Estate Recovery and Liens
Under Medi-Cal law, following the death of the Medi-Cal recipient the state must attempt to recover from his or her estate whatever benefits it paid for the recipient’s care. However, no recovery can take place until the death of the recipient’s spouse, or as long as there is a child of the deceased who is under age 21 or who is blind or disabled. While states must attempt to recover funds from the Medi-Cal recipient’s probate estate, meaning property that is held in the bene
Protections for the Healthy Spouse
The Medi-Cal law provides special protections for the spouse of a nursing home resident to make sure she has the minimum support needed to continue to live in the community. The so-called “spousal protections” work this way: If the Medi-Cal applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the date of “institutionalization,” the day on which the ill spouse enters either a hospital or a long-term care fa
Treatment of Income
The basic Medi-Cal rule for nursing home residents is that they must pay all of their income, minus certain deductions, to the nursing home. The deductions include a $35-a-month personal needs allowance (this amount may be somewhat higher in particular states), a deduction for any uncovered medical costs (including medical insurance premiums), and, in the case of a married applicant, an allowance for the spouse who continues to live at home if he or she needs income support.
Exceptions to the Transfer Penalty
Transferring assets to certain recipients will not trigger a period of Medi-Cal ineligibility. These exempt recipients include the following: A spouse (or a transfer to anyone else as long as it is for the spouse’s benefit) A blind or disabled child A trust for the benefit of a blind or disabled child A trust for the sole benefit of a disabled individual under age 65 (even if the trust is for the benefit of the Medi-Cal applicant, under certain circumstances). In addition, sp
The Transfer Penalty
The second major rule of Medi-Cal eligibility is the penalty for transferring assets. Congress does not want you to move into a nursing home on Monday, give all your money to your children (or whomever) on Tuesday, and qualify for Medi-Cal on Wednesday. So it has imposed a penalty on people who transfer assets without receiving fair value in return. These restrictions, already severe, have been made even harsher by enactment of the DRA. This penalty is a period of time during
Resource (Asset) Rules
In order to be eligible for Medi-Cal benefits, a nursing home resident may have no more than $2,000 in “countable” assets. The spouse of a nursing home resident–called the ‘community spouse’– is limited to one half of the couple’s joint assets up to $119,220 (in 2015) in “countable” assets. This figure changes each year to reflect inflation. This figure is higher in some states, even up to the full maximum of $119,220. All assets are counted against these limits unless the a
Introduction
Medicaid (called “Medi-Cal” in California and “MassHealth” in Massachusetts) is a joint federal-state program that provides health insurance coverage for those with low income, seniors and people with disabilities. In addition, it covers care in a nursing home for those who qualify. In the absence of any other public program covering long-term care, Medi-Cal has become the default nursing home insurance of the middle class. As for home care, Medi-Cal offers very little exce
