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                            What Is Medi-Cal?

 

Medi-Cal (M/C) is California's version of Medicaid.

Medi-Cal is the name of California's state run Medicaid program. Medicaid is a combined federal and state health insurance program for low income families or individuals, the elderly, the disabled or families enrolled in AFDC (Aid to Families with Dependent Children), and others with limited resources and high medical bills. Medi-Cal is a need-based welfare program, that is, eligibility primarily depends on the income and resources a person has.

Medicaid (in California called Medi-Cal) is run by the States, which means that each State determines who is eligible and the range of health services offered. Click on the picture to the right to go to the State of California DHS Medi-Cal home page.

Basis of eligibility:

Scope of Services:

For Californians, a good place to start your search for current Medi-Cal rules and policies is by visiting the State of Califorinia Department of Health Services (DHS) thru the All County Welfare Directors Letters (ACWDLs) and Medi-Cal Eligibility Branch Information Letters (MEBILs) at their policy letter home page. These policy letters inform California county public social services agencies regarding new or changes in policies and procedures used in determining eligibility for Medi-Cal benefits.

How is Medi-Cal different than Medicare?

Medi-Cal and Medicare are two separate health insurance programs. Medicare is health insurance that comes with your Social Security benefits and requires the payment of monthly premiums, deductibles and, by choice, coinsurance for many of its benefits. Medi-Cal, on the other hand, is not tied to Social Security benefits and does not require payment of premiums or deductibles. It provides 100%, comprehensive coverage of most medical expenses. In addition, health care providers who accept Medi-Cal can't bill you for any additional charges as they can under Medicare.

In a nursing home, Medicare will only cover you as long as you came to the nursing home from at least a 3-day hospital stay and need skilled nursing, physician or rehabilitation services every day. Just needing "custodial care" - in other words, help with personal care, daily activities or taking medications - does not qualify for Medicare to pay your nursing home expenses. Medi-Cal does pay for custodial care, however, and can take over payment after Medicare benefits stop for nursing home residents who can't afford the nursing home private-pay rates.

 

Medi-Cal Per Diem Rates

 

(Nursing Facility Medi-Cal Per Diem Rate)

  Area

             Facility Size

    1 - 59 beds   60+ beds
  LA County $  99.97   $100.48
  SF Bay $120.65   $126.55
  All Others $106.82   $112.65
 

(Intermediate Care Facility Med-Cal Per Diem Rate)

    1 - 99 beds   100+ beds
  LA County/SF Bay $  72.96   $  84.62
  All Others $  65.98   $  84.62

Can I Qualify Medi-Cal Benefits?

If you are a resident of California, sixty-five (65) years of age, blind or disabled and on Supplemental Security Income (SSI) benefits, you will be automatically eligible for "SSI-Based Medi-Cal" without a share of cost amount.

Proof of California residence does not have to be provided if you are the child of a parent already receiving Medi-Cal with California residency; if your spouse has already provided proof of the same (both residing at the same address) or if you are applying for minor consent services.

If you are a disabled widow/widower who received Supplemental Security Income (SSI) prior to age sixty (60), you will remain eligible for Medi-Cal even if you become ineligible for SSI if you receive Title II based on your retired spouse's benefits.

If your income is too high to qualify for SSI, you may be eligible, with a share of cost, if you meet the Medi-Cal resource limits ($2,000 for an individual, $3,000 for a couple); you are age sixty-five (65), blind, or disabled; and payment of your medical bills would leave you with less that the available "need standard" to pay other living expenses. Medi-Cal can supplement Medicare like "Medi-gap" insurance does, or pay for those things not covered under Medicare, e.g., extended care in a nursing home.

Medi-Cal can pay for part B Medicare insurance under the Qualified Medicare Beneficiary (QMB) Program, and medical bills with a "share of cost" for those in the Medically Needy Only Program who do not qualify for benefits under the Supplemental Security Income (SSI) Program.

Can you have both Medicare and Medi-Cal benefits?

