Does Medi-Cal pay for Residential Care Facilities for the Elderly (RCFE’s), also known as Assisted Living or Board and Care?

Friday, Jan. 22nd 2021 5:21 AM

Currently, Medi-Cal does not pay for board and care in a RCFE, since RCFE care is not considered to be medical care. In addition, RCFE’s are not licensed as medical care providers. Medi-Cal does, however, allow an individual to retain income each month, up to the amount of the monthly charge of the facility, as long as the person requires and is receiving custodial care within the facility. If an individual is residing in an RCFE simply because the individual enjoys the luxury of not having to cook, clean and do laundry, Medi-Cal does not allow the individual to retain the additional income. If the individual is residing in the facility, however, because he or she requires assistance and needs custodial care, MediCal allows the individual to retain more of his or her income.

For example, a single individual residing in a RCFE receives $1,000 a month from Social Security and the RCFE charges $1,000 per month.

This individual would normally only be able to retain $600 per month because he or she is not residing in a hospital or intermediate or skilled nursing facility. Because he or she requires custodial care in an RCFE, the county allows the individual to retain $600 per month and considers the remaining $400 per month “unavailable” (similar to an income deduction) because the facility charge is $1,000 per month. This individual, then, has a zero share of cost and Medi-Cal pays all of the individual’s medical expenses
in that month for Medi-Cal covered services. If, however, the facility charges only $900 per month, the county will consider only $300 per month (in addition to the $600) as “unavailable”. In this case, the individual has a share of cost of $100 per month that he or she pays or obligates him or her to pay on medical expenses before Medi-Cal pays the remainder of Medi-Cal covered services.

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Posted on Friday, Jan. 22nd 2021 5:21 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

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