Medi-Cal Planning

The goal is to protect the family's assets. 
Don't get caught unaware...

Transferring Assets Prior to Medi-Cal Qualifications

Under the old law, any transfer of resources made by a Medi-Cal applicant or his spouse during the 30-month period preceding application for Medi-Cal, to the extent it was a gift, resulted in a period of ineligibility from Medi-Cal equaling 30 months. This was called the "lookback period". Therefore, you could literally give away 1 million dollars under the old law and apply for Medi-Cal in the 31st month after you gave it away. This is no longer the case.

Under the new law, the "lookback period" is potentially unlimited. It is equal to the value of the assets gifted divided by the average cost of a nursing home in the state of California per month, which is approximately between $4,419 per month, depending upon the year of calculation. Therefore, if you give away $100,000, this will result in a period of disqualification from Medi-Cal of approximately 22 months.

After you meet income and resource requirements, and if a doctor or health care provider certifies that your stay is "medically necessary", your room, board, and medical bills will be paid for by the State of California.

Liens against the Homestead

A lien can be imposed on the home of an institutionalized individual if it is determined that the nursing home resident cannot reasonably be expected to return home. Federal law allows these liens to be imposed and there is a rebuttable presumption that the institutionalized spouse cannot reasonably be expected to return home if any of the following conditions are met:

• The beneficiary has been institutionalized for six months or longer with no discharge plan in place

• The nursing home resident has received 30-days written notice and an opportunity to be heard on the lien issue

• The nursing home resident has not stated that he or she “intends to return home” in a legally enforceable document

A lien cannot be imposed if:

• A minor, blind, or disabled child is living in the home. Under the recent case of DeMille v. Belshe, a lien can be imposed when there is a spouse still living in the home, if there has been a hearing on the lien issue, and notice has been given.

• The nursing home resident’s sibling, who has an equity interest in the home, has resided there at least one year before the individual’s admission to a nursing home.

• Any individual, other than the spouse, is living in the home at leas two years before the resident was admitted to the nursing home and who provided care that enabled the resident to remain at home.
  

Liens and Estate Recovery Claims

Changes to the 7/1/00 Law

The law, which went into effect on 7–1–00, is called “Health Care Decisions” and expanded
the law in several areas that include the following:

• The power of the agent to withdraw or withhold artificial nutrition or hydration, as well as all other forms of health care decisions, such as the right to halt cardio-pulmonary resuscitation and to provide a standing order for the doctor “to not resuscitate.”
• The law also provides individuals the right to grant your agent if you so desire the authority to determine your residence, provide your meals, hire household employees, and arrange entertainment
• “Informed consent” has been deleted and replaced by the phrase ”capacity to consent.”  If a patient refuses to consent to the medical treatment, the court cannot force him or her to so consent to the treatment as long as he or she is deemed to be mentally competent.
• All durable powers of attorney executed prior to 7–1–00 are still VALID.
• Advance, directive decisions can be made by any person with mental capacity and these decisions can be made orally or in writing. However, if you are in a nursing home, one of the witnesses must be an ombudsman.
• The Secretary of State is directed to establish a registry for all health care directives to be centrally filed and located with the ability to make all such information available to health care providers.
  
  

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