FAQs

  1. How is Medi-Cal funded?
  2. What are the basic eligibility requirements for obtaining Medi-Cal benefits?
  3. How can I obtain Medi-Cal benefits when I have too many assets?
  4. What Is Spend Down?
  5. Why are more people not qualifying for Medi-Cal benefits if it is as simple as you suggest?
  6. Is this legal?
  7. Do you only have to apply for Medi-Cal once?
  8. How long does it take to qualify for Medi-Cal benefits?
  9. Can I qualify for Medi-Cal even if I am under 65 years old?
  10. How do you apply for Medi-Cal benefits?
  11. What is the most common reason people are denied Medi-Cal benefits?
  12. Do Medi-Cal qualification requirements change at all from year to year?
  13. Must I give up my existing doctor and medical services when I have Medi-Cal benefits?
  14. What does the “30-month look back” period mean?

How is Medi-Cal funded?

Medi-Cal is California’s version of the Federal Medicaid Program. A portion of our California income taxes and our Federal income taxes have been funding the Medicaid/Medi-Cal Program since 1966. Medi-Cal is a needs-based, means-tested Entitlement Program that is funded by our Federal and State tax dollars. Because this is an Entitlement Program, it cannot be legally denied to those who qualify and choose to participate.

What are the basic eligibility requirements for obtaining Medi-Cal benefits?

There are two distinct programs within Medi-Cal. The first program is the “Medical” Benefit, which acts as a health insurance benefit. The asset qualification depends on single or married status. If single, an individual must hold less than $2,000 in total assets excluding one home and one car. Life Insurance and Burial Plan must each be equal to or less than $1,500 in cash value.

For a married couple, with one spouse in a SNF, they are allowed one home of any value, one car of any value, no more than $2000 of assets in the name of the institutionalized spouse. In addition to one car/one home, the value of an IRA may be exempted as long as the recipient is receiving a monthly distribution based on the Medi-Cal formula. The healthy spouse is allowed $119,220 in cash or investible assets, and each spouse is allowed their own individual burial policy and life insurance policy, wiht a value of $1500 each, respectively.

The “Long Term Care” entitlement will cover medical expenses but also help with Skilled Nursing Facility expenses and Hospice in most cases. However, there will be a monthly “share of cost” based on the individual’s fixed income.

If both spouse’s are in a Nursing Home, their joint assets cannot exceed $2000 excluding a home, car and burial policies as described above.

How can I obtain Medi-Cal benefits when I have too many assets?

Many laws exist in the Medi-Cal Code of Regulations. There are a variety of allowances and exceptions that enable your money to be rearranged or transferred in a way that lets individuals qualify when previously they did not. However, they may wish to consult a professional who is an expert in this field to help with this process, to ensure the approval of this benefit.

What Is “Spend Down?”

Many people have often heard the term “spend down” when referring to qualifying for Medi-Cal benefits. They are even told that they must spend their money until they are destitute to qualify.

This need not be the case. “Spend down” is a technical term used by the government to change your financial status in order to qualify. However, in no way should a person have to “spend down” their hard earned assets if there is another way to utilize an entitlement our older generation has been funding with their tax dollars all these years. Rather, certain Medi-Cal regulations allow re-titling or transferring assets which will ultimately acheive the required resource eligibility. This process is then fully disclosed to the Medi-Cal Eligibility Worker upon application, according to the Medi-Cal laws and regulations.

Why are more people not qualifying for Medi-Cal benefits if it is as simple as you suggest?

Medi-Cal is a web of exceptions and details. Most professionals do not take the time to become experts in this field. Qualifying is not ‘simple’; however, PFS has worked with and studied Medi-Cal long enough to understand the “ins and outs” of the system.

Is this legal?

