Nursing Home Medicaid in 2023 must:

1) Have assets under $130,000

2) Require the care provided in a nursing home facility

Please note the criteria varies with marital status and other eligibility factors in California.

Be sure to talk to your local Medi-Cal office, an elder law attorney, or a qualified Medi-Cal Consultant to find out more about eligibility for the program.

You will need documentation such as proof of income, residency, and citizenship or immigration status. And depending on your situation, yes, you may also need a letter from your doctor or other medical documentation.

The paperwork required for Medi-Cal eligibility can vary depending on your circumstances and the type of Medi-Cal coverage you seek.

You may be applying for healthcare coverage based on low income, you may be applying due to a disability, or you may be needing Medi-Cal to help pay for a nursing home.

Depending on the reason for your application, they may require documentation such as a letter from your medical provider(s).

If you are applying on your own, you can contact your local Medi-Cal office, an elder care attorney, a qualified Medi-Cal consultant, or visit the California Department of Health Care Services website to learn what documentation will be required.

If you are hiring a consulting service such as Financial Security Designs, we will guide you through the entire process, alleviating any worries or concerns about what’s required.

Yes, you may still be eligible for Medi-Cal even if you own a home.

The Medi-Cal program does have income and asset limits that determine eligibility, but owning a home does not automatically disqualify you from qualifying for benefits.

The value of your home and how you position your assets are all considered and disclosed to the County during the application process.

Eligibility requirements for Medi-Cal can vary depending on your specific situation.

People are often surprised to learn that Long Term Care Medi-Cal is not an income-based benefit.

The program will consider your income and assets, also known as your “countable resources.” Countable resources are things you own that can be converted to cash (such as bank accounts, stocks, and bonds) and used to pay for your medical expenses.

Some assets not counted when determining Medi-Cal eligibility include your primary residence, one car per household, and certain personal belongings.

Certain types of trusts and annuities may not be counted, depending on their specific terms and conditions. It’s important to consult attorneys who specialize in Medi-Cal or Family and Elder Law or consultants that specialize in these kinds of cases if you need proper planning.

The rules for what assets are counted when determining Medi-Cal eligibility can be complex and vary depending on your specific circumstances.

• Lying on their application or filling it out incorrectly or incompletely
• Not understanding the eligibility requirements – it is important to understand these requirements and gather all of the necessary documentation before applying 
• Not disclosing all your assets and income – failing to report all income and assets – can result in a denial of benefits or repayment of benefits received
• Not understanding the “Look-Back” period in California (the amount of time that the state will review an individual’s financial records in order to determine eligibility for Medi-Cal)
• Not planning ahead – Medicaid/Medi-Cal has strict rules about how assets can be transferred or gifted in order to qualify for benefits
• Not understanding the different types of Medicaid/Medi-Cal programs – each has its own eligibility requirements and benefits
• Not seeking professional help – although it’s not required, applying for Medicaid/Medi-Cal can be a complex process, and it is important to seek the help of a qualified professional, such as an elder law attorney or Medi-Cal benefits consultancy like Financial Security Designs
• Not submitting the required paperwork by the Medi-Cal deadlines
• Not keeping your Nursing Home administrator updated on the status of Medi-Cal eligibility/payments

The length of time it takes to become eligible can vary depending on a number of factors, including the completeness of your application and documentation, assets, as well as the volume of applications being processed at the time you apply.

If you have an elder loved one requiring long term care or a nursing home, the sooner you apply for eligibility, the better.

Your Medi-Cal coverage would be effective the first of the month of the application but may be able to get coverage for the previous 3 months if you were within the Medi-Cal guidelines. As with all things Medi-Cal, check with your local Medi-Cal office or a qualified consultant to understand eligibility rules and effective dates.

If you are in need of long-term care and you have assets, you may be able to get help paying for these expenses through Medicaid. It depends on the value of your assets and how these assets are positioned.

The income and asset limits vary by state. When determining eligibility, “countable assets” often include things such as bank accounts, stocks, and real estate. However, Medicaid does not count all of your assets when determining eligibility. Feel free to book a complimentary consultation to understand your options and what benefits are available in your situation.

If you have assets that exceed the Medicaid limits, you may still be able to qualify for Medicaid by using certain planning strategies to ethically and legally “re-position” your assets.

This may involve using your assets to pay for your long-term care expenses or transferring your assets to a family member or trust.

It is important to note that there are rules and restrictions around these types of asset transfers, and it is best to seek the advice of a qualified professional if you are considering this option.

If you are in a nursing home and you run out of money to pay for your care, it is possible that the nursing home could seek to recover the unpaid amounts from your assets, including your home.

However, there are several factors that can affect whether or not the nursing home is able to take your home, including state laws and the specific terms of any contracts you have with the nursing home.

If you are worried about the potential for the nursing home to take your home, there are steps you can take to protect your assets, such as creating a trust or transferring ownership of your home to a family member.

It is important to note that there are rules and restrictions around these types of asset transfers, and it is best to seek the advice of a qualified professional, attorney, or Medi-Cal consultant.

Yes. However, the specific government programs available to you – and the eligibility requirements for those programs – will depend on your family’s circumstances, such as your income, assets, and the type of care you need.

One option for financial assistance for elder care is Medicaid (Medi-Cal), which is a joint federal and state program that provides health insurance and long-term care coverage to low-income individuals and families.

Medi-Cal will generally pay for nursing home care if you are eligible for the program and if the nursing home is Medicaid-certified.

