Medi-Cal is California’s version of the Medicaid program designed to help pay medical bills for eligible individuals. Medi-Cal is not related to Medicare insurance. Eligibility for Medi-Cal mainly depends on amount of income a person has.

SSI recipients are automatically eligible. As of 2024 there is no asset limit or citizenship requirement for Medi-Cal eligibility. Others may also qualify if their income is within the Medi-Cal limits. This includes:

1. Low-income or unemployed persons
2. Some persons with dependent children
3. Children under 21
4. Pregnant women
5. Indigent adults in skilled nursing or intermediate care or
those who qualify for Medi-Cal funded home and community based
option programs.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal eligibility and Asset Protection Options

California law has a fixed maintenance need standard for those who are living at home. The need standard for a single elder (at least 65) or disabled person is $600 per month, for a couple – $ 934 per month.

Generally, if your monthly income is higher than the need standard, you will have a “share of cost” for your medical bills each month. Once you pay your monthly share of cost towards your medical bills, Medi-Cal will cover the rest of the expenses.

Medi-Cal share of cost works similar to an insurance deductible and is determined by the Medi-Cal case worker. The amount of the share of cost is equal to the difference between your gross monthly income, minus certain deductions like Medicare or private insurance and minus the need standard.

You may not have any share of cost if you qualify for the Aged & Disabled Federal Poverty Level Program.  

Due to the enormous cost of nursing home care, many California’s nursing home residents have Medi-Cal program pay for their care. If you meet the Medi-Cal standard, you will be eligible for Medi-Cal.

The share of cost for the nursing home residents is determined a little bit different than for those who are still living at home.  Medi-Cal share of cost equals gross income minus the cost of health insurance or other eligible deductions, minus the Monthly Maintenance Need Allowance.

If a nursing home resident is married, his spouse may be able to keep his income without surrendering it to the nursing home as a share of cost.

Your share of cost is your monthly financial obligation to the nursing home; Medi-Cal will pay the rest.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal eligibility and Asset Protection Options

Under 2024 Medi-Cal rules the asset limit has been eliminated.  Exempt and Non-Exempt property no longer relevant because property does not affect eligibility.  What is very relevant is protecting your property from Medi-Cal recovery and considering how property and resources affect share of cost.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and asset protection options.

As of January 2024, spend down of your resources is no longer necessary because the asset limit has been eliminated.  Income produced by resources will continue to count toward share of cost.

Please call our law offices at 1-866-822-7211 to consult regarding other Medi-Cal planning and asset protection options

As of January 2024 you no longer need to be concerned with gifting assets away to get below the asset limit.  The asset limit has been eliminated.  These rule changes allow for certain transfers of assets that can be advantageous without triggering the “look back period.”

Gifting is not always the best option because of certain tax implications sucha as loss of step up in basis.  We utilize various trust instruments to achieve the best result.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and asset protection options.

Even if you are eligible for Medi-Cal benefits, you may still be responsible to pay a share of cost. When you are in a nursing home most of your Social Security, pension and other income will go toward your share of cost and Medi-Cal will pay the rest.

Private health insurance premiums that the resident has to pay will be deducted from the share of cost. If you have any outstanding medical bills prior to you becoming eligible for Medi-Cal, your share of cost could be applied towards those bills instead of paying a share of cost to the nursing home. Also, any medical expenses that are not covered by Medi-Cal can also be deducted from the share of cost as long as the prescription is provided.

A nursing home resident should pay the “estimated” share of cost while his application is pending and not allow the income accumulate in the account as this can impact his Medi-Cal eligibility.

There are a number of strategies that can be employed by a Medi-Cal Attorney to reduce or eliminate the share of cost.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal eligibility and Share of Cost

If you are signing a nursing home admission agreement for another, you should do so in a capacity as an “agent” (under power of attorney; conservatorship) rather than “responsible party”. Otherwise you may make yourself personally liable for the expenses.

If you are acting as an agent for the nursing home resident’s assets, always use the resident’s income to pay the share of cost as willful avoidance of this duty can be a misdemeanor. An agent will be held responsible for the funds that were received by the resident but not distributed by the agent and not for any of the resident’s debts.

If your application for the benefits is improperly denied you can file for the fair hearing. It is important to apply for the hearing in a timely manner, which is indicated in the notice of action of denial letter.

Call our office if you need help with an application that has been improperly denied.

According to Medi-Cal rules, the spouse that is staying at home can retain a certain amount of income.  If their income is below this amount they can keep some of their spouses income and share of cost will be offset.  We have a number of strategies to help reduce the share of cost for married couples.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal eligibility and Asset Protection Options

Such funds In the name of at home spouse are excluded and do not have to be liquidated or cashed out.

Distributions for a spouse that is in need of Medi-Cal benefits will go toward share of cost calculation.  We have a number of strategies to reduce share of cost.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and IRA, Pension plans’, other assets protection options.

Annuities are usually treated differently from IRAs and work-related pensions. The periodic payments have to be set up so that the full amount of the annuity is exhausted by the time of life expectancy however any unpaid amount, depending on when the annuity was purchased, can be recovered by Medi-Cal. All periodic payments will be included towards income and added to the share of cost.

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and asset protection options if you have purchased an annuity.

A well spouse can keep all of his or her own income and potentially some or all of the institutionalized spouse’s income. As of 2014, California law states that there is a “minimum monthly maintenance need allowance” set of  which is increased each year. What it means is that if the at home spouse does not have her own income or gets very little, then she can keep some of the institutionalized spouse’s income. Well spouse can also potentially keep all household income through spousal impoverishment or a court order

Yes, that can be done through a Fair Hearing or obtaining a court order. The resource allowance can be increased if the income between both spouses does not add up to “minimum monthly maintenance need allowance”

The “minimum monthly maintenance need allowance” can also be increased if hardship is proved

Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal eligibility and Asset Protection Options

Warning: you may be able to own a home and still qualify for Medi-Cal benefits, but be aware that your home is still subject to Medi-Cal recovery claims.

The financial support extended to a Medi-Cal recipient can be recovered by the state after Medi-Cal recipient’s death. Medi-Cal recovery department can recover up to the amount available after the house is sold, but not more than the actual expenditures.

California now seeks recovery from real or personal property or any other assets that are probated.

There are ways of protecting the property from future Medi-Cal recovery that you should be aware of. Please call our law offices at 1-866-822-7211 to find out how to protect your home from future Medi-Cal claims.

You should also be very careful when transferring the residence out of the Medi-Cal recipient’s name as there are many rules governing such transfers.

Please call our law offices at 1-866-822-7211 to consult how to transfer the property properly without triggering ineligibility for benefits or future recovery by Medi-Cal.