Yes. If you have Medicare coverage and are also eligible for Medi-Cal, then your Medi-Cal benefits will be used to supplement your Medicare coverage. It will pay for the premiums, deductibles and coinsurances required by Medicare and also for certain items, such as prescription drugs and custodial or personal care at a nursing home.

You generally will not need any Medicare supplemental or "Medigap" private health insurance once you become eligible for Medi-Cal.

What is "Medi-Cal Planning?"

Medi-Cal eligibility is determined by the amount of income and resources available to the applicant. Therefore, Medi-Cal Planning involves the purchasing, transferring, conversion and/or liquidating of assets to enable you or your loved one to qualify under Medi-Cal's 2-prong test of income and resources.

Is this legal?

Yes, it is! Due to changes in federal laws enacted in 1996, almost anyone can qualify under Medi- Cal's eligibility tests. This is done by working within the Medi-Cal rules, and the planning may be different for one individual to the next. It all depends on your own personal set of circumstances and objectives.

In fact, the Department of Health Services (DHS) makes the Medi-Cal applicant sign a declaration that he is aware that such is possible - the "Notice of Spendown."

However, the Medi-Cal rules are very complex, and change every year. Since an improper transfer may result in a period of ineligibility up to 5 years, please consult with a qualified professional before attempting to qualify for Medi-Cal benefits.

Can you be on Medi-Cal and also be part of an HMO?

Yes, if you so choose. Medi-Cal does offer an HMO (health maintenance organization) option. HMO's restrict the provision of services to those from health care providers and facilities they designate. If you choose this option, you must join an HMO that has a Medi-Cal contract. You are entitled to all of the services and items covered by Medi-Cal but all of your care must be provided by the HMO. How do you qualify for Medi-Cal? If you are over 65, or blind or disabled and on SSI (Supplemental Security Income - federal assistance to low-income Social Security recipients), you are eligible for Medi-Cal benefits. Others who are elderly or disabled may be eligible if they have limited resources (less than $2000 in countable assets for single persons, $3000 for couples) and payment of medical bills would leave them with less than the available "need standard" for their living expenses, currently $600 per month for a single person, $934 for a couple (persons with a higher monthly income must contribute the excess, called a "share-of-cost," toward their medical expenses). Example: John, who is 71, lives on a monthly income of $750 and has $1,000 in his bank account but no other major assets. He falls and incurs medical expenses of $1500 in one month. While his assets are below the $2000 Medi-Cal limit, his income is greater than the "need standard" for a single person - $600 per month. John can get Medi-Cal assistance with his medical bill only if he pays the difference between his income and the need standard - $150 (minus a $20 standard deduction and the costs of any Medicare or health insurance premiums he has to pay). This amount is his share-of-cost". Even people with relatively high incomes will often qualify for Medi-Cal assistance with nursing home expenses, due to the high cost of nursing home care. While receiving Medi-Cal assistance, nursing home residents are allowed to keep $35 of their income for personal needs and up to $2175 in countable assets, with the remainder of their income and assets going toward payment for their care.

In determining Medi-Cal eligibility, there are specific assets that are not counted which includes, but is not limited to, the following: the home (with an intent to return to the home), whole life insurance policies with a face value of $1,500 or less, term life insurance, burial plots, prepaid (irrevocable) burial plan of any amount (and up to $1,500 in specific burial funds), on care used by the beneficiary or for the applicant or used for medical reasons, rings and/or jewelry, cash, periodic payments on interest and principal of pension funds and annuities, and up to $2,000 in cash reserve.

You can usually apply for Medi-Cal at the social services office of the county in which you live (call them or your local Area Agency on Aging to find out for sure). You want to file an application as soon as possible after you incur (or see that you will incur) a medical expense you cannot afford. Hospital and nursing homes have staff who can assist you with applications. Eligibility for Medi-Cal can be made retroactive for up to 3 months prior to the month in which you apply.

Can I Get Medi-Cal If I Am Not a U.S. Citizen?