To be eligible for Medi-Cal, you must meet certain income and asset limits, and Medicaid will consider your countable assets. Your primary residence is not included as a countable asset.

However, if you run out of money and cannot pay for your care, the nursing home or other care facility may seek to recover the unpaid amounts from your assets, including your home.

Having experienced guidance can mean preventing estate recovery.

That’s why it’s useful to consult a Medi-Cal professional or contact your local Medi-Cal office if you’re unsure of the process of eligibility and recovery.

There are also other government assistance programs that may be able to help you pay for elder care, depending on your circumstances. For example, the Department of Veterans Affairs (VA) offers a range of benefits for veterans, including assistance with long-term care expenses.

The VA also has programs specifically designed to help seniors, such as the Aid and Attendance Pension, which can provide financial assistance to veterans and their spouses who need help with activities of daily living.

If these VA programs apply to you, we can help you understand at no cost. We will discuss all the benefits available during our initial consultation (and subsequent meetings if we accept your case).

Medi-Cal can help pay for assisted living if you are eligible for the program and if the assisted living facility is Medi-Cal-certified. You must meet certain income and asset limits.

Another option is the Assisted Living Waiver (ALW) program, which is administered by the California Department of Aging. The ALW program provides financial assistance to low-income seniors at risk of nursing home placement and needing help with activities of daily living, such as bathing, dressing, and medication management. The ALW program is available to Medi-Cal beneficiaries who meet certain eligibility requirements, including income and asset limits (as discussed above).

Again, there are other government assistance programs that may be able to help you pay for assisted living or long term care, depending on your circumstances. Be sure to speak with a qualified consultant to understand all of your options.

VA Benefits can also help pay for long-term care expenses depending on each family’s situation. The VA also has programs specifically designed to help seniors, such as the Aid and Attendance Pension (described on our website), which can provide financial assistance to veterans and their spouses who need help with activities of daily living.

If you are seeking financial help paying for assisted living in California and you own a home or other assets, it is important to consult with a qualified professional, attorney, or VA and Medi-Cal Consultant.

We can help you understand the eligibility requirements for various assistance programs and advise you on the best way to protect your assets while still obtaining the care you need.

Good question. The answer is maybe.

If you are within the guidelines for a single individual in a nursing home, the Medi-Cal recipient is allowed to have $130,000.00 and qualify. However, the Medi-Cal Estate Recovery will come after the assets once the recipient passes away. 

Financial Security Designs would get our clients eligible and then guide them on how to transfer the assets legally and ethically out of the Medi-Cal recipients’ names so Estate Recovery can’t touch the assets.

If the assets are over the allowable amount of $130,000.00, that amount would need to be transferred out of the Medi-Cal recipient’s name prior to becoming eligible. There must be full disclosure of the asset transfers and a complete paper trail provided to the county (Medi-Cal) showing the transfers.

Yes, it would protect Medi-Cal Estate Recovery from coming after the home. We do not recommend transferring the home to anyone other than through a Trust, which would also protect the home from Medi-Cal Estate Recovery without concern of the child getting in financial difficulty and possibly losing the home.

If you are unable to pay for a nursing home and you have no assets or income, there are several options available to help cover the cost of your care. Some of these options may include:

Medicaid

To be eligible for Medicaid, you must meet certain income and asset limits as discussed above. These limits vary by state. Medi-Cal will consider your countable assets, which may include things like bank accounts, stocks, and real estate, when determining your eligibility.

However, Medi-Cal does not count all of your assets when determining eligibility. For example, Medicaid generally does not count your home, if it is your primary residence, or certain personal property, such as a motor vehicle.

Further, if you are unable to pay for a nursing home and have no assets or income, you may be considered “medically indigent” and eligible for Medicaid under your state’s medically indigent program.

Each state has its own rules and regulations for determining medical indigence, so it is important to contact your local Medicaid office or a qualified professional for more information on your options.

Your Medi-Cal coverage would be effective the first of the month of the application, but you may be able to get coverage for the previous three months if you were within the Medi-Cal guidelines.

It is important to note that Medi-Cal eligibility is determined on a case-by-case basis, and the specific requirements for eligibility may vary depending on your individual circumstances.

If you have questions about Medi-Cal eligibility or the application process, you should contact your local Medicaid office or a qualified attorney or professional for more information.

Long-term care insurance

If you have long-term care insurance, it may cover the cost of a nursing home or other long-term care services.

Veterans Affairs (VA) benefits

If you are a veteran, you may be eligible for VA benefits that can help cover the cost of a nursing home or other long-term care services.

Family and friends

In some cases, family members or friends may be able to help cover the cost of a nursing home or provide financial assistance.

It’s important for family members to understand – they are not required to sign admission agreements as the financially responsible parties.

Medical facilities are not allowed to discharge the resident without a discharge plan, but unfortunately, some facilities will still do it.

That’s why it’s important to consult with a Medi-Cal expert to make sure families understand the process.

In California, yes, you can. However, the parent with the IRA would have to liquidate the IRA, and it would be reported as taxable income. The nursing home fees might be deductible as a medical expense and offset that income. Since IRAs are exempt if receiving the RMD (Required Minimum Distribution), you can get Medicaid/Medi-Cal eligibility and just the income pays the bill.  

Your best bet is to consult a CPA or Medicaid Expert in your area to ensure you’re making the best financial decision for your family. With proper planning, you can avoid the need to liquidate while still qualifying (becoming eligible) for Medi-Cal (Medicaid) Long-term care financial support.