Asset protection from MediCal recovery

Long term care is costly. Be proactive, include a life insurance agent and estate planner/lawyer in your retirement planning.

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Ruth and John, a married couple, spent their lives, their working lives, building up their nest egg for retirement. They enjoyed the fruits of their labor and they both retired for about 10 years. Then John was diagnosed with Dementia. Ruth cared for him for as long as she possibly could, about seven years, but eventually, John needed to be placed in a care home because she could no longer care for him. She found a skilled nursing facility that cared for late-stage Dementia patients, and they charged a whopping $12,000 a month. Within two years, their savings was wiped out, and Ruth applied for long-term care benefits through Medi-Cal. She was able to keep their house, as it is exempt from calculations and qualifying for Medi-Cal. And because she had spent all the savings paying for his care prior, they met all the requirements to qualify for Medi-Cal, and John’s health care or skilled nursing facility costs were paid for by Medi-Cal for another 18 months until he passed away.

After John’s death, Ruth lived another five years, and at her death, all their assets were to go to their two children. However, the only asset left in their estate was their house, ’cause it was exempt at the time John applied for Medi-Cal. Well, after Ruth died, the children received a notice from Medi-Cal demanding to recover the $216,000 they had spent on his care during those 18 months.

You’re thinking to yourself, “Can they do that?” Yes, they can. It’s called Medi-Cal Recovery. And as a result, the children received pretty much nothing, because Medi-Cal places a lien on the house, the house is sold, and their recovery debts are paid through that money. And it’s only after those debts are paid do the children inherit.

Could Ruth and John have prevented this? Yes. They could’ve prevented the depletion of their savings for his care initially, and they could have protected their home from any recovery that Medi-Cal would seek after they both passed away. But she didn’t seek out that advice or that help, and often people don’t know that it’s out there. If she had contacted a qualified attorney who handles Medi-Cal benefit planning, she could have at least saved the home from recovery.

Medi-Cal Planning from Start to Finish


Kirsten Howe

Kirsten Howe

Attorney at Absolute Trust Counsel
67 articles 

In this series of posts we will focus on Medi-Cal for our over-65 clients who need assistance with long-term care. We will take you through the laws and what we do for our clients, from the initial meeting until we receive that eligibility letter, to help them qualify, apply for and receive Medi-Cal, for long-term care.

The Initial Appointment – Gathering Information

Every client’s case is different, of course, but our over-65 clients come to discuss Medi-Cal planning with us for a few common reasons. In our initial meeting we must uncover what exactly their situation is so that we can recommend solutions. One common scenario is our client has recently discovered he has a degenerative illness, such as Alzheimer’sdisease, and he and his wife are worried about their future, worried about spending all their savings at the rate of $10,000 or more per month for the husband’s long-term care. The client may be unmarried with a similar diagnosis and not wanting to burden her children if she runs out of money paying long-term care expenses.

A third scenario involves a client already in a nursing home, already paying unbelievable amounts of money for care every month, and the spouse or other family members are in a panic. Each of these cases presents us with a different set of possible solutions to explore and we must ask lots of questions, including:

What Kind of Care is Needed?

Medi-Cal provides a wide variety of services that fall under the umbrella of long-term care. For those who would otherwise require nursing-home level care but prefer to and are able to remain in their homes with the available support, Medi-Cal has a number of Home and Community Based Services (HCBS). Which programs are available varies by county. Some programs directly provide support through agencies that contract with the county. Some programs allow the Medi-Cal recipient to hire caregivers they select themselves, which could be friends or family members. For some of our clients, remaining in their home is just not possible. Medi-Cal also provides support to those in need of nursing-home level care in nursing homes.

What Planning Do We Have or Can We Do?

One very important preliminary step is to make sure we have the legal ability to do planning, now and in the future. As long as our client has the mental capacity to do the necessary planning, everything is fine. However, if our client no longer has the mental capacity necessary to understand the work we do and to participate in the planning, we check documents- trusts and power of attorney- to see if someone else has been granted the power to do planning.

Medi-Cal planning often requires our clients to give away their property. This power to give away property is often not included in trusts and powers of attorney. Two very common misconceptions: husbands and wives can do just about anything with each other’s property, especially in a community property state like California; and all powers of attorney are the same. The law, however, is that without your written authorization nobody, not even your spouse, can legally give your property away to anyone, including themselves. To do so without proper authority could be considered theft and elder financial abuse and it would not be recognized as a completed gift for Medi-Cal eligibility purposes.

