A new study by researchers at the University at Buffalo and the University of California, Irvine, to be published in the September issue of the journal Pain, reveals that, for people with chronic back pain, having a little adversity in your life can be protective and beneficial.

If you’ve ever groaned, “Oh, my aching back!”, you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Most back pain goes away on its own, though it may take awhile. Taking over-the-counter pain relievers and resting can help. However, staying in bed for more than 1 or 2 days can make it worse.

 For a complete listing of specialty programs and hours of operation, please refer to the Medi-Cal Directory in the provider manual.

Mailing Address:
HP Enterprise Services
PO Box 13029
Sacramento, CA 95813-4029

Medi-Cal Fraud is Against the Law
Medi-Cal fraud costs taxpayers million each year and can endanger the health of Californians. Help protect Medi-Cal and yourself by reporting violations today.

DHCS Medi-Cal Fraud Hotline: 1-800-822-6222

The call is free and you can remain anonymous. Knowingly participating in fraudulent activities can result in prosecution and jail time. Help prevent Medi-Cal fraud.

Stop Illegal Tobacco Sales
The simplest way to stop illegal tobacco sales to minors is for merchants to check ID and verify the age of the tobacco purchasers. Report illegal tobacco sales to 1-800-5-ASK-4-ID.

For more information, see the California Department of Public Health – California Tobacco Control Web site.

In California, any transfer of a non-exempt asset (also called “countable”) within 30 months of an individual’s application for Medi-Cal for nursing facility level of care may result in a period of ineligibility. This period of ineligibility will only apply to the nursing facility level of care and, if
otherwise eligible, the individual would be eligible for all other Medi-Cal covered services. Remember, the look-back period does not apply to those assets that are exempt (also called “not countable”). The most common exempt asset is the individual’s principal residence. The period of ineligibility is determined by dividing the average private pay rate (APPR) in California, currently $4,322, into the value of the transferred non-exempt asset. Let us take a look at the following example:

Ten months prior to Ms. Peabody’s (a single individual) application to Medi-Cal to pay for her stay at Sunnyside Nursing Facility, she transferred $200,000 from her bank account to her son John. She meets all other eligibility requirements for Medi-Cal. Would Ms. Peabody have a period of ineligibility for payment to the nursing facility as determined by her eligibility worker? If so, what would be the period of ineligibility?

Yes, Ms. Peabody would have a period of ineligibility of 21 months. Here is how it is calculated:

The first step taken by the eligibility worker would be to determine the maximum period of ineligibility. This is accomplished by dividing the value of the $200,000 non-exempt transfer by the APPR for 2002, which is $4,322. For this example, the calculation results in 46 months. OBRA 93 (Omnibus Budget Reconciliation Act) lifted the ceiling on the maximum period of ineligibility. Remember, however, that the maximum period of ineligibility in California is still 30 months. In this example, the transfer took place 10 months prior to Ms. Peabody’s application for Medi-Cal. In determining the actual period of ineligibility, the eligibility worker would start counting beginning with the 10th month and continue through the 30th month. The ineligibility period would thus be 21 months. Medi-Cal would not begin to
pay for Ms. Peabody’s nursing facility costs until another 21 months had passed.

The period of ineligibility is always the lesser of one of the following: – 30 months; or – the number of months obtained by dividing the value of the transfer by the APPR; or – the difference between 30 months from the date of the transfer and the date of application for Medi-Cal benefits, inclusive. In other states, the look-back period and the period of ineligibility may differ from that used in California.

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.

Walter and Eliza Hall Institute scientists have identified the three protein fragments that make gluten – the main protein in wheat, rye and barley – toxic to people with coeliac disease. Their discovery opens the way for a new generation of diagnostics, treatments, prevention strategies and food tests for the millions of people worldwide with coeliac disease…

The risk of esophageal cancer among patients who suffer from gastroesophageal reflux disease (GERD) is not as high as many may think, according to new research from University of Michigan gastroenterologists. GERD is considered a relative risk for developing esophageal adenocarcinoma, but the absolute risk is not known, says Joel Rubenstein, M.D., M.Sc.

There is no such thing as a Medi-Cal-friendly annuity. The balance of an annuity is considered unavailable as long as the owner receives equal monthly payments for a number of years, less than or equal to life expectancy (based upon life expectancy tables designated by Health Care Financing Administration for this purpose). The final payment may be smaller to exhaust the annuity. If payments are not equal and monthly, the cash surrender value is counted. If payments extend beyond life
expectancy, a period of ineligibility for nursing facility level of care may result. Some annuities pay very small amounts, with a balloon payment at the end. These annuities, even though set up to exhaust within life expectancy, are not annuitized in accordance with DHS rules. The cash surrender value is counted in determining eligibility. In many cases, these annuities are irrevocable and do not have a cash value and there is nothing to count. Individuals who purchase this type of annuity lose financial control while cashing in their life insurance policies, stocks, bonds, etc. Many times they have to pay heavy capital gains taxes and surrender penalties in the process.

The institutionalized spouse has $200,000 of assets protected through a Partnership policy. The spouse at home gives $200,000 to a child on January 1,1999, and applies for Medi-Cal on February 28, 2000. Is there a penalty under the rules for transfer of property?

In this example, assuming the couple has no other countable property (all they have is $200,000 in assets) at the time of the transfer, the transfer of the protected assets is considered a transfer of exempt property. Therefore, there is no period of ineligibility for nursing facility level of care. This above exemption only applies during the lifetime of the institutionalized spouse for eligibility purposes. After the institutionalized spouse dies, this exemption no longer applies. For estate recovery purposes, however, the $200,000 of asset protection continues even after the death of the protected spouse

The term “exempt” applies to a “type” or “classification” of property given exempt status by statute or regulation. Assets from a prior marriage are not a type of property that is exempt. Property from a prior marriage may be considered separate property if it has not been combined with the property of the current spouse. If the property is separate property, it may or may not be counted, as in the living situations described above. Estate recovery can file a claim against any asset (e.g., the community property interest) that passes from the deceased person to the surviving spouse upon his or her death. Estate recovery only takes place, however, when the surviving spouse dies.

Anxiety Increases Risk Of Complications For Heart Disease Patients

Patients with heart disease who also suffer from an anxiety disorder have a significantly higher risk of having a heart attack, heart failure, stroke and death, compared to other heart disease patients, according to Dutch scientists. You can read about this study in the peer-reviewed medical journal Archives of General Psychiatry

In the case of an inheritance, the assets disregarded for determining eligibility are the same as those in a pre-nuptial agreement. The estate recovery program can only file claims against the assets that pass from deceased Medi-Cal beneficiaries to their surviving spouses upon death. Any assets that pass to the surviving spouse before the death of the Medi-Cal beneficiary are not recoverable.