Archive for the 'Medi-Cal' Category

If a Medi-Cal applicant’s spouse transfers assets, will that result in any period of ineligibility for nursing home care?

Thursday, Nov. 26th 2020 5:31 AM

Generally, California will not impose any period of ineligibility for nursing home care on the applicant if his or her spouse previously transferred assets. The exception is if the asset/resource transferred originally belonged to the applicant. In that case, a disqualification period will be imposed if the spouse received the assets from the applicant before the applicant went into the nursing home and then transferred them to a third party. This is because the Medi-Cal rules differ for a “community spouse” and an “individual spouse”. If the spouses wait until one of them goes into the nursing home, the spouse will be a “community spouse”. Then a transfer of property from the spouse in the nursing home to the community spouse that is then transferred to a third party, does not trigger any period of ineligibility

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Posted on Thursday, Nov. 26th 2020 5:31 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

If a person applies for Medi-Cal, can they have a principal residence in another state (outside of California) and still qualify for Medi-Cal?

Sunday, Nov. 22nd 2020 5:28 AM

Yes, but the person has to distinguish between “principal residence” and “primary residence”. In other words, they can have a principal residence anywhere, as long as they eventually return to it to live. In order to qualify for Medi-Cal, a person must show that they are presently living in California with the intention to remain permanently, or for an indefinite period. A person could be living in a California nursing home with the intention to remain indefinitely, but still have the intention to eventually return to
their principal residence out-of-state.

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Posted on Sunday, Nov. 22nd 2020 5:28 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Can a nursing home resident give away their income, or does it need to be spent on medically necessary care? Let us say a person is in a nursing home and wants to give their grandchild $50 for their birthday. Can they do that?

Monday, Nov. 16th 2020 5:43 AM

There is currently no transfer of income penalty in California. However, a nursing home resident’s income must be used to meet their SOC, or Medi-Cal will pay for NO services during that month. The nursing home resident is allowed only $35 for personal needs. It is fine if he/she wants to give their $35 away, but then there will be nothing for personal needs unless the individual wants to dip into their $2,000 property reserve. Funds from their $2,000 property reserve may also be given away without penalty. When funds are used from the $2,000 property reserve, the reserve can be increased the following month to the $2,000 limit

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Posted on Monday, Nov. 16th 2020 5:43 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

How long before applying for Medi-Cal can a person transfer assets?

Thursday, Nov. 12th 2020 5:37 AM

The Medi-Cal “Look-Back” period in California is 30 months. “Transfer” means an outright gift or a “sale” made at less than “fair market value.” If a disqualifying transfer of property is made, Medi-Cal will calculate the period of ineligibility for nursing facility level of care. It will be the number of months resulting when the “net fair market value” of the transferred asset, which would have resulted in excess property at the time of the transfer, is divided by the monthly average private nursing facility cost. In
2002, the average cost used to calculate the period length is $4,322 per month. In 2001, this amount was $4,163.

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Posted on Thursday, Nov. 12th 2020 5:37 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

What are the community spousal resource limits for 2002 when qualifying for the Medi-Cal nursing home benefit?

Sunday, Nov. 8th 2020 5:34 PM

The 2002 community spouse resource allowances are $89,280 in assets and $2,232 in monthly income. For a married couple with one spouse in a nursing home and the other spouse at home, the spouse at home may keep up to $89,280 in resources (property and other assets) while the spouse in a nursing home may keep $2,000. The spouse at home may keep all of the income received in his or her name, regardless of the amount. If the amount is below $2,232 per month, the spouse in the nursing home may
allocate income to bring the at-home spouse’s income up to the $2,232 per month limit. The spouse in the nursing home is permitted to keep $35 a month for personal needs. (For 2001, the amounts were $87,000 in assets and $2,175 in income).

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Posted on Sunday, Nov. 8th 2020 5:34 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Can a facility transfer or discharge a resident out of the facility because of a change in the resident’s method of payment from private or long-term care insurance payment to Medi-Cal payment?

Wednesday, Nov. 4th 2020 12:30 PM

Generally, no. The only exception is if the facility is not certified to accept payment from the Medi-Cal program. In that case, the facility would be allowed to transfer or discharge the resident if the resident’s stay is no longer covered by long-term care insurance and he/she is unable to continue to pay privately. However, the facility is required to inform residents of this possibility at the time they are admitted to the facility.

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Posted on Wednesday, Nov. 4th 2020 12:30 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

What property/assets are allowable for Medi-Cal?

Wednesday, Oct. 28th 2020 5:51 AM

The Medi-Cal program determines eligibility for benefits on a “means” tested basis. If a Medi-Cal applicant’s property/assets are over the Medi-Cal property limit, the applicant will not be eligible for Medi-Cal unless they lower their property/assets according to the program rules. The Medi-Cal
eligibility worker looks at how much an applicant and their family has each month. If their property/assets are below the limit at any time during that month, the applicant will get Medi-Cal, if otherwise eligible. If a person has more than the limit for a whole month, Medi-Cal benefits will be
discontinued.

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Posted on Wednesday, Oct. 28th 2020 5:51 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Where can I get more information on Medi-Cal Eligibility?

Friday, Oct. 23rd 2020 6:34 AM

You can find more information by downloading a copy of “Before You Buy,” found on the Partnership’s web site. This document, which provides an explanation of asset protection and Medi-Cal Eligibility rules, must be provided to consumers when long-term care presentations are made, in compliance with Partnership regulations. “Before You Buy” is updated annually with new figures on current Medi-Cal resource and income limits.

