Access to affordable healthcare has been a hot topic in the United States in recent years. Although we have some of the best medical care and practitioners throughout the world here in the U.S., we also have some of the highest costs. The high cost of healthcare is particularly problematic for seniors who are often living on a fixed income. For those who are eligible, California’s Medi-Cal program can help. How do you know if you qualify for Medi-Cal as a senior though? In this blog, the Northern California Center for Estate Planning & Elder Law offers guidance on California Medi-Cal for seniors.
Medicare vs. Medi-Cal
For those who have relied on employer-sponsored or private health insurance prior to retirement, both Medicare and Medi-Cal can be confusing. While both Medicare and Medi-Cal are government programs that provide healthcare coverage, the similarities stop there. Medicare is a federal program, funded and administered by the Social Security Administration (SSA). Throughout your working years, you, and/or your spouse, most likely paid into the Medicare program. Consequently, you are automatically entitled to Medicare enrollment when you reach retirement age. Medi-Cal is California’s Medicaid program. Medi-Cal is primarily funded by the federal government, though the states can subsidize that funding if they choose to do so. Unlike Medicare, however, Medicaid is administered by the individual states, causing some variation in eligibility guidelines and benefits from one state to the next. Moreover, Medi-Cal is a “needs based” program, meaning an applicant much demonstrate a need for the benefits to be eligible. In the case of Medi-Cal, an applicant must typically demonstrate a financial need, among other eligibility criteria. If you qualify you can be enrolled in both Medicare and Medi-Cal at the same time.
Medi-Cal for Seniors Eligibility
To qualify for Medi-Cal for the aged, blind, or disabled, you must be over 65, blind or disabled as well as meet the residency requirements and pass the income and asset tests. There is more than one way to qualify for Medi-Cal for the aged, including:
- SSI eligibility: If you qualify for Supplemental Security Income (SSI), then you automatically qualify for full Medi-Cal coverage. SSI (Supplemental Security Income) is a program funded by the state and federal governments which provides cash assistance on a monthly basis. Eligibility criteria include being elderly, blind, disabled, or a person whose income is low and assets are limited. For 2018, the income limit for an individual is just $910.72 per month and for a couple it is $1,532.14. In addition, an individual may not have more than $2,000 worth of non-exempt assets and a married couple not more than $3,000.
- Aged and Disabled Federal Poverty Level Program (A&DFPLP): A&DFPLP program was reinstated in 2001 by the State of California in order to provide Medi-Cal coverage to elderly and disabled persons who meet SSI’s resource limits, but have a higher income than SSI limits. For 2018, the income limits are $1,242 per month for a single person and $1,682 per month for a married couple. The same asset limits for SSI apply for this program.
- Medi-Cal Share of Cost (SOC): If you meet the asset requirements for the SSI or A&DFPLP Medi-Cal programs, but your income is too high, you might qualify for the Share of Cost Medi-Cal program. SOC functions like a deductible. You must pay this amount in any month you incur medical costs. After your SOC is paid, Medi-Cal will pay the remaining amount of your medical bills for that month. For 2018, your SOC amount is determined by subtracting $600 (for an individual) or $934 (for a couple) from your monthly income, and any other health-insurance premiums you may be paying. What is left is your SOC for the month. For example, if you are single and your income for the month is $1,600, your SOC would be $1,000. Medi-Cal would start helping pay for medical bills for the month in excess of $1,000.
Medi-Cal Long-Term Care Eligibility
Medi-Cal also has a long-term care program for individuals who require the type of care only available in a nursing home type facility. To be eligible for the Medi-Cal long-term care program you must meet the following requirements:
- Care test – you must qualify to live at the skilled nursing level of care as determined by your ability to perform daily tasks of living.
- Income — patients pay a share of cost based on an income after deduction for health insurance premiums and other expenses. You also receive a $35 personal needs allowance each month that is not factored into the share of cost formula.
- Assets — countable assets must be no higher than $2,000 for an individual applicant. If you are married with a spouse remaining at home, referred to as a “community spouse,” countable assets can reach $123,600. The rules for income and assets are complex when a community spouse is part of the equation so be sure you discuss your specific circumstances with an experienced Medi-Cal planning attorney.
Contact Medi-Cal Planning Attorneys
Please download our FREE estate planning checklist. If you have additional questions or concerns regarding Medi-Cal planning, contact the Medi-Cal planning staff at the Northern California Center for Estate Planning & Elder Law today by calling (916)-437-3500 or by filling out our online contact form.