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.
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.
The American College of Sports Medicine (ACSM) has just released new recommendations on the quantity and quality of exercise for adults, definitively answering the age-old question of how much exercise is actually enough. The position stand, titled “Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise,” reflects current scientific evidence on physical activity and includes recommendations on aerobic exercise, strength training and flexibility.
The energy density of food and drink, portion size, and the number of meals and snacks per day have all been linked to increases in the average daily total energy intake of US adults over the past 30 years, but increases in the number of eating occasions and in portion size have accounted for most of this increase: energy density of food consumed may have actually slightly decreased.
In 2007, Stephen Luby (SPL), Head of the Program on Infectious Diseases and Vaccine Sciences at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDRB) and colleagues studied hand washing behavior in 347 households from 50 villages across rural Bangladesh. Following the results of their study, they concluded that washing of hands with soap, or simply rinsing hands without soap prior to preparation of food can reduce the occurrence of diarrhea in children.
As major cardiac complications occur in a significant proportion of patients with community-acquired pneumonia-pneumonia contracted outside of health care settings-doctors should be more aware of this association to better inform, treat, and manage patients with this infection, especially as this form of pneumonia is the most frequent cause of infectious disease-related mortality in the US causing 60,000 deaths every year.
Cells that lack the protein HMGB1 have a different organization of genetic material than normal cells, which increases their sensitivity to genetic damage and changes the way that information contained within DNA is retrieved. These are the findings of a new study, published on 28 June in the online, open-access journal PLoS Biology.
Regulator Takes Enforcement Action Against East Sussex Hospitals NHS Trust For Failing To Protect Safety And Welfare Of People, UK
The Care Quality Commission (CQC) has taken enforcement action against East Sussex Hospitals NHS Trust because it has failed to protect the safety and welfare of people who use its service. The enforcement action is in the form of a Warning Notice which requires the trust to make urgent improvement to patient care. In February this year CQC carried out a routine review of all five hospitals which make up the East Sussex Hospitals NHS Trust.
The government’s announcement of temporary measures for next year aimed at preserving financial support for medical students is a step in the right direction, but it must become a long term settlement, medical student leaders said today (Tuesday, 28th June 2011). David Willetts MP, the Minister for Universities and Science, confirmed in a statement to the House of Commons that the government intends to preserve the current arrangements for the NHS Bursary for the 2012 intake.
Medtronic, Inc. (NYSE: MDT) today announced the launch of Medtronic’s first mobile application for use with implantable cardiac devices. As health care shifts care delivery from outpatient to home, Medtronic is leading the implantable cardiac device industry by offering cutting-edge technology designed to give physicians greater flexibility in monitoring patient data. The CareLink™ Mobile Application allows clinicians to access cardiac device diagnostic and patient data directly from their mobile devices.
Patients treated with sunitinib and sorafenib responded to the flu vaccine, which suggests the agents do not damage the immune system as much as previously feared, according to a study in Clinical Cancer Research, a journal of the American Association for Cancer Research. Keith Flaherty, M.D., director of developmental therapeutics at the Massachusetts General Hospital and a senior editor of Clinical Cancer Research, said the findings have broad implications beyond questions of patient management.
The ultimate source of some cancers is embryonic cells. Research published in the June 24th Cell, a Cell Press publication, traces the precursor of deadly esophageal cancers to leftover embryonic cells found in all adults. Some people with gastric reflux disease have a greater risk of developing esophageal cancer.
First Patient Enrolled And Treated In The U.S. For EndoGastric Solutions’ Randomized Study Of Transoral Incisionless Fundoplication (TIF)
EndoGastric Solutions (EGS), the leader in the emerging field of Natural Orifice Surgery (NOS), today announced that the first patient has been enrolled and treated in the RESPECT study (Randomized EsophyX vs. Sham/Placebo Controlled Trial). The RESPECT trial was designed by co-principle investigators Dr. John Hunter, Chairman of Surgery, Oregon Health & Science University, and Dr.