Carol A. Peters - Attorney at Law
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Medi-Cal Eligibility

Medi-Cal is a public benefits program that operates like an INTEREST-FREE LOAN for medical care. Understand the difference between ELIGIBILITY now and ESTATE RECOVERY later:

ELIGIBILITY now, can be established for a SNF patient (at a Skilled Nursing Facility) even if the SNF patient owns all of these EXEMPT ASSETS: see
http://www.canhr.org/factsheets/medi-cal_fs/html/fs_medcal_limits.htm
Step 1 is to have a Care Plan.
Step 2 is to think in terms of EXEMPT assets, NON-EXEMPT assets and EXCESS assets.
Step 3 is to look at the Big Picture so that both spouses are cared for properly and appropriately. The spouse of a married patient may own $115,920 additional assets (CSRA) for 2013 plus all of the exempt house, car, furniture and furnishings, own IRA and pensions, plus the first $2,898 of JOINT monthly income. OR may instead use the Name On The Check rule.

The 2013 divestment penalty divisor is $7,549 to determine the period of INELIGIBILITY after the Date of a Gift. California has not yet adopted the federal DRA’05 rule of beginning the period of ineligibility as of the Date of Application (for benefits). Since many other states have adopted the DRA ’05 rules, before moving to another state, make sure that the Care Plan is designed prior to the move, and do not assume all other states are the same as California (which still currently has its own rules which are more generous, but which may change when the pending draft regulations are adopted.

LTC-Medi-Cal is not the only door to Medi-Cal coverage.
LTC Medi-Cal is one of several sets of Eligibility rules, but not the only rule-set.

  • A person may be eligible for community-based Medi-Cal, also called Medically Needy Only (MNO) Medi-Cal.
  • A person who is receiving SSI will also receive a Medi-Cal card too. So even a small SSI check may be medically helpful.

ESTATE RECOVERY later occurs only after death, after care is received, after none of the deferral reasons or hardship waiver reasons apply.
Medi-Cal operates like an INTEREST-FREE LOAN for medical care. So whether (or not) the loan can be repaid depends upon what assets are owned by the deceased Recipient’s Estate at the time of death, plus whether or not other rules apply that could result in deferral, for the benefit of other family members. IF the patient leaves an Estate, and IF none of the defer all or hardship criteria apply and IF the California Dept. of Health Services files its ESTATE RECOVERY claim properly, after proper notice, then the Estate Recovery Claim may be repaid from the Recipient Estate.

Failure to give notice is not wise, because such failure can result in the Estate’s Personal Representative (Trustee, Executor, Administrator) incurring personal liability for the Recipient’s obligation, whereas there would be NO liability if proper notice were given (with a copy of the death certificate and by certified mail, Return Receipt Requested) to the correct DHCS address in Sacramento. Notice to the Los Angeles County eligibility office is inadequate notice: it is not a state office and is not the correct office to which statutory notice must be directed.

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The premier organization for accurate and specific information about various levels of assisted living, and uniform regulation of same to prevent the elderly from being taken advantage of is the California Association for Nursing Home Reform (CANHR), a 501(c)(3) located in San Francisco, CA.

Up-to-date information about the status of Medi-Cal legislation and enforcement, including litigation initiated by CANHR is available at http://www.canhr.org

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Carol A. Peters, Attorney at Law, is located in Pasadena, CA and serves clients in and around Altadena, Sierra Madre, South Pasadena, Alhambra, La Canada, Eagle Rock, Highland Park, Glendale, Echo Park, Silverlake, Arcadia, Monrovia, Duarte, San Gabriel, Temple City, Whittier, Los Angeles, Huntington Park, Norwalk, Santa Fe Springs, Pico Rivera and Los Angeles County.
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