Anyone who becomes a US citizen can immediately be eligible for benefits she/she is otherwise eligible for.

A majority of non citizens, affected by the federal welfare bill, known as the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) PL. No. 104-193, passed by Congress and signed by the President on August 22, 1996, will probably be able to qualify.

However, new procedures used by the Immigration and Naturalization Service (INS) and a large number of applicants for citizenship have caused the time for processing an application to increase to a year or more.

Also, federal law bars federal benefits for five years after entry for persons entering the US after August 22, 1996, with certain exception, namely refugees, asylees or those who have been granted withholding of deportation and veterans and active duty members of the Armed Forces, and their spouses and unmarried, dependent children under 18 (22 if attending school).

Will My Income Be Counted?

Eligibility is based on both income and assets. Income is divided into earned and unearned.

Earned income is wages from employment etc. Unearned income includes gifts, support/maintenance in kind, retirement, and disability pensions, e.g., Social Security benefits.

What Is the Income Limit?

As of March 1994, under California law, the maintenance need standard for a single elder (over 65) or disabled person is $600 per month; for an elder and/or disabled couple it is $934 per month. If the monthly income is higher than the need standard, a "share of cost" may have to be paid for monthly medical bills.

The amount of the share of cost is equal to the difference between your gross monthly income, minus deductions such as insurance premiums (Medicare Part B and/or private insurance) and the need standard. Once you agree to pay a monthly share of cost towards your medical bills, a Medi-Cal card will be issued which can be used to pay for those services covered by Medi-Cal.

Will My Resources Be Counted?

Medi-Cal classifies property as "exempt" and "nonexempt."

Exempt property is not counted in determining eligibility. Exempt property that is not counted in determining Medi-Cal eligibility includes but is not limited to: whole life insurance policies with a total face value of $1,500 or less; term life insurances; burial plots; prepaid irrevocable burial plan of any amount and $1,500 in designated burial funds (if kept separate from other accounts); the home (must have an intent to return to the home); other real property (if used in whole or in part as a business or means of self-support); household goods and personal effects; one car (if used for the benefit of the applicant/beneficiary or if needed for medical reasons); jewelry (e.g., wedding/engagement ring(s), etc.) cash, surrender value of the balance of pension funds and annuities (considered unavailable if periodic payments of the interest and principal are received), up to $2,000 in cash reserve, e.g., savings, checking, etc. (Subject to change)

Nonexempt property is counted. Any resources above the allowable property reserve limits ($2,000 for an individual, $3,000 for a couple, etc.) or any resource that is not exempt will be counted by Medi-Cal in determining eligibility for Medi-Cal benefits. These resources include but is not limited to: cash, savings, stocks, the cash surrender value of whole life insurance if the face value exceeds $1,500, and any other nonexempt resource. (Subject to change)

Can I Spend Down My Resources?

If your resources are too high, you can become eligible for Medi-Cal by transferring or spending down your resources to the allowable Medi-Cal resource limitation.

Resources must be reduced to the resource level by the end of the month eligibility is desired. Assets can be spent down on any item for the benefit of the applicant(s); to remodel/repair the home, pay off a mortgage/car loan, or purchase new clothing.

One might even consider converting nonexempt assets into exempt assets, e.g., using nonexempt cash reserves to buy a burial plot and/or create a prepaid irrevocable burial plan. Evidence regarding expenditures must be provided, so keep receipts, etc.

While spending down is usually easy to do and document, it may be difficult to find nursing home placement if there are no resources and you must find a bed in a Medi-Cal certified facility.

While most nursing homes designate a few beds for Medi-Cal patients, the demand usually is greater than the supply. The longer a person can pay as a private patient, the more options they will have when looking for a nursing home.

Does Medi-Cal Allow Retroactive Spendown of Excess Property?

Under the settlement in Principe v. Belshe, (implemented by DHS County Letter NO. 9741, October 24, 1997), Medi-Cal beneficiaries with excess property in the month of a Medi-Cal application may become eligible by spending the excess property down in the following month.

