There may come a time when you need help paying for health care expenses that are not covered by Medicare. Fortunately, Medi-Cal may be able to help. Medi-Cal is the name of California’s Medicaid program. Here’s an overview how to apply for Medicaid (Medi-Cal) in California.
Will You Qualify for Medi-Cal?
Medicaid (referred to as “Medi-Cal” in California) is intended to help low-income families, pregnant women, children, the disabled and the aged with healthcare costs. Because Medicaid is a “needs based” program, you must demonstrate a financial need for benefits. This means that an applicant cannot have income nor assets that exceed the program limit. Generally, your income cannot exceed the current limit for your household which is tied to the Federal Poverty Level for your area. In addition, an individual cannot have “countable resources” that are worth more than $2,000. For the average retiree on a fixed income, the countable resources limit is where the problem lies. If your assets do exceed the program limit, Medi-Cal will deny your application and you will need to “spend-down” your assets before applying again. If you are applying for Medi-Cal to help you cover long-term care (LTC) expenses, what this means is that you are expected to sell those assets and use the proceeds to pay your LTC expenses during the waiting period. If you failed to plan ahead, you could lose your entire retirement nest egg in a matter of months considering the fact that the average cost of LTC in California is over $10,000 per month in 2021.
The eligibility requirements become even more complicated when an applicant is applying for assistance with nursing home care expenses because the Medicaid “Spousal Impoverishment Rules” come into play. The rules are intended to ensure that a spouse who remains in the community is not impoverished when his/her spouse enters a nursing home because of the Medi-Cal “spend-down” requirements. The “Community Spouse” is allowed to keep a certain amount of income and resources when the other spouse enters a long-term care facility. The other Medi-Cal rule you must also be aware of when applying for Medi-Cal is the look-back rule that currently allows Medi-Cal to review an applicant’s finances for the 30 month period prior to applying for benefits. Any asset transfers made during that period for less than fair market value may trigger a waiting period during which time the applicant will not be eligible for Medi-Cal benefits. Experienced and qualified elder law attorneys may be able to help with transfers within the 30 month period that do NOT violate teh look back rules. These are just a few examples of the complex nature of Medi-Cal and why Medi-Cal planning should be included in your estate plan long before you may need to qualify for Medi-Cal.
Applying for Medi-Cal in California
The process of applying for Medi-Cal benefits in California is also not simple although eligibility guidelines are where many seniors have a problem if they failed to plan. Many Medi-Cal applications fail due to improperly completed forms or failure to provide the required supplemental documents. Again, this is where experienced and qualified elder law attorneys may be able to help. They are knowledgeable about the required forms and documents needed to successfully apply for Medi-Cal
Please download our FREE estate planning checklist. If you have additional questions or concerns about applying for Medi-Cal , contact us at the Northern California Center for Estate Planning & Elder Law by calling (916)-437-3500 or by filling out our online contact form.