Medi-Cal is California’s Medicaid program that provides health insurance coverage for low income individuals and families. You may go your entire life without ever needing Medi-Cal benefits – until you suddenly need them to cover the high cost of long-term care as a senior. If you failed to plan ahead for that possibility, you may be denied benefits. More accurately, you may be required to suffer through a waiting period before Medi-Cal benefits will kick in and start covering your expenses. During the waiting period you will be expected to use your own assets to pay for your long-term care expenses. Understandably, you may not like the idea of watching your nest egg disappear. If you find yourself in this position – of if you want to avoid finding yourself in this position — a Medi-Cal attorney may be able to help.
Why Would You Need Medi-Cal as a Senior?
At age 65, we all stand about a 50-50 chance of eventually needing to spend time in a long-term care facility. Every year after that your odds increase. If you are fortunate enough to still be here at age 85, your odds of needing long-term care before you die increase to 75-25. The cost of that care is not cheap. Nationwide, the average cost of a year in long-term care runs about $80,000; however, in the State of California you can expect to pay, on average, about $100,000 a year. Don’t expect your private health insurance plan to cover long-term care expenses because most will not unless you purchased a separate long-term care rider at an additional cost. Medicare won’t help either as Medicare only covers long-term care costs under limited circumstances, and even then only for up to 100 days. With nowhere else to turn, about half of all seniors end up relying on Medi-Cal to help with the high cost of care in a long-term care facility.
The Problem Qualifying for Medi-Cal
While Medi-Cal may, indeed, be the solution to your long-term care cost problems, you must first qualify for benefits. Because Medi-Cal is intended to help low income recipients, applicants must have income below the program income limit as well as not have assets valued above the program asset limit. For many seniors on a fixed income, the income test is not a problem; however, after a lifetime of working, saving, and investing it is not hard to imagine why many seniors fail the asset test – particularly when you consider the fact that the asset limit is just $2,000 for an individual and $3,000 for a couple. There are a number of assets that are exempt, meaning they are not used when calculating the value of your assets; however, it is easy to see how you might have countable assets that exceed the program limit. Transferring those assets out of your estate isn’t a solution either because a five year “look-back” period is used when determining your eligibility. In essence, the “look-back” rule allows Medi-Cal to review your finances for the preceding five years and effectively add back in the value of most asset transfers made during that time period. If your assets do exceed the allowable limit, you will be required to wait before benefits are approved. Your waiting time is calculated using the average cost of long-term care in the state and the amount your assets exceed the limit. The idea, however, is to force applicants to use their own assets to cover the cost of care before Medi-Cal will help.
How Can a Medi-Cal Attorney Help Me If I Was Denied?
Ideally, Medicaid planning start early on in your life and is made part of your overall estate plan; however, if you did not include Medicaid planning in your estate plan prior to the need for Medicaid benefits, help may still be available. An experienced California Medi-Cal attorney may be able to utilize some last minute Medicaid planning tools and strategies to help “spend-down” your countable assets to the point where they are below the program limit. The important thing is to consult with a California Medi-Cal attorney as soon as you realize there is a problem.
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