Normally, a person who has excess resources in the entire month of application would be ineligible for that month. But if the applicant has incurred medical expenses in the month the Medi-Cal application is mad or prior to that month and pays the medical expenses with the excess property in a subsequent month, the person becomes eligible in the month of application.

Note: It is important that persons who suddenly incur medical expenses apply for Medi-Cal before the end of the month since the policy does not apply retroactively to months prior to the month of the Medi-Cal application.

Can I Get Medi-Cal If I Give My Resources Away?

A single person may have resources up to $2,000 and a couple may have up to $3,000 and still qualify for Medi-Cal.

If your resources are too high, you can transfer or spend down your resources and become eligible for Medi-Cal. Giving away resources or hiding assets by transferring them to a family member, or selling them below fair market value for the purpose of making someone eligible for Medi-Cal is considered an "improper transfer" and Medi-Cal may be denied.

Pursuant to a 1993 federal law, a thirty-six (36) month "look back" for transfers of assets and a sixty (60) month "look back" is required for transfers of certain types of trust.

If it is determined that an improper transfer has occurred, the total amount transferred within that period of time is divided by the current average private patient monthly nursing home rate (adjusted annually but somewhere between $3,000 to $4,000). That determines the number of months a person is ineligible for Medi-Cal. Before you give away or transfer any property, contact a lawyer and/or other qualified person experienced in Medi-Cal law.

Will My Home Be Exempt?

Absolutely yes. A home is not considered by Medi-Cal to be an asset which is counted against you for eligibility purposes as long as you live there. If you become a resident of a nursing home, Medi-Cal does not count your home as an asset if any one of the following is true:

  1. You are expected to be able to return home (which you can demonstrate by simply stating this on your Medi-Cal application);

  2. Your spouse lives there;

  3. Your child who is under 21 or is blind or disabled lives there;

  4. A sibling lives there who is part owner of the home and lived with you for at least a year prior to your entering the nursing home;

  5. An adult child lives there who lived with and provided care for you for at least two years prior to your entering the nursing home;

  6. You are making a good faith effort to sell your home; or

  7. Your home is a multiple dwelling unit, one which is the principal residence.

Can I Transfer Title of My Home and Still Get Medi-Cal?

You can transfer the interest in your home and still get Medi-Cal benefits as otherwise eligible. Transfer of the home can be made at any time to any of the following persons:

Your spouse - this applies whether the transfer of your home occurred prior to or after you entered into a nursing home;

A son/daughter under 21 years of age or is blind or permanently disabled;

A son/daughter who has equity in the home and who was residing in the home at least one year immediately prior to your admission to a nursing home;

A son/daughter living in the home at least 2 years immediately prior to admission and enabled you to remain at home;

To anyone, as long as the home was exempt at the time of transfer.

Can I Get Medi-Cal If I Go Into a Nursing Home?

If your income is limited and your resources meet the Medi-Cal standard, you may be eligible for Long Term Care Medi-Cal benefits.

Is Medi-Cal Obligated to Pay for Medicare Co-Pay, Deductible for Nursing Home Services?

Provisions in the Balanced Budget Act, 4714, and a federal Ninth Circuit decision in Beverly Community Hospital Association v. Belshe, 1997 WL 739011 (1197), provide that Medi-Cal is not obligated to pay the Medicare co-pay and deductible for persons eligible for both Medicare and Medi-Cal benefits.

DHS All County Letter 95-96 (December 1, 1995) DHS has announced that Medi-Cal will continue to pay the full cost-sharing Part A coinsurance and Part B deductible and/or coinsurance for Medicare services rendered in a long term care facility to Medi-Cal eligible residents.

This full coverage applies only to the nursing facilities charge and does not apply to services of a doctor or other providers to nursing home residents.

Can A Nursing Home Evict Me If I Get Medi-Cal After Being Admitted?

