Medicaid & Medi-Cal for Long-Term Care in California
Our law firm provides comprehensive, personalized, and tailored legal services to meet all of our client’s estate planning needs. Our firm utilizes a variety of tools to help families preserve their assets for generations to come. Specifically, we work with our clients to minimize estate taxes and ultimately avoid the lengthy and expensive probate process by utilizing Wills (simple & complex), Powers of Attorney, Living Trusts, Living Wills, Family Limited Partnerships, Irrevocable Trusts, and Charitable Gifting Strategies.
When it comes to Medicaid & Medi-Cal Services & Elder Law, our goal is to protect our clients’ nest eggs. We ensure that our clients qualify for Medicaid services and other government medical benefits so that their estates are protected from expensive nursing home and hospital bills. If you become disabled and unable to work, we will help you determine if you qualify for SSD coverage. As a Social Security disability lawyer, James Dolenga will also inform you about the monthly disability benefits and health coverage for a deceased, disabled or retired worker’s disabled dependents.
Understanding California Medicaid
Medi-Cal is California’s Medicaid program that provides medical services to low-income people at little or no cost. It is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS).
Who is Eligible for Medi-Cal?
Many people are wrongfully told (or assume) that they must be financially destitute to qualify for Medi-Cal / Medicaid for long-term care.
Clearly, individuals can’t just give away, transfer, or quitclaim away property as this will trigger severe penalties.
The Medi-Cal / Medicaid law has many exceptions and loopholes which can allow families to preserve most of their accumulated assets and wealth.
For institutional / nursing home / skilled nursing care, there is no income limit.
Medi-Cal will however require that excess income be applied to care as a Share of Cost.
Depending on the level of care needed, the applicant may still end up using their entire monthly income and still need to spend down from other assets.
Asset limits (real estate other than a primary residence, bank accounts, investment accounts, certain retirement accounts, etc.) are listed as $2,000 for a single applicant and $3,000 for married applicants when both are applying.
For married applicants when only one spouse is applying, the non-applicant spouse is allowed to retain up to $137,400 (called the Community Spouse Resource Allowance) plus the $2,000 allowance for the institutional/applicant spouse.
For assistance under the “waivers” programs, which covers caregivers, in-home supportive services, and assisted living, the income limits are $1,564/mos for the applicant and $2,106 for a couple when both are applying. The asset limits remain the same.
Applicants are told that they must “spend down” their assets until they get below these asset limits.
Again, the Medi-Cal / Medicaid rules have very explicit carve-outs and exceptions that can allow an applicant or their family to protect hundreds of thousands or even millions of dollars with proper planning.
That’s where we come in.
We will work with you to legally protect those assets and to shepherd the Medi-Cal / Medicaid application through the government bureaucracy from application to approval.
Once qualified, we can work with you to further protect those assets from Medi-Cal / Medicaid recovery after death.
James Dolenga will create a well-written, customized estate plan, so you can ensure that your wishes are carried out and your goals are achieved while protecting your family and legacy. Get help today.
Providing exceptional Estate Planning, SSI, SSDI, and Medicaid & Medi-Cal Planning for seniors and families in Torrance, Los Angeles, Orange County, Anaheim, Huntington Beach, Long Beach, Riverside, Moreno Valley, Simi Valley, Ontario, San Bernardino and more.
Should You Hire an Elder Law Attorney to Assist with a Medi-Cal Application?
Elder law attorneys like James Dolenga work to help seniors with long-term care planning, estate planning and government benefits. He has experience in both the federal and unique California rules and regulations, and helps families by identifying strategies to legally obtain and maintain eligibility for public benefits.
Medi-Cal is a complicated benefit for residents of California. It’s important to seek the advice of a seasoned professional who understands the rules, process and provisions under these laws. Without professional guidance, families risk losing the assets and inheritance they worked so hard to create.
California Medicaid Penalties- What You Should Know
California has a Medicaid Look-Back Period, which immediately precedes one’s Medicaid application date. While most states utilize a 60-month “look back”, CA is much more lenient with a 30-month “look back”. As part of the application review, Medicaid checks to ensure no assets were sold or given away under fair market value during this period. Violating this rule results in a penalty period of Medicaid ineligibility.
