It’s no secret that long-term care can be quite expensive. Many private health insurance policies don’t cover these long-term care services. For California residents who need long-term care, Medi-Cal may be an important source of funding. In fact, Medi-Cal covers the long-term care expenses of the majority of Californians who are residents in nursing homes. However, applying for and receiving assistance from Medi-Cal requires planning. Being prepared for the potential need for long-term health care requires proper planning with the help of Medi-Cal lawyers.
Medi-Cal and nursing home care
Medi-Cal is state Medicaid program for California residents. Like all other Medicaid programs, it is run by the State but funded by federal and state funding. The California Department of Health Care Services (DHCS) manages long-term care programs in California, including nursing home services. In general, skilled nursing facilities offer round-the-clock skilled nursing care in addition to other supportive services. Nursing homes are usually quite expensive. Most people cannot afford to pay their own nursing home expenses. That is where proper planning comes in and our Medi-Cal lawyers can help.
Payment for “medically necessary” nursing home services
Med-Cal benefits are limited when it comes to long-term care. Medi-Cal only pays for nursing home services when those services are deemed “medically necessary.” California defines that term “medically necessary” as “reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.” In order for Medi-Cal to pay for a nursing home stay, the patient’s treating physician must prescribe that nursing home case based on the need for continual, around-the-clock skilled nursing care services. This type of care may also be referred to as “intermediate care.” If you have questions about your options, let our Medi-Cal lawyers know.
You may be able to “spend down” your assets
You may be allowed to “spend down” your assets so that you qualify for Medi-Cal. “Spending down” means you can use your assets to pay off legitimate debts or expenses. However, you must be careful. If you feel you need to spend down your assets, consult with Medi-Cal lawyers first in order to avoid fraudulent transfers and a penalty period that will affect your benefits.
Will the nursing home take my house?
A prevalent concern among many clients is whether they will lose their homes after moving into a nursing home. The truth is, your home may not even be counted as an asset for purposes of qualifying for Medi-Cal. In every state, Medicaid recipients are allowed to keep their homes, regardless of equity, as long as their spouse or another dependent lives in the home. However, problems can arise if the home is sold and now the value of the home is in cash. This increase in liquid assets can make one ineligble for Medi-Cal. Also, if the home is still in the named of the recipient of Medi-Cal services at his or her death, it could be subject to recovery by the State for the value of services paid by Medi-Cal. An experienced and qualified elder law attorney like Mr. Murphy is able to provide assistance with preventing these outcomes, but must be consulted BEFORE the property is sold or the patient dies.
Estate recovery after your death
Once you die, the state Medi-Cal agency will seek to recoup the benefits paid for your care from your estate. This is known as “estate recovery.” Again, there are ways to protect your home and other assets from estate recovery. Consult an experienced and qualified elder law attorneyas soon as possible to determine your options.
Download our FREE estate planning checklist today! If you have questions regarding long-term care planning or any other Medi-Cal matters, please contact us at the Northern California Center for Estate Planning and Elder Law for a consultation. You can contact us either online or by calling us at (916) 437-3500. We are here to help!
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