Once admitted to a Medi-Cal certified facility, a resident cannot be transferred or evicted simply because of a change from a private pay to Medi-Cal payment status even when duration of stay had been signed.

However, although duration of stay requirements, i.e., making a patient pay privately for a set period of time, are illegal, nursing homes can and do review potential patient "financial status" prior to admission. Some facilities are unwilling to accept those who are eligible for Medi-Cal upon admission.

Naturally, if your resources are limited, this option of private pay may not be practical. Nonetheless, these facts should be considered if they fit an option available to you.

What Will Happen to My Spouse If I Go Into A Nursing Home?

Couples do not have to spend all their resources in order for one spouse to be eligible for Medi-Cal coverage in a nursing facility. The Federal Medicare Catastrophic Coverage Act (MCCA) of 1988 included provisions to prevent the impoverishment of the at-home spouse when one spouse enters a nursing home.

On January 1990, California implemented these provision. The laws were again amended by the August 10, 1993 passage of the Omnibus Budget Reconciliation Act, Medicaid amendments and the revisions to California's recovery laws.

Under California law, the community spouse (the at-home spouse) can retain nonexempt resources available to the couple at the time of application. The resource and income amounts may increase every year. For example, effective January 1, 1998, the spousal impoverishment CSRA increased from $79,020 (1997) to $80,760.00. The monthly maintenance needs allowance increased from $1,976.00 (1997) to $2,019.00. The institutionalized spouse can keep up to $2,000 in a separate account. Under some circumstances, the allowable income and resources may be higher than are shown above.

Can I Transfer My Home to My Spouse And Still Get Medi-Cal?

Under federal law, if you enter into a nursing home, you can transfer the title of your principal residence to your at-home spouse without it affecting your Medi-Cal eligibility.

This applies whether the transfer occurs prior to, or after you enter a nursing home. If the home is sold before you apply for Medi-Cal, even if the home is only in your spouse's name, the assets from the home will be considered along with other nonexempt assets held by both of you, and you will still be limited to the community spouse resource allowance. (See "Can I Transfer Title of My Home and Still Get Medi-Cal")

Can I Give Away Assets and Still be Eligible for Medi-Cal If I Am In A Nursing Home?

Eligibility for Medical benefits will depend on when you give away the assets and whether you enter a nursing home.

An improper transfer is basically giving away or gifting away property without receiving something of equal value in return or for purposes of qualifying for Medi-Cal. If you give away nonexempt property and then require nursing facility level of care anytime within thirty (30) months of the transfer, the resident may be ineligible for Medi-Cal reimbursement from the date of the give away for the amount of time those resources could have paid for the nursing home care. Such transfers will be reviewed carefully by the county.

In August 1996, former President Clinton signed into law the Health Insurance Portability and Accountability Act. Under the law if you decide to qualify for Medicaid by transferring assets you had better do the transfers correctly or suffer stiff consequences. Specifically Section 217 Article 6 of the law states, that effective January 1, 1997:

"(6) Whosoever knowingly and willfully disposes of assets (including any transfer in trust) in order for an individual to become eligible for medical assistance under a State plan title XIX, if disposing of the assets results in a period of ineligibility for such assistance under section 1917 (c),

shall be (i) guilty of a felony and upon conviction thereof fined not more than $25,000 or imprisoned for not more than 5 years of both, or (ii) be guilty of a misdemeanor and upon conviction thereof fined not more than $10,000 and imprisoned for not more than one year, or both."

Then, in February 1997, the U. S. Department of Health Services released information and instructions on the implementation of the new federal penalties that may result against an institutionalized individual for making a disqualifying transfer of property.

The release instructs the counties that the transfer of assets rules were not changed and counties are to continue to follow ACWDL No. #90-01, 50408-50411.5 to determine whether or not a period of ineligibility will be imposed for a transfer.

There are no changes regarding the treatment of/or transfer of assets, with the exception that, if an applicant applies while a period of ineligibility is running, the applicant, after an opportunity for a hearing (and only if the ALJ upholds the county's position) will be referred to the federal authorities for prosecution.

