Long-term care Medi-Cal is a critical lifeline for seniors in California, offering financial assistance for their essential care needs. Whether in nursing homes, at home, or in assisted living facilities, Medi-Cal provides a vital safety net.

Here's what it covers:

• Payment for nursing home care, including room and board.

• Assistance with personal care tasks like bathing, dressing, and eating.

• Access to skilled nursing and physician visits.

• Coverage for prescription medications and mental health counseling.

Navigating this complex system can be overwhelming, especially with strict eligibility criteria and asset limits in place. California's version of Medicaid, known as Medi-Cal, is designed to offer comprehensive support to seniors needing long-term care.

I'm Marty Burbank, a dedicated advocate specializing in elder law and long-term care Medi-Cal. With years of experience, I've helped guide many families through the intricacies of securing the care they deserve. Let's dive into how Medi-Cal can ease your path forward.

Understanding Long-Term Care Medi-Cal

Navigating Long-term care Medi-Cal can feel like a maze, but understanding the basics makes it easier. Let's break down the key aspects: eligibility, income limits, and asset limits.

Eligibility

To qualify for Long-term care Medi-Cal, you need to meet specific criteria. The program is designed to assist seniors, individuals with disabilities, and other low-income Californians. Here are the main groups who are eligible:

• People aged 65 or older

• Individuals who are blind or disabled

• Low-income families with dependent children

• Pregnant women

• Children under 21

Importantly, as of January 1, 2024, Medi-Cal no longer considers assets when determining eligibility. This change opens the door for more people to receive benefits.

Income Limits

Income is a crucial factor in determining eligibility for Medi-Cal. The Modified Adjusted Gross Income (MAGI) system is used to assess most applicants. For a single individual, the income limit is typically set at $18,755 annually. Larger households have higher limits, reflecting their increased financial needs.

If your income is above the limit, you might still qualify through a "spend down" process. This means using your income on medical expenses until you reach the qualifying level.

Asset Limit

While assets are no longer counted for eligibility, understanding how they were previously assessed can help in planning. Before 2024, the asset limit for an individual was $2,000, with certain exemptions:

• Primary residence: If you live in it, your home is exempt.

• One vehicle: The car you use for transportation doesn't count.

• Personal belongings: Everyday items like clothes and furniture are not considered.

Understanding these criteria helps you steer the Medi-Cal application process more effectively. With the right guidance, you can ensure that you or your loved ones receive the necessary care without unnecessary financial burden.

Coverage and Benefits of Long-Term Care Medi-Cal

When it comes to Long-term care Medi-Cal, understanding the coverage and benefits is key. Let's explore the main services available: nursing-home services, custodial care, and home care.

Nursing-Home Services

Long-term care Medi-Cal covers nursing-home services for eligible individuals. This is crucial for those who need a Nursing Facility Level of Care. Here's what you can expect:

• Room and Board: Medi-Cal pays for your stay in a nursing home, including meals and lodging.

• Medical Services: This includes physician visits, skilled nursing care, and prescription medications.

• Personal Care: Assistance with daily activities like bathing, dressing, and eating is provided.

However, certain items like private rooms, specialized food, and non-medical personal items are not covered. While all qualified applicants are entitled to benefits, not every nursing home accepts Medi-Cal. It's essential to ensure the facility of your choice does.

Custodial Care

Custodial care is another critical component of Long-term care Medi-Cal. This type of care is for individuals who need help with daily activities but do not require skilled medical intervention. It includes:

• Assistance with Activities of Daily Living (ADLs): Help with mobility, toileting, and grooming.

• Supervision and Safety: Ensuring the safety of individuals who may have cognitive impairments.

Custodial care is typically provided in nursing homes or through home care services, depending on the individual's needs and preferences.

Home Care

For those who prefer staying in their own homes, Long-term care Medi-Cal offers Home and Community-Based Services (HCBS) Waivers. These waivers help eligible individuals receive care in a community setting rather than a nursing home. Here's what home care covers:

• Personal Assistance: Help with ADLs in the comfort of your home.

• Homemaker Services: Support with household tasks like cooking and cleaning.

• Transportation: Assistance with getting to medical appointments and other essential outings.

While HCBS Waivers cover care services, they do not pay for room and board costs like rent or utilities.

