How To Choose a Long-Term Care Facility

Medi-Cal Planning Questions & Answers

• Is Medi-Cal different than Medicare?

• Do I give up Medicare benefits while on Medi-Cal?

• What kind of things can you do to protect your assets and still qualify for Medi-Cal?

• What about the stay-at-home spouse?

• Can you keep your home?

• Can the state place a lien on your home to recover costs of care in a nursing home?

Is Medi-Cal different than Medicare?

Yes. Medi-Cal and Medicare are two entirely separate health insurance programs.
In a nursing home, Medicare will only cover you as long as you came to the nursing home directly from a hospital for at least a 3-day stay and require skilled nursing, physician or rehabilitation services every day. "Custodial care" - e.g., help with personal care, with daily activities or with taking medications - is not enough for Medicare to pay your nursing home bills.
On the other hand, Medi-Cal will pay most (if not all) of the high cost of nursing homes provided you are qualified.

Do I give up Medicare benefits while on Medi-Cal?

No. If you have Medicare coverage and are also eligible for Medi-Cal, Medi-Cal benefits will be used to supplement your Medicare coverage. It will pay for the premiums, deductibles and coinsurance's required by Medicare as well for items such as prescription drugs, custodial care or personal care while staying at a nursing home (which Medicare will not cover).



What kind of things can you do to protect your assets and still qualify for Medi-Cal?

Since the institutionalized spouse (i.e., the "sick" spouse") is only allowed to keep $2,000, most Medi-Cal plans would involve taking his or her name off all community accounts, or transfer his or her separate accounts to the stay-at-home spouse (i.e., the "well" spouse). This may be done at any time - before or after applying for Medi-Cal.

In addition, any excess resources (above $2,000) for an individual or $104,400 for married couple.

After becoming eligible for Medi-Cal, your home can be transferred to anyone, not just your spouse, as long as it is an exempt asset at the time of transfer.

What about the stay-at-home spouse?

Medi-Cal does not require that the spouse of a nursing home resident also be poor. To provide support for the spouse who remains at home, federal spousal protection laws allow him or her to keep $104,400 in non-exempt assets.

In addition, the stay-at-home spouse is entitled to keep all of his or her separate income, or up to $2,610 per month of the sick spouse's or community income (i.e., the Minimum Monthly Maintenance Need Allowance, or "MMMNA").

Can you keep your home?

Absolutely yes. A home is not considered by Medi-Cal to be an asset which is counted against you for eligibility purposes as long as you live there. If you become a resident of a nursing home, Medi-Cal does not count your home as an asset if any one of the following is true:

1. you are expected to be able to return home (which you can demonstrate by simply stating this on your Medi-Cal application);
   

2. your spouse lives there;
   

3. your child who is under 21 or is blind or disabled lives there;
   

4. a sibling lives there who is part owner of the home and lived with you for at least a year prior to your entering the nursing home;
   

5. an adult child lives there who lived with and provided care for you for at least two years prior to your entering the nursing home; or
   

6. you are making a good faith effort to sell your home.

Can the state place a lien on your home to recover costs of care in a nursing home?

Due to a state law effective January 1, 1996, the state of California no longer has authority to impose liens on your home, as long as you are alive, for repayment of Medi-Cal nursing home benefits you receive. You should still state your intent to return home, however, on your Medi- Cal application to satisfy the state bureaucracy (if you have failed to do so, don't panic - it can be corrected).
The state can still attempt recovery from your estate after you die. For information on how to protect your home from a future Medi-Cal lien, please consult a competent professional for advice.