Medi-Cal is a big subject. This post discusses one aspect of it: Medi-Cal’s benefit that pays for nursing homes, the most common Medi-Cal subject that arises in my estate planning practice.

Medi-Cal is both a federal and state program. On the federal level, it is governed by the federal Medicaid statutes (42 USC §§1396–1396v) and regulations (42 CFR §§430.0–456.725). The federal Medicaid statute mandates that states must provide a minimum of enumerated services (e.g., physician care, hospital care, nursing home care; see §9.8) to eligible individuals. 42 USC §1396a(a)(10).  Medi-Cal is California’s version of Medicaid.

Please excuse the bullet point tone of the following text.  These are taken from my notes and haven’t been massaged into a nice narrative format. Nevertheless, even in this format, it may prove useful to the reader.

Medi-Cal Application form:  The mail-in application is 14 pages long.  It’s the same application as the Covered California application.  The Form says, “With just one application, you’ll find out if you qualify for free or low-cost health insurance, including Medi-Cal.”  (“Application for Health Insurance:  Your destination for affordable health insurance, including Medi-Cal,” cover page.) [6/11/18] 

            Step 1 asks about the “main contact for this applicant.”

            Step 2 asks about the applicant and family members

            Step 3 is the applicant’s signature and space to name an authorized representative.

Form at http://file.lacounty.gov/SDSInter/dpss/237739_ENG-CASingleStreamApp.pdf  [6/11/18]

Medi-Cal – Apply:  How to apply for Medi-Cal?  The applicant can apply

• Online
• In person at a county office
• By mail. “Apply for Medi-Cal with a Single Streamlined Application, provided in English and other languages.”

(California DHCS, http://www.dhcs.ca.gov/services/medi-cal/Pages/ApplyforMedi-Cal.aspx)  [7/7/15]

There is no wrong door when applying for health coverage in California. Please choose one of the following ways to apply:

In Person: 
Apply at your local county social services office, where you can get personal assistance completing your application.

By Mail:
Apply for Medi-Cal with a Single Streamlined Application , provided in English and other languages. Send completed and signed applications to your local county social services office.

By Phone:
To apply over the phone, call your local county social services office.

Online:
Apply online at www.CoveredCA.com . Applications are securely transferred directly to your local county social services office, since Medi-Cal is provided at the county level.

If you need additional help applying or have additional questions, you can contact a trained Certified Enrollment Counselor (CEC) for free. Search a list of local CECs or call 1-800-300-1506.

            (Ca.Gov, http://www.dhcs.ca.gov/individuals/Pages/How.aspx)  [11/6/17]

            In Los Angeles County, one applies through the Department of Public Social Services.

Department of Public Social Services  
(Search for the nearest District office to Apply)

1 (877) 597-4777  Toll Free
1 (866) 613-3777  Customer Service Center

 Los Angeles Department of Public Social Services Website  

(http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices3.aspx)  [11/6/17]

The only Westside office is in Rancho Park:

Rancho Park – 60
11110 W. Pico Blvd.
Los Angeles, CA 90064
Participant Help Line
(310) 258-7400
(626) 569-1399
Open to the Public
Monday thru Friday
08:00 a.m. to 05:00 p.m.

Medi-Cal – Apply – L.A. County:

How To Apply

• Apply Online

Click on the “Your Benefits Now!” link above.

• Apply By Mail

Applications can be mailed to the Medi-Cal Mail-in Application Office at: P.O. Box 77267, Los Angeles, CA 90007-9819.

Click on a language to download an application.

English    Spanish  Arabic    Armenian    Cambodian   Chinese (etc.)

• Apply In Person

Please visit the nearest District Office.

LA County DPSS http://dpss.lacounty.gov/wps/portal/dpss/main/programs-and-services/health-care/  [6/11/18]

Medi-Cal – Assets:  See “Medi-Cal – Eligibility – Assets,” below.

Medi-Cal – Available and unavailable assets:  “Even if an asset is not exempt, it can be counted in determining eligibility only if it is actually “available.” 22 Cal Code Regs §50402, 22 Cal Code Regs §50402(a) (Draft). An asset is considered available if the applicant or beneficiary has the legal power and authority to liquidate it. 22 Cal Code Regs §50402(a) (Draft).

(CEB, Cal. Elder Law Resources §9.27) [7/21/14]

Medi-Cal – Debts:  Secured debts are good for the beneficiary.  Unsecured are not.  Encumbered assets are valued at their netmarket value.

For Medi-Cal purposes, assets that are encumbered are valued at their net market value, which is determined by subtracting the encumbrances of record from the fair market value. 22 Cal Code Regs §50415(b). Unsecured debts are not deducted in calculating the applicant’s property reserve.

