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How To Qualify For Medi-cal Without Going Broke

How To Get Medi-cal Without Going Broke First

The average nursing home cost in Southern California is now (2018) $8,515/mo. How long will your loved one be in a nursing home / Long-Term Care at $8,525/mo before they and their spouse are penniless? For most people, the answer is NOT VERY LONG.

80% of all Americans will spend an average of 24 months in a nursing home in their lives.

At $8,515/month, most of us will incur nursing home bills of $204,360 OR MORE, before we die.

My job is to help you plan so that this doesn’t destroy your family’s resources.

Medi-Cal is California’s version of Medicaid. Medi-Cal is needs-based financial aid for people who cannot afford to pay for their medical care at home or for nursing home care when that becomes necessary. All California counties have Medi-Cal offices which are governed by the state Department of Health.

I do more than just wills and truste. I also help people qualify for MediCal without spending all of their money, or without leaving their spouse in poverty. In other words, I handle Medi-Cal issues for long-term nursing home care.

Medi-Cal places limits on the resources a person may keep to be eligible.

Very Important Note: Don’t Panic.

My job is to legally and ethically help you to preserve MORE of your assets than this. I have a large variety of planning tools available to help you. Please call me to discuss your needs.

Here are some Medi-Cal Basics to Get You Started:

2018 Resource Allowance for the Medi-Cal recipient ($2,000.00)

In order to be eligible for Medi-Cal in a Skilled Nursing Facility (SNF), your resources, excluding ‘exempt ‘assets, must be below $2,000.00 for at least one day of the month in which you apply for Medi-Cal. In order to make this determination, an accounting must be done of both your exempt and non-exempt assets.

2018 Community Spouse Resource Allowance (CSRA) is $120,900)

The amount of liquid assets (savings, CDs) which your at-home spouse may have in his/her separate name for purposes of Medi-Cal eligibility.

2018 Minimum Monthly Maintenance Needs Allowance (MMMNA) is $3,023)

The minimum amount of income the at-home/community spouse must have. If s/he earns or receives less (from Social Security for example), the Medi-Cal spouse’s monthly income (which would otherwise go as the “share of cost” directly to the SNF thus saving Medi-Cal payment) may be ordered transferred to the community spouse by a Superior Court order to make up the difference between the at-home spouse’s income and the MMMNA.

2018 Average Private Pay Rate (APPR) is $8,515

This is the average monthly nursing home care cost in our area.

If You Don’t Make a Plan, How Long Can You or Your Spouse Pay $8,515/mo before you’re both penniless?

Medi-Cal defines assets as either EXEMPT or NON-EXEMPT for purposes of Eligibility

“Exempt Assets”

Your Home

  • Your Principal residence with “Intent to Return Home” checked on the Medi-Cal Application
  • Other Real Property – certain limits
  • Business Property – certain limits
  • Household Goods
  • Personal Effects *Jewelry
  • One Car
  • Whole Life Insurance
  • Term Life Insurance
  • Burial Plot (any amount, paid for)
  • Prepaid/Irrevocable Burial Plan
  • Designated Burial Funds
  • Pension Funds
  • IRAS
  • Some Annuities

“non-exempt Assets”

  • CASH

What Should You Do With “non-exempt” Assets?

  1. TALK TO AN ATTORNEY. This is an extremely complex area, and a good Family Asset Protection Planning attorney can save your loves ones literally hundreds of thousands of dollars.
  2. SPEND DOWN (Before Medi-Cal Application is filed): on necessities; ordinary expenses like paying off medical/legal bills; paying off a mortgage on a primary residence; burial funds; prepaying health insurance premiums; prepaying board and care .
  3. CONVERT (To an Exempt Asset): Use liquid assets to purchase an exempt new car, or a home.
  4. TRANSFER (Out of Medi-Cal Recipient’s Estate): There is a penalty for transfer or “giving away” without consideration. This must be done very carefully with an attorney’s guidance.


ELIGIBILITY Becoming eligible for Medi-Cal

SHARE OF COST Income that goes to the nursing home

STATE RECOVERY After death, California will look to see if there is anything in the Medi-Cal recipient’s name/estate that it is authorized to take in order to cover Medi-Cal costs. Even though a house is an exempt asset for purposes of ELIGIBILITY, if it is still in the name of the Medi-Cal recipient, the state may take up to the value of the Medi-Cal expenses it has paid for.

This is another reason why you should consult an attorney regarding eligibility and estate planning for the at-home spouse.

I use a large variety of sophisticated strategies to help my clients in their Family Asset Protection Planning. Please contact me to discuss your family’s needs.

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Estate Planning Attorney Eric Ridley