Because you are in good health right now does not mean you will never need long-term care in the future. This is a common misconception shared by many Sacramento area residents. You may not have health issues today, but you simply cannot predict how healthy you will be in 20 or 30 years. In fact, an unexpected injury could leave you with health issues that ultimately require long-term care, as well. According to some studies, more than two-thirds of those over the age of 65 need long-term care at some point in their lives. Therefore, it would be a mistake not to at least be familiar with the Medi-Cal process and we are here to help.
Even healthy clients might need long-term care at one point
So many people ignore the fact that sickness is not the only reason you may need long-term care. For instance, if you suffered a terrible injury following an automobile accident, there is certainly a possibility that you will need long-term care in order to fully recover from that injury. In many cases, loved ones are admitted to nursing homes because of the need for daily assistance with activities such as dressing and grooming, simply as a result of aging.
Medi-Cal eligibility requirements for Sacramento residents
One important aspect of the Medi-Cal process is determining eligibility. Medi-Cal is essentially one basic benefits program that you can qualify for in several different ways known as eligibility categories. For instance, SSI-Linked Medi-Cal is an eligibility category which allows individuals who qualify for SSI to automatically qualify for Medi-Cal benefits. There are many other eligibility categories, each with its own rules and requirements. Once you meet the requirements of any eligibility category, you are considered eligible for either full or partial-scope Medi-Cal.
Common eligibility categories for California residents with disabilities
If your family has income at or below 138% of the Federal Poverty Level, you may be eligible for Income-Based Medi-Cal. If you are aged or disabled, you may be eligible for Aged & Disabled Federal Poverty Level Medi-Cal. If you are disabled and working, you may be eligible for California’s Working Disabled Program.
If you are aged, blind, or disabled, but your income is too high for other Medi-Cal programs, you may be eligible for Aged, Blind, and Disabled – Medically Needy Medi-Cal. For this program, you may need to “spend down” a certain amount of your own money before Medi-Cal begins to pay for medical services. This payment is called a share of cost.
Health insurance generally does not cover the cost of long-term care
Unfortunately, far too many people misjudge the real cost of long-term care, which is typically rather expensive. The average annual rate of long-term care in California is currently more than $102,000. Add to that the likelihood that nearly half of the California citizens age 65 and older need long-term care for some time period of time. That can be overwhelming enough. Yet, there is a common misconception that Medicare and private health insurance will be sufficient to cover the costs of long-term care. In reality, they cover very little of these costs.
What is involved in the California Medi-Cal process?
One of the primary differences between Medicare and Medicaid, or Medi-Cal as it is known in California, is that Medi-Cal is an income-based or needs-based healthcare assistance program. Federal, state and local tax funds are used to aid eligible individuals with paying their medical expenses. Generally, Medi-Cal recipients are only required to pay a small co-payment for covered medical expenses, if anything at all. Medi-Cal does cover some limited in-home services, but only if a physician certifies that home care services are actually needed for specified medical reasons.
The benefits of Medi-Cal planning
The purpose of Medi-Cal benefits is to assist low-income California residents in paying for medical services. Because Medi-Cal is a needs-based program, recipients can have no more than $2,000 in assets. The goal of Medi-Cal planning is to keep you from exhausting all of your resources in order to be eligible for benefits.
Also, if an applicant for Medi-Cal gives away property or assets right before submitting an application, those transfers of property can be seen as fraudulent and result in your benefits being delayed or denied. However, if you understand the Medi-Cal process and plan ahead, you can avoid the appearance of fraudulent transfers.
Download our FREE estate planning checklist today! If you have questions regarding the Medi-Cal process or any other Medi-Cal issues, 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!