Medi-Cal and Long-Term Care in California

Couple Worried About the Future

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One of the most complicated and fear-inducing aspects of Medi-Cal (called Medicaid in most other states) is financial eligibility. The rules for qualifying for Medi-Cal to pay for the cost of long-term care are complicated and can be difficult to understand. This is especially true when the Medi-Cal applicant is married, reports Delco Times in the article “Medicaid–Protecting Assets for a Spouse.”

Generally speaking, to be eligible for Medi-Cal (Medicaid) long-term care, the applicant may not have more than $2,000 in countable assets in their name. That’s the 2019 income limit.

There are Federal laws that mandate certain protections for a spouse, so they do not become impoverished when their spouse enters a nursing home and applies for Medicaid. This is where advance planning with an experienced elder law attorney is needed. The spouse of a Medicaid recipient living in a nursing home, who is referred to as the Community Spouse, is permitted to keep as much as $126,420, known as the “Community Spouse Resource Allowance,” without putting the Medi-Cal eligibility of the spouse who needs long-term care at risk.

Determining the Community Spouse Resource Allowance requires totaling the countable assets of both the community spouse and the spouse in the long-term care facility, as of the date of admission to the nursing home. The date of admission is referred to as the “snapshot” date. The community spouse is permitted to keep countable assets up to a maximum of $126,420 in 2019. The rest of the assets must be spent down.

Countable assets for Medi-Cal include most belongings.  However, there are a few exceptions. Personal possessions, including jewelry, clothing and furniture, one car, the applicant’s principal residence,  and assets that are considered inaccessible, such as a spouse’s retirement accounts.

Unless an asset is specifically excluded, it is countable.

While there are also Federal rules regarding how much the spouse is permitted to earn, this varies by state. In California, the spouse is permitted to keep all of their own income, regardless of the amount.

The rules regarding requests for additional income are also very complicated, so an elder law attorney’s help will be needed to ensure that the spouse’s income aligns with their state’s requirements.

These are complicated matters, and not easily navigated. Talk with an experienced elder law estate planning attorney to help plan in advance, if possible. There are many different strategies for Medicaid applications, and they are best handled with experienced professional help.

Reference: Delco Times (June 26, 2019) “Medicaid–Protecting Assets for a Spouse