The majority of families considering Medicaid, have too much income or too many assets or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning attorney, families can employ a variety of strategies to help them become Medicaid eligible and protect their home from Medicaid’s estate recovery programs.
What is HCBS Waiver in California?
Home and Community-Based Services (HCBS) Waivers allow states that participate in Medi-Cal in California, to develop creative alternatives (like in-home care) for individuals who would otherwise require care in a nursing facility or hospital. Medi-Cal has an agreement with the Federal Government, which allows for waiver services to be offered in either a home or community setting. The services offered under the waiver must cost no more than the alternative institutional level of care. Recipients of HCBS Waivers must have full-scope Medi-Cal eligibility.
What is a HCBS program?
Home- and Community-Based Services (HCBS) are types of person-centered care delivered in the home and community. A variety of health and human services can be provided. HCBS programs address the needs of people with functional limitations who need assistance with everyday activities, like getting dressed or bathing.
What is IHSS in California?
IHSS is the California Medicaid (Medi-Cal) In-Home Supportive Services (IHSS) Program.
The In-Home Supportive Services (IHSS) Program is a statewide Medi-Cal program that provides long-term services and supports for aged, blind or disabled California residents who are at risk of nursing home placement. Available benefits include personal care assistance and homemaker services to assist these individuals in living safely and independently in their home or the home of a loved one. Program participants have the option to self-direct their care, which allows them to choose and hire their own caregivers, including friends and relatives.
Within IHSS, there are 4 programs, the first two of which serve the majority of IHSS program beneficiaries.
– Community First Choice Option (CFCO) – for Medi-Cal eligible persons who require a nursing home level of care.
– Personal Care Services Program (PCSP) – for Medi-Cal eligible aged, blind or disabled individuals who require personal care assistance, but do not require the level of care that is provided in a nursing home.
– IHSS Plus Option Program (IPO) – provides payment to spouses or parents of Medi-Cal eligible persons who do not need a nursing home level of care, but require care assistance, and receive it from a spouse or parent. Prior to becoming a Medi-Cal state plan option, this program was previously called the IHSS Plus Waiver.
– IHSS Residual Program (IHSS-R) – provides a pathway of eligibility for persons who are not eligible for Medi-Cal, but require IHSS care services.
What is a 1915C Waiver?
Within broad Federal guidelines, States can develop home and community-based services waivers (HCBS Waivers) to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. In 2009, nearly one million individuals were receiving services under HCBS waivers.
Nearly all states and DC offer services through HCBS Waivers. States can operate as many HCBS Waivers as they want — currently, more than 300 HCBS Waiver programs are active nationwide.
How Do I Get an Assisted Living Waiver in California?
The Assisted Living Waiver (ALW), also called a Dementia Waiver, is a Home and Community-Based Services (HCBS) waiver that was created by legislation that directed the California Department of Health Care Services (DHCS) to develop and implement the project to test the efficacy of assisted living as a Medi-Cal benefit.
To be eligible to receive services as an ALW Participant, an individual must meet all of the following ALW eligibility criteria:
- Age 21 or older;
- Have full-scope Medi-Cal eligibility with zero share of cost;
- Have care needs equal to those of Medi-Cal-funded residents living and receiving care in Nursing Facilities;
- Willing to live in an assisted living setting as an alternative to a Nursing Facility;
- Able to reside safely in an assisted living facility or public subsidized housing;
- Willing to live in an assisted living setting located in one of the following counties providing ALW services: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.
Research shows that having a professional representative can boost your chances of getting Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Make sure you’re represented.
Are you ready for exceptional help with Estate Planning, SSI, SSDI, and Medicaid & Medi-Cal Planning for seniors and families in Torrance, Los Angeles, Orange County, Anaheim, Huntington Beach, Long Beach, Riverside, Moreno Valley, Simi Valley, Ontario, San Bernardino and surrounding areas? Then let’s Get Started!