January 2008 Update on Medi-Cal
The California Department of Health Services has drafted legislation and regulations to implement the federal Medicaid provisions included in the Deficit Reduction Act of 2005. These provisions include drastic changes to the eligibility requirements for applicants and recipients of Medicaid/Medi-Cal who are receiving nursing home or home and community based care.
However, given the slow progress through the California regulatory system, it appears that the changes brought about by the DRA of 2005 will probably not be fully enforced in California at least until late 2008. Fortunately, it appears that there will be no retroactive implementation of these changes when they are fully implemented. No one should, however, wait out the Legislature. People with concerns about what will happen to their assets or their houses if they require nursing home care should contact an elder law attorney with Medi-Cal knowledge in 2008. The cost of a consultation will more than be made up for by the savings available from acting on current, reliable information and current law.
Medi-Cal Resources Allowances 2008
For Someone in a Skilled Nursing Facility (SNF)
Community Spouse Resource Allowance (CSRA)-$104,400 (up from $101,640 in 2007).
The amount of liquid assets (savings, CDs) which the at-home spouse may have in his/her separate name for purposes of the spouse's Medi-Cal eligibility.
Minimum Monthly Maintenance Needs Allowance (MMMNA) $2,601 (up from $2,541 in 2007).
The minimum amount of income the at-home spouse must have; if s/he earns less, the Medi- Cal spouse's monthly income (which would otherwise go as Share of Cost directly to the SNF, thus saving Medi-Cal payment) may be ordered transferred to her/him to make up the difference (Was $2,489 in 2006).
Average Private Pay Rate (APPR)-$5,101. (New amount will be available in February 2008)
This is the average monthly nursing home care cost that Medi-Cal uses as the divestment penalty divisor to determine the number of months of ineligibility that a "gift" or divestment of money within the past FIVE YEARS. This is NEW. (The figure for 2006 was $5,031.00).
Monthly Personal Needs Allowance - $35.00
The amount of money a Medi-Cal recipient may keep from his/her monthly income before the rest is deducted as Medi-Cal Share of Cost. Has not changed in years!
Resource Allowance for an Individual - $2,000.00
The maximum amount of money (not including "exempt" assets) which a Medi-Cal recipient in a SNF may have in his/her name. Has not changed. Allowance is $3,000 for a couple in a Nursing Home.
Summary of California Regulations as of January 1, 2008
In order to be eligible for Medi-Cal in a Skilled Nursing Facility (SNF), an applicant's resources, excluding 'exempt 'assets, must be below $2,000.00 for at least one day of the month in which s/he, (the "elder" over 55 years in age) applies for Medi-Cal. In order to make this determination, an accounting must be done of both your exempt and non-exempt assets.
"Exempt Assets"
"Non-exempt Assets" - no changes expected
Cash |
Bonds |
What Should You Do With "Non-exempt" Assets?
- Spend Down (Before Medi-Cal Application is filed: on necessities; ordinary expenses like paying up medical/legal bills; paying off a mortgage on a primary residence; burial funds; prepaying health insurance premiums; prepaying board and care.
- Convert (To Exempt) Use liquid assets to purchase an exempt asset, like a car.
- Transfer (Out of Recipient's Estate) There is a penalty for transfer or "giving away" without consideration. 30 months (in California)/36 months (at Federal level) "look back" period and ineligibility.
NOTE: For Federal purposes, the "look back" period is now increased to FIVE YEARS
For a more thorough grounding in Medi-Cal and faster updates, go to www.canhr.org, California Advocates for Nursing Home Reform.