Decisions about whether or not to prosecute specific individuals will be made only by the federal government and to ensure that only absolutely accurate cases are forwarded to the federal authorities.

While this is a major exception, most applicants do not and should not apply for Medi-Cal until such time the period of ineligibility has run.

Can the State Place A Lien on My Home If I Get Medi-Cal?

Generally no. An injunction filed by California Advocates for Nursing Home Reform and Senate Bill SB 412 signed in September 1995, stymied the state's ability to impose liens.

As of January 1, 1996, California is no longer permitted to impose liens against the homes of nursing home residents, their surviving spouses or dependent children, except in cases where the home is not exempt, and the resident has listed the home for sale, but it is not sold.

Proportionate Share Estate Recovery Violates Medicaid Act

States may recover the cost of Medicaid (Medi-Cal) benefits from the estate of a deceased Medi-Cal beneficiary, but only after the death of the spouse, child under age 21, or adult child who is blind or totally disabled. 42 U.S.C. 1396 (b) (2). California adopted a "proportionate share" rule that permitted recovery from the estate of the proportionate share of the estate left to persons not falling in the exempt category.

*On January 1997, in a class action lawsuit, Dalzin v. Belshe, No C-97-0072-VRW (N.D. Cal November 14, 1997) decree at 1997 WL 811763 December 22, 1997, was brought by California Advocates for Nursing Homes Reform and six individual plaintiffs challenged the Department of Health Services from seeking "proportionate share."

In the suit brought to enjoin collection from the estate, the federal district court ruled that the clear language of the statue prevented collection from the parent's estate during the lifetime of the disabled children*California Advocates for Nursing Home Reform, Victory in Dalzin Case: (Recovery Against Disabled Children dated November 20, 1997.)

Can the state place a lien on your home to recover costs of care in a nursing home?

Due to a state law effective January 1, 1996, the state of California no longer has authority to impose liens on your home, as long as you are alive, for repayment of Medi-Cal nursing home benefits you receive. You should still state your intent to return home on your Medi-Cal application.

The state can still attempt recovery from your estate after you die. If you are over the age of 55 at the time of receiving Medi-Cal benefits the state can try to recover from your estate all Medi-Cal benefits paid for your medical care unless you are survived by a spouse, a minor or a disabled child or certain other relatives (see list in "Can You Keep Your Home?, " above). If you are under the age of 55 at the time you receive benefits, the state can only recover Medi-Cal benefits paid for nursing home care( See the last section for information on how to protect your home from a lien even after you die.)

What happens if one spouse needs a nursing home and the other remains at home?

Medi-Cal does not require the spouse of a nursing home resident to sell their home in order to qualify for Medi-Cal. To provide support for the spouse who remains at home, federal spousal protection laws allow him or her to keep all of the couple's income (Monthly Maintenance Needs Allowance - MMNA) up to $2,175 a month (minus the nursing home spouse's $35 personal needs allowance) and all of their combined countable resources (Community Spouse Resource Allowance- CSRA) up to $87,000.

Example: Ed has gone into a nursing home. He has a monthly income of $1200 and his wife Martha who continues to live at home has a monthly income of $450. They have a joint savings account containing $20,000. Martha also has in her name investments valued at $100,000. Ed will not be eligible for Medi-Cal until their combined resources - $120,000 - are spent down to $87,000 (plus $2000 which can be kept in Ed's name). When Ed goes on Medi-Cal, however, Martha will be able to keep all of their income (except for $35 which Ed will get for his personal needs in the nursing home) because their combined total monthly income is less than $2,175.

What can you do to protect your assets and also qualify for Medi-Cal?

Do not transfer money or property without consulting a licensed, elder law professional for advice as Medi-Cal eligibility can be delayed as a penalty for transferring assets without receiving fair value in return. This penalty period is determined by dividing the amount transferred by what Medi-Cal determines to be the average private pay cost of a nursing home. This period of ineligibility begins on the first day of the month of the transfer. Also be aware that Medi-Cal may look at transfers made 36 months prior to your Medi-Cal application or 60 months if the transfer was made to specific trusts. An elder law professional will be able to advise you on this and many other rules and regulations. That being said, a few basic examples of how to retain your assets are provided below.

