California Medicaid Long Term Care Eligibility

California Long Term Care (Medi-Cal)

california-medicaid Applications take anywhere between 45-90 days with both financial and health qualifications that must be met. The program covers, but is not limited to, nursing home daily rates after income as been applied, doctor’s visits, medical equipment such as diapers, and dental care. Unfortunately, rates at senior residences, board and care facilities, and assisted living facilities are not covered.

Medical Qualifications:

An Individual must qualify to live longer than thirty days at the skilled nursing level of care. This determination is dependent on the applicant’s ability or inability to complete at least four out of six Activities of Daily Living (ADLs) without help. The ADLs test includes: mobility, bathing, feeding, using the restroom unaided, dressing, and regulating/taking medication. If the individual can’t do three out of the six unaided, then he or she qualifies for a skilled nursing bed and could receive Medi-Cal benefits for long term care.

Asset and Income Qualifications:

If the applicant is single, countable assets must be no higher than $2,000. If married with a spouse remaining at home (community spouse), combined countable assets can reach $106,400. In terms of income, patients pay a share of cost based on an income after deduction for health insurance premiums and other expenses. There is a personal needs allowance of $35.00 per month that is not factored into the countable income.

Countable assets include, but are not limited to: Checking or savings accounts, CDs, investment accounts like mutual funds, stocks and bonds; life insurance policies with a value more than $1500, cars (anything over one car is counted); second homes and non-business properties; accounts held in revocable trusts; promissory notes, etc.

Exempt Assets include: the primary residence, if there is an at-home spouse or if the applicant intends to return home; property used in business or trade; pre-need burial expenses; life insurance with face value under $1500, IRAs, pensions, and annuities. The state can put a claim on a home after the death of the Medi-Cal patient or after the death of the last living spouse. The home is only exempt while the person is still alive.

In order to pass on assets from a retirement account or life insurance policy a person must have a named beneficiary; otherwise, the state will claim these policies after the death of the recipient. Likewise, to pass on a house the long term care recipient must transfer the property prior to death because if the house is left in the recipient’s name, the state can acquire it. The state also looks back 30 months prior to the application to see if there are any disqualifying financial transfers. Giving lump-sum gifts to spend down assets is one of the main reasons people are disqualified for Medi-Cal.

Spousal Rules:

Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $119,220. If the community spouse’s assets do not equal $119,220, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
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Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,981. The maximum amount of income that can be retained is $2,981.

Further Information:

Contact information for Medi-Cal offices: http://www.dhcs.ca.gov/services/medi-cal/Pages/Contacts.aspx

How to apply: http://www.dhcs.ca.gov/services/medi-cal/pages/applyformedi-cal.aspx

Long term care ombudsman: (800) 231-4024

Medi-Cal toll free number for general eligibility questions: (877)-597-4777