Archive for the 'Medi-Cal' Category

How does the look-back period affect a person’s eligibility for Medi-Cal benefits?

Monday, Jan. 25th 2021 3:26 PM

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:

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Posted on Monday, Jan. 25th 2021 3:26 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

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.

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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 »

Acid Reflux Disease

Tuesday, Jan. 19th 2021 3:12 PM

For Acid Reflux Disease Patients, Esophageal Cancer Risk Lower Than Expected

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Posted on Tuesday, Jan. 19th 2021 3:12 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Is there such a thing as a “Medi-Cal Friendly Annuity”?

Friday, Jan. 15th 2021 3:03 PM

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.

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Posted on Friday, Jan. 15th 2021 3:03 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

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?

Tuesday, Jan. 12th 2021 5:29 AM

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

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Posted on Tuesday, Jan. 12th 2021 5:29 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Are assets from a prior marriage exempt for eligibility purposes? What about estate recovery?

Saturday, Jan. 9th 2021 5:20 AM

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.

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Posted on Saturday, Jan. 9th 2021 5:20 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Anxiety and Heart Disease

Thursday, Jan. 7th 2021 2:16 PM

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

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Posted on Thursday, Jan. 7th 2021 2:16 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Are assets my spouse inherits disregarded for eligibility purposes when I apply for Medi-Cal? For the purpose of estate recovery?

Monday, Jan. 4th 2021 5:12 AM

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.

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Posted on Monday, Jan. 4th 2021 5:12 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Inflammation In Heart Disease

Thursday, Dec. 31st 2020 5:04 AM

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.

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Posted on Thursday, Dec. 31st 2020 5:04 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

How Does Alzheimer’s Disease Develop?

Tuesday, Dec. 29th 2020 5:03 AM

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.

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Posted on Tuesday, Dec. 29th 2020 5:03 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Are the assets identified in a pre-nuptial agreement disregarded for the purpose of eligibility when an individual applies for Medi-Cal? What about estate recovery?

Saturday, Dec. 26th 2020 5:59 AM

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.

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Posted on Saturday, Dec. 26th 2020 5:59 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, Dec. 24th 2020 4:59 PM

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, Dec. 24th 2020 4:59 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

How are retirement annuities treated for Medi-Cal eligibility?

Sunday, Dec. 13th 2020 5:52 AM

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.

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Posted on Sunday, Dec. 13th 2020 5:52 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

What percentage of nursing homes is Medi-Cal approved? Medicare approved?

Wednesday, Dec. 9th 2020 5:50 AM

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%

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Posted on Wednesday, Dec. 9th 2020 5:50 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Share of Cost – Partnership Policy Covers

Sunday, Dec. 6th 2020 4:48 PM

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?

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Posted on Sunday, Dec. 6th 2020 4:48 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

How much does a person have to pay for services while on Medi-Cal?

Friday, Dec. 4th 2020 1:42 PM

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.

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Posted on Friday, Dec. 4th 2020 1:42 PM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »