Q: What is Medicaid/Medi-Cal Planning and what does it involve?
Medicaid (called Medi-Cal in California) is a federal program that will pay for nursing home care. Medi-Cal is not to be confused with Medicare, which in most cases will not pay for extended nursing home care. Medicare is a program which people pay into during their working years, while Medi-Cal is a needs-based program intended to help impoverished Americans with medical and long-term care expenses.
Q: Doesn’t Medicare provide coverage for long-term care?
Medicare does not provide coverage for long-term care, such as nursing home care. Medicare will pay for up to 100 days of skilled nursing care per illness. A patient must be hospitalized for at least three days for the illness, and the patient must receive a high level of care in a nursing home that could not be provided at home or on an outpatient basis. After 20 days of nursing home care, there is a large copayment required of the patient for the remainder of the stay.
Medicare will also pay for home health benefits if you are housebound and if a doctor has ordered home health services for you, at least some of which are skilled. Medicare will pay for up to 35 hours of services per week, and patients only have to pay for 20 percent of the cost of medical supplies and equipment.
Q: What is long-term care insurance and is it really necessary?
Long-term care insurance covers the risk that you may at some point in your life need to live in a nursing home by covering some or all the expenses associated with nursing home care. It also frequently covers assisted living care or care in your home. Long-term care insurance can be a very valuable tool that can help you avoid depleting your estate in order to pay for nursing home care. Nursing homes vary greatly in cost depending on the quality of the home and the geographic area of the country in which the home is located. The S.F. Bay Area has some of the most expensive nursing homes in California. At a minimum, you can expect to pay several thousand dollars a month for decent nursing home care, which can rapidly deplete an individual’s savings.
Q: Is Medi-Cal Planning legal?
Medicaid/Medi-Cal planning is legal. Elder law attorneys work to protect clients’ assets within the bounds of the law. Congress allows citizens to qualify for Medicaid after meeting certain requirements, and those requirements could be changed if Congress felt they were being abused. Medi-Cal planning is not any more illegal than planning to avoid taxes.
Q: Should I wait until I need Medi-Cal benefits before I see an elder law attorney?
If you anticipate needing Medi-Cal at any point in the foreseeable future, it’s prudent to seek the advice of a qualified elder law attorney. There are steps you can take to protect your assets which may not be available when you actually need Medi-Cal. Some of those steps may include transferring your assets or establishing trusts. An elder law attorney with expertise in Medi-Cal planning can evaluate your situation and advise you on the most prudent steps to take in order to preserve your rights and maximize benefits.
Q: How long will it take to become eligible for Medi-Cal?
There is no simple answer as to how long it might take an individual to qualify for Medi-Cal. There are many variables in every situation that must be taken into consideration and ultimately affect the eligibility timeline, including whether your application is complete, the amount of your assets, your income and expenses, any asset transfers you’ve made to individuals or trusts, and more. Before applying for Medi-Cal, you should consult an elder law attorney in your area. The attorney can help you understand both eligibility and the application process, and should be able to give you an estimate of the time frame you can expect.
Q: Can my children take money out of our joint account without affecting my eligibility?
If a child removes money from your joint account, that could be considered a transfer to him or her. Currently, Medi-Cal has a “look-back” period on transfers of assets of 30 months (and 60 months for transfers to some trusts). The look-back period for all transfers will be increasing to 60 months (5 years) as California adopts the newer DRA regulations already adopted by most other states.
The Medi-Cal look-back period means that any gifts or other transfers of assets you made in the 30 months (or 60 months for transfers to some trusts) before you applied for Medi-Cal will be assessed in order to determine your eligibility. If you did make asset transfers in the “look-back” period before applying for Medi-Cal, you could be subjected to a penalty period. Therefore, if you made a transfer of assets in the past five years, you should not apply for Medi-Cal without consulting an elder law attorney because the penalties could be severe.
Q: What are some criteria to look for when selecting a nursing home?
There are a variety of criteria to consider when selecting a nursing home.
First, how is the nursing home ranked by accreditation agencies or state regulators? Have there been violations or complaints against the nursing home? How does the nursing home rank when compared with other homes in the area?
Another important factor to consider is location. Is the nursing home located in an area that is convenient for family and friends to visit? Would family members be more likely to visit a nursing home located in another area?
Before choosing a nursing home, take a tour and ask for references of family members of current residents. If possible, take the tour at an unscheduled time, so that you know that what you are seeing isn’t staged for your benefit. During the tour, look carefully at the interactions between staff and patients. Does the staff seem caring and concerned? Do the residents seem content? What is the quality of the food served?
Choosing a nursing home can seem overwhelming at first, but often after visiting a few and evaluating their quality of care, the decision becomes easier.
The Law Office of Gretchen J. Kenney assists clients with Elder Law, including Long-Term Care Planning for Medi-Cal and Veterans’ Pension (Aid & Attendance) Benefits, Estate Planning, Probate, Trust Administration, and Conservatorships in the San Francisco Bay Area.