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.

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.

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.

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).

The transfer by the applicant’s spouse must be a real gift transfer. If the adult child, for example, is only holding the assets, it probably really is a trust. In that case, the transfer could either cause a period of ineligibility or simply result in the assets continuing to be counted as available to the applicant.

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

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.

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