Medi-Cal FAQ

When applying for long term Medi-Cal benefits, there are many misunderstandings about the process and how to qualify while protecting your home from Medi-Cal ‘recovery’. This Frequently Asked Questions (FAQ) page addresses many of them. Should you have further questions or would like to speak to an attorney who understands the nuances of qualifying for Medi-Cal benefits, call (707) 769-9975 or visit our contact page.

Yes. But accurate, informed and thoughtful planning is necessary to qualify for benefits–while at the same time retaining true ownership and flexible use of family assets.

Watch video below for more information.

Many people believe that a family must spend down all of their life’s savings in order to qualify for Medi-Cal. That is not the case. The Medi-Cal rules are a compilation of many different federal and state laws. Some of those laws conflict with themselves. Many simply do not apply to residents of California. Our California system allows applicants to re-characterize their assets through differing methods such as; sales, transfers, leases, life estates and other available steps. Spending down does not have to mean going broke in order to qualify for Medi-Cal benefits. Through the legal use of a combination of the laws, California residents can keep their assets and qualify for Long Term Care Medi-Cal benefits. Watch the video below for more information.

Medi-Cal employs several formulas to determine if an applicant has transferred highly valued assets for less than their actual value. Transfers are reviewed to determine if the applicant gave their home to the kids for free; or gave large sums of cash to the kids hoping to become impoverished in order to qualify for benefits. Depending on the individual applicant’s planning methods used prior to applying for benefits, several different look back periods of 30, 36 or 60 months may be used to determine if there were gifts deemed to disqualify the applicant for some number of months.

Watch the video below for more information:

With many things legal: It depends. The first inquiry by the government is to determine if assets were “spent down” to qualify for Medi-Cal benefits. If so, how were the assets spent down, and do the transfers invoke a period of ineligibility? There is a formula used by Medi-Cal to determine if the spend down of assets has caused a time penalty, and if so for how long.

periods are applied differently and depend on which federal and/or state laws were invoked and apply to a family’s transfer of assets to determine IF a time penalty will attach to the application, or whether the planning was successful in preserving the family home and other assets.

Watch the video below for more information:

A Medi-Cal Share of Cost is similar to any other type of co-pay. The difference here is that under most circumstances the Medi-Cal process allows the applicant the right to demonstrate a financial hardship. Once proven, the amount of co-pay can be dramatically reduced, and in many instances reduced to zero.

Watch the video below for more information and example of shared cost:

Yes. Medi-Cal requires a yearly “check-in” and an update detailing any changes in financial status of the recipient that would alter the benefits package over the remaining year. This may be an unexpected inheritance, sale of assets by the well spouse, or any other inflow of cash or assets that are non-exempt. Usually, when unexpected or excess assets or income is received after qualifying for Medi-Cal, there is time to re-characterize the portion above the financial limits, thereby maintaining the uninterrupted ability to continue receiving benefits.

YES, without proper planning. NO, with proper planning. There is a divide in how the Medi-Cal system is designed and operates. One group of “Eligibility” workers sees only applicants and provide assistance solely for completing the application. An entirely separate group of lawyers and accountants are responsible for the “Recovery” of as many assets as possible from the Medi-Cal recipient’s estate at the death of the recipient. That includes as much of the value of the Family Home it takes to repay the amount demanded by the government.

No. The laws of California (rather than federal laws) are applied at the death of the recipient to determine if there is an “Estate” to collect from. Our legal planning and maintenance throughout the years the applicant receives public benefits is meant to comply with the intertwined laws in a way that will prevent the government from “selling the Family Home” or taking any excess cash or assets as a result of having received public benefits. When planned properly, the ill spouse receives all Medi-Cal benefits during their lifetime. Upon death, the recipient’s “Estate” is zero. A zero “Estate” will not be burdened with repayment of money received by the ill spouse during their lifetime. The surviving spouse and family retain the Family Home and all other legally transferred cash and assets without further demand by the government for repayment.

It could be. But once again it depends. The authorities will review how the application process was planned and executed, who was involved in the planning and execution, were rightful heirs wrongly disinherited by the transfers, was the ill spouse protected after the asset transfers, how was the money used during the ill persons lifetime, and who received the remaining assets upon the death of the ill spouse. All of the above are portions of what an alerted authority would look at to determine if assets were wrongly taken from an elder through fraud or other illegal tricks. When a proper plan is presented to the authorities demonstrating that the health and life of the elder was improved by accepting Medi-Cal benefits, we are unaware of any family member being accused of Elder Abuse.

It always pays dividends to plan ahead, rather than waiting for the emergency to arise before acting. This form of “crisis planning” can lead to poor decisions that may ultimately be very costly. At times of emergency the complexity of the situation can double or triple when trying to resolve lifelong issues. That can hinder good decision making.

“Advanced planning” allows the family ample time to carefully discuss, and then execute the agreed upon documents for mom and/or dad. Eventually it becomes clear that mom or dad can no longer take care of themselves. Or that mom is no longer able to care for dad alone any more. Having an “advanced plan” establishes a clear path to walk when a crisis arises. An advanced plan allows all the focus to be on caring for the ill person at the time it is most needed. Following a thoughtful pre-plan is much less stressful than trying to actively manage physicians, social workers, family, friends, bank accounts, stock accounts, insurance, maintenance and upkeep of all the family bills and business. When our loved ones become ill, it is always comforting to know what the future will be like for the entire family. Early advanced planning makes that comfort level possible. It promotes a more healing environment for the family, as well as the person entering skilled nursing.

Qualifying and applying for Medi-Cal can be a complicated and confusing process. We specialize in helping clients who are over the asset limits qualify for Medi-Cal without depleting their life savings. Medi-Cal is a program that is both state and federally funded and is designed to help pay for medical care for those who qualify.

Our firm practices exclusively in Long Term Care Medi-Cal for those who are currently in a skilled nursing facility or getting ready to transition into a skilled nursing facility. We do not assist Medi-Cal for basic health insurance.

Although we hope you will never need Long Term Care Medi-Cal, we as Americans are living longer and the chance of becoming incapacitated before dying is increasing. The price of a stay in a skilled nursing facility is also rising, which is why it is important to consider Long Term Care Medi-Cal if you or a loved one may be facing a nursing home stay in the future.

For more information, please watch the video below.


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