What is the difference between Medicare and Medi-Cal?

Medicare is a federal program for older and disabled persons. It may pay for up to 100 days for the cost of nursing home care, but only in limited circumstances. It will not pay the ongoing costs of such care.

Medi-Cal does not provide health care services by disbursing money to the eligible persons who, in turn, purchase health care. Rather, these individuals obtain medical services from participating hospitals, physicians, pharmacies, and long term care facilities. The providers are reimbursed by Medi-Cal.

Medi-Cal is California’s name for the federal Medicaid program. It is available to qualifying persons who are aged (65 or older), blind, or disabled. Medi-Cal is the only government program that pays the ongoing cost of nursing home care for persons who qualify for its benefits in terms of income and assets.

Who Qualifies for Medi-Cal?

An individual who is aged, blind or disabled will be eligible for Medi-Cal in a skilled nursing facility or intermediate care facility only if she meets the resource and income limitations.

When evaluating an applicant’s resources to see if the resources available to the applicant are within the specified property reserve limits, Medi-Cal will count all available resources except certain resources which are termed exempt assets, which are not included in the eligibility calculation.

The most important exempt assets include the principal residence and a car. Other exempt assets are irrevocable burial trusts or prepaid burial contracts, life insurance with cash values of $1,500 or less, household items, personal effects, burial plots, crypts or vaults, musical instruments, and property used in trade or business.

Non-exempt assets can be retained up to the Community Spouse Resource Allowance, which is $120,900, if one spouse is in a nursing home. In addition, the at home spouse (or well spouse) may receive unlimited income. However, the name on the check must be in the well spouse’s name only. The first $3,023 of income received by the spouse in the nursing home (i.e. name on check is her name) may be kept by the well spouse. The balance of her monthly income must be used toward her share of the nursing home cost. This share of cost can be reduced by amounts incurred by the ill spouse for medical care not covered by Medi-Cal and for health insurance. Thus, the well spouse may keep (1) exempt assets; (2) income payable to the well spouse; (3) up to $3,023 of income payable to the ill spouse; and (3) $120,900, and still may qualify the ill spouse for Medi-Cal.

Liens and Estate Claims

The law requires that California seek recovery from the estates of certain individuals who received Medi-Cal benefits. However, Medi-Cal will not take your home or place a lien on your house. No one is kicked out of their house. In fact, Governor Wilson eliminated liens in 1995. Further, no claim may exist if the deceased is survived by a spouse, a minor, a blind or permanently and totally disabled child. Federal law states that no claims may be made against the estate of the well spouse. However, California law claims it may assert a claim against the surviving spouse’s estate or against those who received property from the surviving spouse by distribution or survival.

Claims may not be pursued where enforcement of the claim would result in substantial hardship to other dependents, heirs, or survivors of the individual against whose estate the claim exists.

I have substantial assets. Can I still qualify for Medi-Cal?

Yes. The Law Office of David A. Esquibias specializes in advising clients how to legally arrange and value assets to assist you in qualifying for Medi-Cal and avoiding Medi-Cal reimbursement, at an affordable cost. The value of these services may save tens of thousands and sometimes hundreds of thousands of dollars. If you anticipate a need for Medi-Cal benefits or are concerned about eligibility or reimbursement by Medi-Cal, please contact us at 805-267-1141, or send an immediate e-mail inquiry to one of our qualified lawyers.