In recent years, more and more adult children are taking on the role of caregiver to an aging parent in the United States. As the population of older Americans continues to increase, healthcare for seniors has become a hot topic as well. If you have a parent whose health is deteriorating, now is the time to start worrying about the high cost of long-term care (LTC), if you have not already done so. At an average cost of almost $10,000 a month in California, may seniors must rely on Medi-Cal to help cover the cost of LTC. With that in mind, do you know if your parent will qualify for Medi-Cal, California’s Medicaid program? The Medi-Cal eligibility guidelines are complex; however, we will explain the basic requirements for a senior to qualify for Medi-Cal.
Medi-Cal Eligibility for Seniors
As a senior, you may qualify for Medi-Cal for the aged, blind, or disabled several different ways. First, you must be over 65, blind or disabled as well as meet the residency requirements. There is also an income and asset test that applies. In California, you might qualify for Medi-Cal under any of the following categories of eligibility:
- 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 2019, the income limit for an individual is just $932.72 per month and for a couple, it is $1,564.14. 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 early 2019, 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 2019, 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
In addition to basic Medi-Cal that covers general healthcare expenses, 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 qualify for the Medi-Cal long-term care program the following requirements apply:
- Care test – you must qualify to live longer than thirty days 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 Roseville Medi-Cal Planning Attorneys
Please download our FREE estate planning checklist. If you have additional questions or concerns about qualifying for Medi-Cal, contact us at the Northern California Center for Estate Planning & Elder Law to find out today by calling (916)-437-3500 or by filling out our online contact form.