A Summary of Medi-Cal for Long Term Care

As Elder Law attorneys, we often help people qualify for Medi-Cal for Long Term Care benefits, available to eligible people who reside in skilled nursing facilities. Unfortunately, the requirements for Medi-Cal eligibility can be very confusing, technical and at times appear even nonsensical.

If a person receives Supplemental Security Income (“SSI”), he or she automatically qualifies for Medi-Cal, but can only receive Medi-Cal for Long Term Care if he or she also resides in a skilled nursing facility.

Otherwise, an unmarried person can have no more than $2,000.00 in non-exempt assets to qualify for Medi-Cal for Long Term Care. The list of exempt assets that do not count towards this $2,000.00 is short and includes the person’s residence, one car, musical instruments, and certain other assets. If an unmarried person has more than $2,000.00 in non-exempt assets, then he or she must reduce his or her assets, which can be done in various ways. We recommend that you speak to us about the various methods of reducing your assets to become eligible for Medi-Cal for Long Term Care before doing anything. The State of California looks at transfers made by the applicant prior to filing an application, and it is important to speak with us about how these transfers may impact Medi-Cal eligibility.

The Medi-Cal rules for married couples are even more complex than the rules for unmarried persons. However, the rules permit the couple to retain assets equaling a much higher value (rather than $2,000) and still have the incapacitated spouse qualify.

Once an unmarried person receives Medi-Cal for Long Term Care, he or she must pay a portion of his or her income towards monthly medical costs, called a “Share of Cost.”

Medi-Cal for Long Term Care is, for all intents and purposes, a loan that must be repaid after the recipient’s death. Therefore, after a Medi-Cal for Long Term Care recipient dies, the State of California can bring a claim against that person’s estate to recover the amount of Medi-Cal benefits paid to or for that person during his or her lifetime. Careful advance planning can often prevent this from happening.

Not everyone needs or will need Medi-Cal for Long Term Care, but it is beneficial to speak to an attorney if you think you or a member of your family might require this now or in the future. Having correct information is the first step to avoiding a crisis later.

[Disclaimer: The materials contained on this website have been authored or gathered by the Law Offices of Stuart D. Zimring, and are intended for informational purposes only. It is not intended to be and is not considered to be legal advice. Transmission is not intended to create and receipt does not establish an attorney-client relationship.]