If you or your spouse is in or is entering a nursing facility, read this
You or your spouse do not have to use all your resources, such as
savings, before Medi-Cal might help pay for all or some of the costs
of a nursing facility.
You should be aware of the following to take advantage of these
provisions of the law:
An unmarried resident is financially eligible for Medi-Cal benefits if
he or she has less than $2,000 in available resources. A home is
an exempt resource and is not considered against the resource
limit, as long as the resident states on the Medi-Cal application that
he or she intends to return home. Clothes, household furnishings,
irrevocable burial plans, burial plots, and an automobile are
examples of other exempt resources.
If an unmarried resident is financially eligible for Medi-Cal
reimbursement, he or she is allowed to keep from his or her
monthly income a personal allowance of $35 plus the amount of
health insurance premiums paid monthly. The remainder of the
monthly income is paid to the nursing facility as a monthly
deductible called the “Medi-Cal share-of-cost.”
If one spouse lives in a nursing facility, and the other spouse does
not live in a nursing facility, the Medi-Cal program will pay some or
all of the nursing facility costs as long as the couple together does
not have more than $113,640 in available assets. The couple’s
home will not be counted against this $113,640 as long as one
spouse or a dependent relative, or both, lives in the home, or the
spouse in the nursing facility states on the Medi-Cal application that
he or she intends to return to the couple’s home to live.
If a spouse is eligible for Medi-Cal payment of nursing facility costs,
the spouse living at home is allowed to keep a monthly income of
at least his or her individual monthly income or $2,841, whichever
is greater. Of the couple’s remaining monthly income, the spouse
in the nursing facility is allowed to keep a personal allowance of $35
plus the amount of health insurance premiums paid monthly. The
remaining money, if any, generally must be paid to the nursing
facility as the Medi-Cal share-of-cost. The Medi-Cal program will
pay remaining nursing facility costs.
Under certain circumstances, an at-home spouse can obtain an
order from an administrative law judge that will allow the at-home
spouse to retain additional resources or income. Such an order
can allow the couple to retain more than $113,640 in available
resources if the income that could be generated by the retained
resources would not cause the total monthly income available
to the at-home spouse to exceed $2,841. Such an order
also can allow the at-home spouse to retain more than $2,841
in monthly income, if the extra income is necessary “due to
exceptional circumstances resulting in significant financial duress.”
An at-home spouse also may obtain a court order to increase the
amount of income and resources that he or she is allowed to retain,
or to transfer property from the spouse in the nursing facility to the
at-home spouse. You should contact a knowledgeable attorney for
further information regarding court orders.
The paragraphs above do not apply if both spouses live in a nursing
facility and neither previously has been granted Medi-Cal eligibility.
In this situation, the spouses may be able to hasten Medi-Cal
eligibility by entering into an agreement that divides their
community property. The advice of a knowledgeable attorney
should be obtained prior to the signing of this type of agreement.
Note: For married couples, the resource limit ($113,640 in 2012)
and income limit ($2,841 in 2012) generally increase a slight..
MORE ..read DHCS 7077
Call Connie Dello Buono CA Life Lic 0G60621 408-854-1883 email@example.com to help you navigate this regulation, part of Long Term Group, RDC , that helps solve long term care fears.