Understanding the coverage and benefits of Long-term care Medi-Cal ensures you or your loved ones receive the necessary support. Whether you need nursing-home services, custodial care, or prefer home care, Medi-Cal provides options to suit different needs.

Financial Considerations for Long-Term Care

When planning for Long-term care Medi-Cal, understanding the financial aspects is crucial. Let's explore the key areas: income allocation, personal expenses, and spouse income designation.

Income Allocation

For individuals residing in a nursing home under Long-term care Medi-Cal, most of their income goes toward the cost of care. However, there are allowances:

• Personal Needs Allowance: You can keep $35 per month for personal expenses. This is your money to spend on small items like snacks, toiletries, or magazine subscriptions.

• Medical Premiums: Any Medicare or insurance premiums you pay are also deducted from your income before it goes to the nursing home.

If you're receiving SSI, your personal needs allowance increases to $50. And for those getting VA Aid and Attendance benefits, the allowance is $125.

Spouse Income Designation

If you're married and eligible for Long-term care Medi-Cal, you can allocate some of your income to your spouse living at home. This is known as the Community Spouse Resource Allowance (CSRA). The amount depends on your spouse's income:

• Community Spouse: You can designate income to ensure your spouse at home has enough to live on. This is vital to prevent financial hardship for the spouse not in care.

• Family Allocation: If you have dependent children or other family members living with your spouse, additional income can be allocated for their support.

In some cases, you might need to file for a fair hearing to increase the spousal allowance if the set amount isn't enough to cover living expenses.

Personal Expenses

While Long-term care Medi-Cal covers many costs, there are still personal expenses to consider. These include:

• Non-Covered Items: Expenses for items like specialized food, private rooms, or personal grooming products.

• Additional Medical Costs: Any medical services or supplies not covered by Medi-Cal will need to be paid out-of-pocket.

Understanding these financial considerations helps ensure that while you receive care, your family remains financially stable. Next, we'll address some frequently asked questions to clear up common concerns about Long-term care Medi-Cal.

Frequently Asked Questions about Long-Term Care Medi-Cal

Does Medi-Cal cover long-term care in California?

Yes, Medi-Cal covers long-term care services in California. This includes care in nursing homes, assisted living facilities, and even in-home care for those who qualify. Medi-Cal is designed to help low-income individuals get the care they need without depleting their savings. It's essential to know that while Medi-Cal covers a wide range of services, it does not pay for everything. For instance, room and board in assisted living are not covered, but personal care services and medical needs are.

How long does Medicaid pay for long-term care?

One of the benefits of Medicaid is that there is no time limit on how long it will pay for long-term care, as long as you continue to meet the eligibility requirements. If you're in a nursing facility, Medicaid will cover your care for as long as you need it. This is a significant advantage for those who require extended care, as the costs can be exorbitant, often exceeding $8,000 per month in California.

What is the biggest drawback of long-term care insurance?

While long-term care insurance offers more flexibility and options than Medicaid, it has its drawbacks. One major issue is eligibility; not everyone qualifies for a policy, especially if they have pre-existing health conditions. Another significant concern is the cost. Premiums can be expensive, making it inaccessible for many. Additionally, there's an asset limit to consider. Some people might find that the benefits don't justify the cost, especially if they have limited assets to protect.

Navigating long-term care can be complex, but understanding these key points about Medi-Cal and insurance options can help you make informed decisions about your care needs.

Conclusion

Navigating the complexities of Long-term care Medi-Cal can be overwhelming, but you don't have to do it alone. At OC Elder Law, we specialize in providing compassionate guidance to help you and your loved ones make informed decisions. Our team is dedicated to ensuring that you understand your options and receive the care you deserve.

Asset protection is a crucial part of planning for long-term care. We work with you to safeguard your hard-earned assets, ensuring they remain within your family and are distributed according to your wishes. Our strategies often involve creating specific trusts custom to your needs, helping you preserve your legacy for future generations.

At OC Elder Law, we pride ourselves on our empathetic approach. Our experienced attorneys are not just legal experts; they are compassionate advisors who understand the importance of sensitivity and empathy. We are here to support you at every step, ensuring that your estate planning journey is as smooth and stress-free as possible.

Choosing the right legal partner can make all the difference. By working with us, you're not just another client; you become part of our family. Let us help you secure peace of mind and a harmonious future for your loved ones.

Learn more about our services and how we can assist you with Medi-Cal managed care plans.