January 2010 Medi-Cal
DRA Update: No changes in California until regulations are filed.
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 until all of the non-emergency regulations are filed. 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 immediately. 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 2010
For Someone in a Skilled Nursing Facility (SNF)
Community Spouse Resource Allowance (CSRA)-$109,560
Same as 2009
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)
$2,739. Same as 2009
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.
Average Private Pay Rate (APPR)-$5,698 (2009)
New
APPR is announced in February or March
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.
Let's Do the Math: Figures based on 2009 APPR
Mrs. White, a California resident, had $32,000 of countable assets on March 1, 2008. She gave $30,000 in cash to her nephew on March 15, 2008; she has made no other transfers since then. One year later (let’s use April 15, 2009), Mrs. White had a stroke and needed nursing home care. At the time she had only the $2,000 in countable assets. She applied for Medi-Cal. As she was required to disclose in her application, Mrs. White listed the $30,000 gift. Because of the gift, Mrs. White was deemed ineligible for Medi-Cal for five months ($30,000 divided by $5,496 equals 5.45, rounded down by Medi-Cal to 5.0). Her ineligibility period began with the month in which she made the gift (March 15, 2008) and lasted for five months. She was eligible for Medi-Cal in July 2008).
If she gave $30,000 away on January 1, 2009, and had a medical emergency requiring nursing home care in February 2009, the period of ineligibility will be determined as follows: $30,000 divided by the 2009 APPR of $5,698 = 5.26 months rounded down to 5 months. She would be eligible by July 1, 2009.
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. 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
Summary of California Regulations as of January 1, 2010
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) 60 months (at Federal level) "look back" period and ineligibility.
For faster updates, go to www.canhr.org, California Advocates for Nursing Home Reform.