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Posted on Friday, Oct. 23rd 2020 6:34 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

The U.S. Supreme Court has issued an opinion that upholds the Affordable Health Care Act

Thursday, Jun. 28th 2012 11:17 AM

The U.S. Supreme Court has issued an opinion that upholds the Affordable Health Care Act


This includes the individual mandate for coverage.  The case challenged the constitutionality of several parts of the law, including the rule that most people in the U.S. must get health coverage.   We will continue to carry out provisions of the law by thoughtfully implementing the new requirements for customers and members. We will also continue to look for ways to address increasing costs that are crippling our health care system, including: ·      Advancing our partnership with primary care physicians announced earlier this year that we believe will substantially improve quality and member health, and potentially reduce the trend in overall medical costs by as much as 20% by 2015. ·      Coordinating patient care through the use of IBM-Watson technology to promote evidence-based health care and ensure that millions of Americans receive the most effective courses of treatment.  We look forward to continuing our efforts to work with policymakers and other key stakeholders to build a health care delivery system that provides security and affordability to all Americans.

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Posted on Thursday, Jun. 28th 2012 11:17 AM | by Share of Cost | in Medi-Cal | 1 Comment »

Share of Cost, Brain Exercise Video Games Can Improve Kids’ School Performance

Friday, Dec. 23rd 2011 6:40 AM

Video puzzle games which exercise a child’s working memory were found to enhance abstract reasoning and problem solving skills significantly, researchers from the University of Michigan in Ann Arbor reported in Proceedings of the National Academy of Sciences. They added that the improvements persisted for at least three months after they stopped playing the games.

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Posted on Friday, Dec. 23rd 2011 6:40 AM | by Share of Cost | in Medi-Cal | No Comments »

Share of Cost, Brain Imaging Study Of Preschoolers With ADHD Detects Brain Differences Linked To Symptoms

Monday, Dec. 19th 2011 6:40 AM

In a study published today in the Clinical Neuropsychologist (e-publication ahead of print), researchers from the Kennedy Krieger Institute found differences in the brain development of preschool children with symptoms of Attention-deficit/Hyperactivity Disorder (ADHD).

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Posted on Monday, Dec. 19th 2011 6:40 AM | by Share of Cost | in Medi-Cal | No Comments »

Walgreens to Anthem script leave network January 1, 2012

Thursday, Nov. 3rd 2011 8:56 AM

In October, we wrote to you about contract talks between Express Scripts, the company that manages the drug store network for us, and Walgreens.  We’re writing today with an update so that you have the very latest news affecting your clients. Despite ongoing talks, it appears the two parties won’t reach an agreement before the end of the year. Absent a last minute agreement, Walgreens will leave the network on January 1, 2012.

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Posted on Thursday, Nov. 3rd 2011 8:56 AM | by Share of Cost | in Medi-Cal | No Comments »

Despite some enrollment losses, most California health plans still turned a profit in 2010

Wednesday, Nov. 2nd 2011 3:46 PM

Health insurance carriers ground California’s market-based health care system, serving about two-thirds of the state’s population. In addition to covering the privately insured, these companies also serve enrollees in managed care plans through Medi-Cal, Medicare, and other public programs.

While California health insurers are a strong economic force overall, enrollment was flat in health plans overseen by both the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). Most major California health plans saw revenue grow at a slower pace in 2010, while two reported declines in revenues, according to this year’s California Health Plans and Insurers from the California HealthCare Foundation (CHCF).

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Posted on Wednesday, Nov. 2nd 2011 3:46 PM | by Share of Cost | in Medi-Cal | No Comments »

Millions of Americans with a Pre-existing Condition Could Be Denied Coverage without Affordable Care Act Protections

Wednesday, Feb. 2nd 2011 6:16 AM

Millions of Americans with a Pre-existing Condition Could Be Denied Coverage without Affordable Care Act Protections: The U.S. Department of Health and Human Services has released a new report showing that, without the Affordable Care Act (ACA), up to 129 million non-elderly Americans who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, could of lose health insurance or be denied coverage altogether. The Pre-existing Condition Insurance Plan program serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a pre-existing condition. Check out “Voices of Health Reform: Cathy’s Story” on the White House Blog.

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Posted on Wednesday, Feb. 2nd 2011 6:16 AM | by Share of Cost | in Medi-Cal | No Comments »

Parents Of Students With Asthma And Allergies, How Do You Know When Your Child Is Ready To Self-Medicate At School?

Tuesday, Aug. 17th 2010 6:47 AM

Students with asthma and allergies will pack more than just a lunchbox and bookbag when they start school this year: They’ll be devising ways to keep their life-saving medications close at hand should they need them. No longer do they have to be locked up in the nurse’s cabinet or the office…

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Posted on Tuesday, Aug. 17th 2010 6:47 AM | by Share of Cost | in Medi-Cal | No Comments »

Dentist participation in Medicaid has been a persistent problem

Monday, Aug. 9th 2010 10:49 AM

Dentist participation in Medicaid has been a persistent problem, with fewer than one in four dentists nationwide seeing more than a handful of Medicaid patients in any given year. The most common reason dentists give for their low participation is inadequate reimbursement for the cost of treating Medicaid beneficiaries.

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Posted on Monday, Aug. 9th 2010 10:49 AM | by Share of Cost | in Medi-Cal | 1 Comment »