What we need to see is a written power of attorney that authorizes someone else to give away our client’s property in order to qualify for Medi-Cal. This is not a power that is granted in most powers of attorney. If the client has a trust, then his trust must also authorize his trustee to give away his property, which, again, is not a common trust provision. If our client has not given these powers to anyone and still has the capacity to do so, creating an appropriate power of attorney and trust language is usually one of the most urgent items for us to do. If our client does not have capacity some planning options will not be available.

Most clients who are considering applying for Medi-Cal are also interested in avoiding Estate Recovery. As we will discuss in more detail in a later post, payments made by Medi-Cal on behalf of the recipient can be recovered from his probate estate upon his death. The need to create an estate plan that avoids probate is obvious here. When our client has capacity or another person has legal authority through a power of attorney, we will want to create a revocable living trust and make sure it owns all appropriate assets.

In our next post we continue to explore the preliminary questions we cover in our first meeting with our clients.

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Medical and Medicare-Paid Pharma and Cancer genetic tests

For Medical and Medicare Paid Pharma and Cancer genetic tests in the USA , contact Connie at or text 408-854-1883

Medicare coverage of genetic services. Under Medicare’s guidelines, BRCA1 and BRCA2 genetic testing is covered for people with: A personal history of breast cancer, with one or more of the following: … a close relative with a known BRCA1 or BRCA2 gene mutation.

Medicare coverage of genetic services

Under Medicare’s guidelines, BRCA1 and BRCA2 genetic testing is covered for people with:

  1. A personal history of breast cancer, with one or more of the following:
    • diagnosed at or before age 45, with or without family history
    • diagnosed at or before age 50 or two breast primaries, with 1 or more close blood relative(s) with breast cancer diagnosed at or before age 50 or 1 or more close blood relative(s) with ovarian cancer/fallopian tube/primary peritoneal cancer
    • two breast primaries when first breast cancer diagnosis occurred prior to age 50
    • diagnosed at any age, with 2 or more close blood relatives with breast and/or epithelial ovarian/fallopian tube/primary peritoneal cancer, at any age
    • close male blood relative with breast cancer
    • personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer
    • of a certain ethnicity associated with higher mutation frequency, (eg, founder populations of Ashkenazi Jewish, Icelandic, Swedish, Hungarian or other) no additional family history required
    • a close relative with a known BRCA1 or BRCA2 gene mutation
  2. Personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer.
  3. Personal history of male breast cancer.

Medicare operates on a regional system in which Medicare Area Contractors (MACs) manage the provision of health services for a specific jurisdiction. In the spring of 2015, four MACs expanded their coverage to better align their services with National Comprehensive Cancer Network (NCCN) guidelines in a number of important areas, including:

  • Expanding coverage of genetic testing for individuals who have or had cancer consistent with hereditary cancer syndromes, including men diagnosed with prostate cancer and men and women diagnosed with pancreatic cancer,
  • Coverage of multigene testing panels if more than one mutation may be indicated, and
  • Clarification of the BRCA testing policy for use of the targeted therapyLynparza (olaparib).

It is important to note that these policy changes apply only to states covered by the four MACs:
Arkansas, Arizona, California, Hawaii, Idaho, Kentucky, Montana, Nevada, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Utah, Virginia, Washington, West Virginia and Wyoming

Medicare does not currently cover the cost of genetic testing in individuals who do not have a personal history of cancer.

Are you a US doctor with more than 10 Medicare patients?

ACO 1Calling all US doctors with at least 10 Medicare patients to join us as ACO participant.

Please join Wellness ACO LLC, a start up ACO health care provider, an organization serving Medicare patients that is seeking doctors with profit sharing.  Must have at least 10 Medicare patients. The government requires 5000 Medicare patients before they give a license.

Let us help the government cut health care costs as a team provider.


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An accountable care organization (ACO) is a healthcare organization that ties payments to quality metrics and the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. The ACO adopts alternative payment models (e.g., capitation). The ACO is accountable to patients and third-party payers for the quality, appropriateness and efficiency of its services. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is “an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it”

Hiring all laid off Pharma representative

We are hiring all laid off pharma representative to help your network of doctors use a non-invasive serum equivalent tester similar to pulse oximeter and invented by NIH.

scananti oxidant scan

We do not sell it but we expand our network by bringing in doctors, nurses and health consumers to use this tester to measure the level of anti-oxidants in our serum. Our team lead, Dr Kent Nelson and I are available for training.  There is a 2-day training in Utah scheduled on Sept 14-15.

We help doctors increase their income stream and increase better patient health outcome.

Practitioners do not have to use the supplements that is manufactured by the maker of the tester, a bio-photonic scanner.

Email for your cell to chat and answer your questions with Kent Nelson. Or you may call/text Ken at 650-861-2070.

Connie Dello Buono 408-854-1883

Distributor ID: USW9578356

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