Degree Of Lifetime Stress Exposure Linked To Inflammation In Heart Disease

Greater lifetime exposure to the stress of traumatic events was linked to higher levels of inflammation in a study of almost 1,000 patients with cardiovascular disease led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

A second pathway through which Alzheimer’s develops has been discovered after researchers identified a new set of genetic markers for the disease. Most Alzheimer’s genetic research focuses on amyloid-beta, which contributes to the formation of plaques found in the brains of people suffering from Alzheimer’s. In this study, published in the journal Neuron, researchers were able to identify genes linked to the tau protein, a protein which develops in the brain as Alzheimer’s slowly progresses.

With a prenuptial agreement, the county considers the living situation of the individual at the time of application in order to determine Medi-Cal eligibility. Let us take at look at three living situations: Example #1: Both spouses are at home. All non-exempt property over $3,000 (including assets
identified in a pre-nuptial agreement) is counted in determining Medi-Cal eligibility. Example #2: Both spouses are in board & care or only one spouse is in board & care and one remains at home or both spouses are in long-term care. The property of the non-applicant spouse that is established as separate property in the pre-nuptial agreement (as long as it remains
separate) is disregarded for purposes of establishing eligibility. Half of the community property is also disregarded.

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.

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

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).

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, ifotherwise eligible. If a person has more than the limit for a whole month, Medi-Cal benefits will be discontinued. A person’s home, furnishings, personal items, and one motor vehicle are not counted. A single person is allowed to keep $2,000 in property/assets, more if they are married and/or have a family. (If a person has a Partnership policy, however, each dollar the Partnership policy pays out in benefits entitles the insured to keep a dollar of his/her assets should he/she ever need to apply for Medi-Cal Services.) For example, if a person receives an inheritance that puts their property/asset amount to more than $2,000, they would be required to spend that amount down to $2,000 before Medi-Cal would pay for any further care.

Question: How long does a person have to be living in California before they can be deemed a resident of California for Medi-Cal eligibility purposes?

Reply: There is no time period associated with being a California resident. However, a person does have to be physically present in California with the intent to remain in California permanently or indefinitely.

Annuities are not considered exempt unless they are IRAs, KEOGHS, or work-related pension funds held in the name of a person who does not want Medi-Cal for him- or herself. If payments are being received, however, those payments are considered income. The cash surrender value of IRAs,
KEOGHS and work-related pension funds held in the name of an individual who does not want MediCal is counted until the individual takes steps to receive either the cash lump sum or periodic payments of principal and interest. The periodic payments are considered income and the balance is considered unavailable.

Question: If a Partnership policy covers a patient’s stay in a private room in the nursing home until policy benefits are exhausted, and the patient transitions into Medi-Cal, with a SOC, and the nursing facility intends to transfer them out of their private room and into a semi-private room, can the patient use their SOC to guarantee their continued stay in a private room?

Reply: Yes, as long as the patient’s SOC, or some combination of their SOC, their assets and/or any remaining insurance, is high enough to cover the rate for the private room. If the nursing facility charges Medi-Cal for any portion of the facility cost, the patient cannot pay the difference between the Medi-Cal covered accommodation and a private roam. The patient may be able to afford to pay the entire cost of the nursing facility charge as their SOC, because they will no longer need to use any of their income to pay for drugs, Medi-Gap (part B) policy co-pays or deductibles, etc.

This is because once the patient is on Medi-Cal; the Medi-Cal benefits will cover all these medically necessary services. The patient’s income therefore, depending on each individual’s circumstances, may be sufficient to pay the facility costs (while meeting their SOC) so they can be sure to remain in a private. If not, the patient may have to move into Medi-Cal covered accommodations. For example, if the private room cost is $3,500 and the policyholder has $3,500 in income, they can use that amount to pay for the private room. Medi-Cal would then be available to cover any other medically necessary item.

Nearly 88% of the 1,400 nursing homes in California accept Medi-Cal:
Title 18 only (Medicare): 8.3%
Title 18/19 (Medicare/Medi-Cal): 80.4%
Title 19 only (Medi-Cal): 7.3%
No Participation 4.0%

Question: If a Partnership policy covers a patient’s stay in a private room in a nursing home until policy benefits are exhausted, and the patient transitions into Medi-Cal, with a Share of Cost (SOC), do they have to spend the SOC for services specifically pertinent to the nursing home?

Reply: No, the patient can spend their SOC on a variety of medical services. This SOC obligation does not necessarily need to be paid to the nursing home. For example, if the nursing home patient needs four occupational therapy treatments per week, but Medi-Cal only allows two per week, the additional occupational therapy treatments could be paid through the SOC. In this example, even though Medi-Cal covers occupational therapy, any additional services a person wants above and beyond what Medi-Cal would have covered could be paid as the SOC. Therefore, the SOC services paid by the patient must not be Medi-Cal covered services in order for their costs to count toward the Medi-Cal SOC. In addition, services that would usually be covered by Medi-Cal, such as the use of a health aide, can be paid as the SOC if the service provider is not a Medi-Cal provider.

The county looks at the applicant’s income after he or she establishes eligibility for Medi-Cal by spending down assets to no more than $89,280 for a couple with one spouse institutionalized or $2,000 for a single individual. The county looks at the income the individual receives in his or her own name and divides in half the income received in the name of both spouses. Of the income that counts as the income of the applicant, all (less $35) of the applicant’s income is considered his or her “share of cost” for Medi-Cal. This works like a regular health insurance deductible. The applicant pays or obligates him or herself to pay that much each month on medical expenses before Medi-Cal pays the remainder of Medi-Cal covered services.

For example, a single individual in a skilled nursing facility has an income of $1,000 per month. This person is allowed to retain $35 per month for personal needs. The remainder ($965) of the countable income goes toward his or her share of cost each month. Medi-Cal pays the remainder of the expenses for the month up to the Medi-Cal reimbursement rate that is negotiated with the facility. The law precludes the facility from “balance billing” or charging the individual or family for any more than the share of cost.

In the case of an institutionalized spouse with a well spouse in the community, the institutionalized spouse is allowed to allocate some of his/her income to the community spouse as long as the community
spouse’s income is below a certain level. For the year 2002, that amount is $2,232. If the community spouse’s income is over that amount, the community spouse retains all of his/her income. Here is an example of a couple with one spouse in a nursing facility and one spouse in the community:

Institutionalized Spouse $1500 Social Security
$400 Pension
$1900 Total
Spouse $600 Social Security

In this case, the institutionalized spouse is allowed to allocate $1,632 each month to his or her spouse ($2,232 -$600 = $1,632). The remainder, in excess of the $35 the institutionalized spouse is allowed to retain for personal needs, goes toward the share of cost each month. Medi-Cal pays the remainder of his or her medical expenses ($1,900 – $1,632 spousal allocation = $268 – $35 = $233 share of cost).

If someone you are caring for has dementia and need to see a dentist you will want to make a dental appointment for early in the day, when the person in question is most alert. Also, make sure to tell him/her where they are going and why.

Let the dentist know ahead of time about the condition of the person with dementia. Communication will make the visit easier.

It is best for someone with dementia to see a dentist as soon as possible after they are diagnosed. And if any procedures are needed, they should get them done as soon as possible. That way, as the disease gets worse, then they should only need easier maintenance treatments