Intermediate 11. What are the income limits? Gross income is counted and computed into the share of cost, (SOC), which is the monthly co-pay for the program. There is no limit, but the SOC will go up accordingly. A Medi-Cal recipient living in a nursing facility is allowed to keep $35 per month for personal expenses.
12. What is covered by Medi-Cal for Long Term Care?
The program covers nursing home daily room rates, after the share of cost is deducted. It will also cover doctor's visits, incidentals such as diapers, and dental care. Daily room rates at senior residences, board & care facilities, and assisted living facilities are not covered.
13. Can you still qualify if you are over PRL (Property Resource Limit)? Yes. You will need to successfully transfer your assets according to state guidelines. This process Is known as the "Spend Down."
14. How do you "Spend Down" assets? Each case is different; therefore, there is no blanket answer. At Senior Medi-Benefits we strongly recommend an evaluation of the potential applicant's situation before deciding a course of action. A partial list of things to be considered are current financial, Insurance, legal, family, and health status.
15. What is the 30-month look back? The county worker will check the applicant's financial history during the past thirty (30) months to see if there were any disqualifying transfers. These would include lump sum gifts. The transfer sums can result in time penalties against the applicant when not transferred properly.
16. What is the Eaves report?
The county worker will check federal and state tax records to generate the Eaves report (computer), to see if the applicant has divulged all accounts. We never recommend hiding or shielding assets, as their discovery later will jeopardize the chances of successfully qualifying for the program.
17. What is the State Recovery Unit?
After the death of the Medi-Cal recipient, attorneys working for the State Recovery Unit will try to find assets in the recipient's name. If there are any assets, the state will put a claim on the asset for reimbursement of funds paid out.
18. Will I lose the family home?
It is possible that the family home can be lost to pay the State back for Medi-Cal payments made to the recipient This situation happens when the State puts a claim on the home after the death of the Medi-Cal recipient or after the death of the last living spouse. Your home is only exempt while you are living. Key Issue Is how the home Is titled at the time of death. We strongly recommend families to get the right advice before taking any action on the home.
19. Do the regulations change often? The property resource limits change on a year-to-year basis. The regulations themselves are always undergoing review at the state level, coming under political pressure from lobbying groups, the state legislature, and the governor's office. There are currently a series of bills that have been introduced by state senators that would change many of the key components to qualifying for Medi-Cal.
20. Will you be denied benefits if you don't have the correct identification documents? You must show a picture ID and one of the following to quality for benefits: birth certificate, religious record, hospital record at time of birth, school record, military discharge papers or final adoption decree. However, you will not be denied benefits if you are showing good faith in attempting to attain verification. Learn important facts about the program that impacts many elderly Californians: PDF DOWNLOAD A full version of LTC Medi-Cal FAQs.
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