(CEB, Cal. Elder Law Resources §9.37) [7/21/14]

Medi-Cal – Eligibility – Assets:  No more than $2,000.

To qualify for Medi-Cal benefits, an individual cannot have more than $2000 in countable assets, referred to as a nonexempt property reserve. The amount of “countable assets” increases with family size, so a couple may have $3000 in countable assets. 22 Cal Code Regs §§50419–50420. Countable assets do not include assets classified as “exempt” or “unavailable.” The most important exempt asset is real property used as the individual’s residence.

(CEB, Cal. Elder Law Resources §9.14) [7/21/14]

Medi-Cal – Exempt Assets:

Under Medi-Cal rules, many assets are considered exempt and are not counted in determining eligibility. The primary exempt assets are

• Principal residence (see §§9.17–9.20);
• Vehicle (see §9.21);
• Burial plots or burial contracts (see §9.22); and
• Income-producing property and property used for self-support (see §§9.23–9.25).

(CEB, Cal. Elder Law Resources §9.16) [7/21/14]

Medi-Cal – Health Care Providers:  Not all health care providers accept Medi-Cal.  It is important to find out before receiving any medical treatment whether the health care provider accepts Medi-Cal, because not all providers do.

Medi-Cal – Income:  Income turns into property the month after it was received.

Generally, receipts during a calendar month are considered “income”; they become “property” at the first moment of the next calendar month. Therefore, income received during a month is not considered property during that month and should not be counted in determining whether the $2000 property limit for that month has been met. 22 Cal Code Regs §50453(a)(1).

(CEB, Cal. Elder Law Resources §9.15) [7/21/14]

Medi-Cal – In-Home Care:  Nope.  Clients must remember that Medi-Cal does not cover care in assisted-living facilities or any substantial home care.

Medi-Cal – Medicare, Difference between:  Medicare provides short-term care.  Medi-Cal provides long-term care.

MEDICARE	MEDI-CAL
Short-Term Care	Long-Term Care
Rehabilitative Care	Custodial Care

Medi-Cal – Nursing Homes:  Medi-Cal covers this.

Medi-Cal covers long-term and short-term nursing home care. Because Medicare coverage for nursing home care is limited to 100 days per spell of illness and can be shortened if an individual is receiving “custodial care” services instead of rehabilitation (see §7.28), individuals are faced with the high cost of nursing home care unless they have long-term-care insurance coverage or qualify for Medi-Cal.

An individual whose assets exceed the Medi-Cal eligibility guidelines must often either spend down or transfer most of his or her assets in order to qualify.

(Onlaw, CEB, Cal. Elder Law Resources §9.12) [7/21/14]

Medi-Cal Planning – Goals: Medi-Cal planning for long-term nursing home care has three purposes:

• Accelerate eligibility;
• Avoid estate recovery; and
• Minimize the applicant’s income contribution.

        (Onlaw, Cal. Elder Law Resources §11.1) [8/11/14]

Medi-Cal Planning – Home: It’s an exempt asset.  The applicant can spend “excess” resources on the home.

Excess assets may be sheltered in the ways described above, resulting in acceleration of Medi-Cal eligibility. The residential interest purchased, however, will be exposed to a Medi-Cal estate recovery claim after the beneficiary’s death for the value of any Medi-Cal benefits paid. This applies to a newly purchased home, an existing home that has had major improvements, and a fractional interest in someone else’s home. However, the applicant or beneficiary can usually defeat the estate recovery claim by transferring the home away before death.

        (Onlaw, Cal. Elder Law Resources §11.28) [8/19/14]

►Medi-Cal Planning – Home Mortgage: Pay off the mortgage!

“Excess resources” can be used to make repairs or improvements to the applicant’s home or pay off or reduce a home mortgage. Indeed, paying off a home mortgage provides an excellent opportunity to absorb and shelter large amounts of excess resources.

        (Onlaw, Cal. Elder Law Resources §11.28) [8/19/14]

Medi-Cal Planning – Home, New: Excess resources can even be used to purchase a new home in which the applicant has never lived

Medi-Cal Planning – Special Needs Trusts:   Rarely used in Medi-Cal planning.

Trusts created under 42 USC §1396p(d)(4)(A) (commonly known as “(d)(4)(A) trusts”) are rarely used for Medi-Cal planning for institutional care because they are limited to beneficiaries under age 65.

        (Onlaw, Cal. Elder Law Resources §11.103) [8/11/14]

Medi-Cal Planning – Trusts:  As a result of recent changes to California law, living trusts can shelter the family home from State reimbursement claims after the beneficiary’s death.  More on this important subject in a later post!

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