Generally you can transfer money or property to your spouse at any time before or after applying for Medi-Cal. After becoming eligible for Medi-Cal, your home can be transferred to anyone, not just your spouse, as long as it is an exempt asset at the time of transfer (see "Can You Keep Your Home?" section, above) and probably should be transferred out of your name to avoid estate liens by the state after you die (see "Can the State Place a Lien on Your Home ..." section, above).

Resources can also be spent down to the $2000 eligibility limit on any item or service for your own benefit as long as you what you purchase will not make you exceed the $2000 limit at the end of the month in which you desire Medi-Cal eligibility (see list in "How do You Qualify for Medi-Cal?" section, above, of items that are not "countable assets"). Because you must provide evidence of what you spend after you apply for benefits, keep all receipts, canceled checks or other documentation of your expenditures.

Where Do I Apply for Medi-Cal?

To apply for Long Term Care (LTC) Medi-Cal benefits contact the Medi-Cal Office at the local Department of Human Services (welfare office).

They can assist you with completing the application and determine eligibility. A worker will ask if you have transferred any property within the past thirty (30) months and ask you if you to provide verification of all your income, personal and real property.

When after a determination has been made, a written notice will be sent informing whether or not there is eligibility. If denied, you have the right to appeal and request an informal hearing.

The appeal must be filed within ninety (90) days of the date on the denial notice. Shortly thereafter an informal hearing will be scheduled. While the hearing is informal and you have the right to represent yourself, you may wish to have an attorney or other person represent you.

If you are homebound or are living in a nursing facility, and are unable to go to the Medi-Cal office, you can request that a representative come to your place of residency and assist in completing the application, and/or that the hearing be held at your residence.

How the State Gets Paid Back

If there are any assets left in the estate of the deceased beneficiary, Medi-Cal will seek to be reimbursed for any Medi-Cal benefits paid.

The State of California can make a claim against the estate of someone receiving Medi-Cal benefits who was fifty-five (55) years of age or older at the time Medi-Cal was received.

This applies whether or not they were in a nursing home in the State of California, "estate" is defined to include any real and personal property that the Medi-Cal beneficiary had any legal title to or interest in at the time of death.

The entire contents of a Medi-Cal recipients joint tenancy, survivorship, life estate, living trust, etc., are also presumed to be available under the definition.

If an asset is held in joint tenancy at the time of Medi-Cal recipients, death, the State can seek recovery, unless the money can clearly be shown to come from income, transfers, or other sources of other person(s) on the joint account.

Documentation necessary to prove the money came from other sources are, bank records, statements/declaration, receipts, check stubs, etc.

However, no recovery can be made until after the death of the surviving spouse and only if there is no minor, blind or disabled dependent.

Medi-Cal Links

All County Welfare Director (ACWD) Letters

Medi-Cal Policy Institute

Medi-Cal FAQs by DHS

Various Medi-Cal Forms

HICAP - Health Insurance Counseling and Advocacy Program

Sources for the Information Contained in this Web Page

Kelley, Kim "If You Think You Need a Nursing Home" and "A Consumer's Guide to Financial Considerations and Medi-Cal Eligibility", Rev. ed. San Francisco: California Advocates for Nursing Home Reform.

California Advocates for Nursing Home Reform. "Long Term Care News." CANHR Advocate. 

Health Insurance Counseling and Advocacy Program(HICAP). "How Medi-Cal Works".

The Nursing Home Advocacy Project of Bet Tzedek Legal Services, "The Nursing Home Companion",  Bet Tzedek Legal Services, Los Angeles, Ca.

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C. Francis Baldwin
chasbaldwin@surewest.net
Updated Wednesday, May 26, 2004