Share of Cost – Partnership policy

Saturday, Dec. 12th 2020 4:54 PM

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?

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Posted on Saturday, Dec. 12th 2020 4:54 PM | by Share of Cost | in 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 »

Share of Cost – Dental Care and Dementia

Thursday, Dec. 3rd 2020 10:02 AM

If someone you are caring for has dementia and need to see a dentist you will want to make a dental appointment for early in the day, when the person in question is most alert. Also, make sure to tell him/her where they are going and why.

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Posted on Thursday, Dec. 3rd 2020 10:02 AM | by Share of Cost | in Share of Cost | No Comments »

What if the above transfer was to a family member, such as an adult child?

Monday, Nov. 30th 2020 5:34 AM

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.

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Posted on Monday, Nov. 30th 2020 5:34 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Share of Cost – Smoking and Your Dental Health.

Saturday, Nov. 28th 2020 9:55 AM

If you are an smoker, you are likely to have bad breath and stained teeth, just for starters. Smoking may make it take longer to recover from a pulled tooth and periodontal treatment. Long-term smoking can raise the chances of oral cancer. And so does your age.

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Posted on Saturday, Nov. 28th 2020 9:55 AM | by Share of Cost | in Share of Cost | No Comments »

If a Medi-Cal applicant’s spouse transfers assets, will that result in any period of ineligibility for nursing home care?

Thursday, Nov. 26th 2020 5:31 AM

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

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Posted on Thursday, Nov. 26th 2020 5:31 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Share of Cost – Braces for Older Adults

Wednesday, Nov. 25th 2020 9:49 AM

With braces there can be a misconception that only kids or young adults can have braces. However, there is no age limit for correcting misaligned (crooked) teeth. If you want to improve your appearance or bite, a dentist or orthodontist can fit you for braces. It is more common than you may think.

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Posted on Wednesday, Nov. 25th 2020 9:49 AM | by Share of Cost | in Share of Cost | No Comments »

If a person applies for Medi-Cal, can they have a principal residence in another state (outside of California) and still qualify for Medi-Cal?

Sunday, Nov. 22nd 2020 5:28 AM

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.

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Posted on Sunday, Nov. 22nd 2020 5:28 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Share of Cost – Sensitive Teeth

Wednesday, Nov. 18th 2020 9:45 AM

Having sensitive teeth can happen to anyone, at any age. Your gum tissue pulls back from your teeth, uncovering some of the root. This can make the area sensitive to temperature hot and cold.

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Posted on Wednesday, Nov. 18th 2020 9:45 AM | by Share of Cost | in Share of Cost | No Comments »

Can a nursing home resident give away their income, or does it need to be spent on medically necessary care? Let us say a person is in a nursing home and wants to give their grandchild $50 for their birthday. Can they do that?

Monday, Nov. 16th 2020 5:43 AM

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

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Posted on Monday, Nov. 16th 2020 5:43 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Share of Cost – Senior Dental Health

Sunday, Nov. 15th 2020 9:26 AM

It is important to know that age in and of itself is not a dominant or sole factor in determining your oral health. However, certain medical conditions, such as arthritis in the hands and fingers, may make brushing or flossing teeth difficult to impossible to perform. Drugs can also affect oral health and may make a change in your dental treatment necessary. The inability to go to the dental office to due lack of mobility. If you have these type of issues that are keeping you from having the best oral health care you can have. You may want to look into a mobile dentist. A mobile dentist comes to you when you can not go to them.

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Posted on Sunday, Nov. 15th 2020 9:26 AM | by Share of Cost | in Share of Cost | No Comments »

Share of Cost – Stomatitis

Friday, Nov. 13th 2020 9:16 AM

Denture-induced stomatitis. First stomatitis is an inflammation of the mucous membrane of the mouth. Ill-fitting dentures, poor dental hygiene, or a buildup of the fungus Candida albicans can cause this condition, which is inflammation of the tissue underlying a denture.

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How long before applying for Medi-Cal can a person transfer assets?

Thursday, Nov. 12th 2020 5:37 AM

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, Nov. 12th 2020 5:37 AM | by Share of Cost | in Medi-Cal, Share of Cost | No Comments »

Share of Cost – Periodontitis/Gum Disease

Tuesday, Nov. 10th 2020 8:55 AM

Periodontitis also known as Gum disease is caused by plaque and made worse by food left in teeth, use of tobacco products, poor-fitting bridges and dentures, poor diets, and certain diseases, such as anemia, cancer, and diabetes, this is often a problem for older adults.

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Posted on Tuesday, Nov. 10th 2020 8:55 AM | by Share of Cost | in Share of Cost | No Comments »