Chances are you—or someone you know—could eventually need long term care. With the cost of nursing homes and skilled care increasing, an extended need for either could quickly deplete your savings. How will these expenses be paid?

WHAT IS LONG TERM CARE INSURANCE?

Long term care insurance typically helps pay for the long term care services you might need as the result of a chronic disease, serious accident, sudden illness or cognitive impairment such as Alzheimer’s Disease that can limit a person’s ability to think or reason. Long term care services may be provided by a health care professional such as a nurse, a home health aide or other personal care providers such as family members and personal care attendants. Varying amounts of care can take place in a variety of locations, ranging from a few hours of care per week at home to round-the-clock care in a nursing home.

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WHAT IS MEDI-CAL PLANNING?

Medi-Cal Planning is the act of identifying and applying the deductions, exemptions, and allowances provided by law to assure the individual  or there spouse does not become completely impoverished in the event of a catastrophic illness.

There are three very important areas to consider in developing a comprehensive Medi-Cal plan:

1. Eligibility Planning – to qualify for Medi-Cal benefits;

2. Income Planning – to reduce or eliminate a Medi-Cal beneficiary’s monthly “share of cost”

3. Medi-Cal Estate Recovery Planning – to reduce or completely eliminate Medi-Cal estate              recovery against the beneficiary’s estate.

We will carefully review your assets, and income to develop a comprehensive Medi-Cal plan tailored to your specific situation. We typically offer our clients several alternative strategies and thoroughly review each strategy with our clients so that they can make an informed decision regarding how they would like to proceed.

WHAT IS MEDI-CAL?

Medi-Cal is the State of California’s version of the federal Medicaid program that provides additional health insurance for qualified individuals who are at least 65 years of age, blind or disabled.  In addition to offering In Home Supportive Services (IHSS), Medi-Cal is particularly helpful to individuals that reside in skilled nursing facilities that have exhausted their Medicare skilled nursing home coverage.  While Medicare often covers the first 20 days of skilled nursing home expenses, coverage for days 21 through 100 requires a co-payment of $148.00 per day and is only available if the patient continues to show improvement in his or her condition.  The co-payment of $148.00 per day may or may not be covered by the patients’ secondary health insurance, depending upon their individual plan.  Upon receiving  a maximum of 100 days of Medicare coverage, the patient is then typically converted to “private pay” status where monthly expenses average approximately $7,000 per month.  On the other hand, Medi-Cal will continue to pay for skilled nursing home expenses indefinitely, regardless of whether or not the patient continues to show improvement.

Unfortunately, many people are misinformed about the eligibility criteria Medi-Cal uses to determine one’s eligibility for the Medi-Cal Long Term Care program.  Such misinformation is likely due to the ever changing and complicated Medi-Cal regulations.  Despite what you might have heard, you do not have to be destitute in order to qualify for Medi-Cal benefits.

STANDARD ELIGIBILITY LIMITS FOR  LONG TERM CARE MEDI-CAL BENEFITS

The applicant must be 65 years of age, blind or disabled in order to receive Medi-Cal Long Term Care benefits. A single applicant may not have more than $2,000.00 (for 2013) in “non-exempt” assets, while a married applicant is allowed $115,920.00 (for 2013) in “non-exempt” assets.

Medi-Cal classifies certain assets as “exempt” and their values are not used in the determining an applicant’s eligibility.  The following are the major assets considered “exempt” by Medi-Cal in determining eligibility:

•  Principal Residence

•  One Vehicle

•  Business Property

•  Personal Effects

•  Term Life Insurance

It is important to understand that the above are “standard” Medi-Cal eligibility limits.

“SHARE OF COST”

Although an applicant’s income is not an eligibility factor, Medi-Cal does review an applicant’s income to determine the applicant’s monthly co-payment (“share of cost”). The formula used to determine an applicant’s “share of cost” has many variables and often allows the applicant’s spouse to retain a large portion of the applicant’s income.  With proper planning it may be possible to reduce one’s “share of cost.”

MEDI-CAL ESTATE RECOVERY

Medi-Cal keeps track of the total amount of benefits it pays out over the lifetime of a Medi-Cal beneficiary and attempts to recover that amount from the beneficiary’s remaining estate.  Medi-Cal may only recover from the assets that the Medi-Cal beneficiary has an ownership interest in at the time of their passing, and only after the Medi-Cal beneficiary’s spouse also passes away.  Thus, the Medi-Cal beneficiary’s spouse will have unrestricted use of the assets for the remainder of their life.  We will carefully review your financial assets in order to minimize or completely avoid potential estate recovery.  A proper Medi-Cal eligibility plan will not only qualify an individual for Medi-Cal benefits (thereby preserving assets), but provide asset protection from potential Medi-Cal estate recovery (including protection of one’s home).  We are experienced in preparing and implementing effective asset protection plans for single or married Medi-Cal recipients.

WHAT ARE VETERANS AID AND ATTENDANCE BENEFITS?

Qualification Requirements.

Unreimbursed Medical Expenses.

Medicare and Medicare Supplement Premiums

Pharmaceuticals

Over-the-Counter Drugs and Supplies

Cost of Assisted Living Facility or Home Health Care

Home healthcare can be provided by professionals, family, and friends.

Any Other Out-of-Pocket Medical-related Expense