The Medi-Cal regulations are as legal as writing off your donations to a charitable organization on your taxes. Planning for Seniors, LLC, uses the Medi-Cal policies, regulations and allowances to your advantage just like you do when filling out your tax return. Planning for Seniors, LLC adheres strictly to all Medi-Cal laws and discloses all information to the Department of Health and Human Services according to their guidelines.

Do you only have to apply for Medi-Cal once?

Yes. After initially qualifying for Medi-Cal benefits, there is an annual Medi-Cal re-determination that has to be filed to ensure you still qualify, each year. PFS, LLC will not only obtain initial benefits, but will retain the benefit each year among the many services offered. Or provide Medi-Cal counseling services for those who have simpler needs and can do some of this themselves.

How long does it take to qualify for Medi-Cal benefits?

This depends on how many assets you have and the complexity of your financial status. However, on average, it takes about one month from our initial meeting to the point of your financial assets to be within the “resource guideline” for Medi-Cal benefits. Once the Medi-Cal application and supporting documents has been submitted to the county, it can take anywhere from one to four months for the county to approve your case. Therefore, in most cases, the total process can take six months.

Can I qualify for Medi-Cal even if I am under 65 years old?

Yes! Medi-Cal qualification is based on age, resources and health-related needs. You can be under 65 and still obtain Medi-Cal benefits if your physical condition qualifies as a Disability.

How do you apply for Medi-Cal benefits?

Application packages are available at your local county office. This is the first of several steps to ensuring your Medi-Cal request for benefits. You can either elect to fill out the application yourself, or contact Planning for Seniors to find out more about the 3 levels of assistance we provide to help you obtain the benefits you deserve.

What is the most common reason people are denied Medi-Cal benefits?

There are many reasons people are denied Medi-Cal benefits. The unfortunate thing is that the most prevalent reasons people are denied benefits are completely avoidable. These include errors in filling out the Medi-Cal application, improper documentation of assets and appearing to have too many assets when in reality it is the allocation of those assets that is the problem.

Do Medi-Cal qualification requirements change at all from year to year?

Medi-Cal regulations are constantly under review by the state, and therefore changes can be made to Medi-Cal requirements at any time. This is another reason it is beneficial to have a Medi-Cal expert on your side. Many times new regulations are not “enforced’ immediately and the applicant can be caught unaware of the latest enforced regulations until they have submitted the application request and waited many months for a determination by the Medi-Cal eligibility department.

Must I give up my existing doctor and medical services when I have Medi-Cal benefits?

No. Remember, Medi-Cal is just another option to supplement existing medical services. In many cases Medi-Cal may pay for medical services that are not already covered by your existing medical insurance or Medicare. Most of our clients only use Medi-Cal to pay for SNF stays. If you already have an existing doctor and medical insurance nothing will change.

What does the “30-month look back” period mean?

The “30-month look back” period refers to the disclosure of all financial transactions and/or changes, pertaining to the Medi-Cal applicant at the time of initial application. The reason for disclosing all financial changes during the previous 30 months is for the Department of Health and Human Services to determine if there is a “period of ineligibility” that would have occurred with any of the financial transactions and/or changes. This period of ineligibility would potentially preclude a Medi-Cal long term care applicant from qualification for this benefit.

When a person is applying for Medi-Cal medical benefits there is no period of ineligibility when transferring excess resources out of their name in order to qualify for Medi-Cal medical benefits.

This subject has been very confusing for most people, as they tend to think that they cannot make any financial transactions or changes to their assets prior to the Medi-Cal application process. As previously mentioned, there are many rules and regulations that allow the proper financial transactions that can occur prior to Medi-Cal application, as long as these rules and regulations have been followed and are disclosed. Hence the importance of obtaining professional help in the pursuit of Medi-Cal benefits.

Take the Extended Care Quiz

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Website content not intended as legal advice. No guarantee implied or promised as to approval of Medi-Cal benefits. Use of information is at user’s sole risk,
without liability, risk, legal exposure to referenced sources, technical advisers, or Planning for Seniors, LLC.