Transcript California Advocates for Nursing Home Reform

California Advocates for
Nursing Home Reform
Medi-Cal & Long Term Care
CANHR Services
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Consumer Hotline: (800) 474-1116
Lawyer Referral Service
Pre-Placement Services:
www.nursinghomeguide.org www.residentialcareguide.org
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Website: www.canhr.org
Legal Services Support
Legislative Advocacy
Legal Information Network
Family Council Organizing
Aged & Disabled Federal
Poverty Level Program
Mrs. Jones wants no
Share of cost Medi-Cal:
$300 Pension
+ $900 SSA
$1,200
Unearned Income
$20 Deduction
$1,180
- $125 Medicare
$1,055 < $1,081=
No Share of Cost
If income was $1,250 she
would not be eligible
$1,250
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$20
Unearned Income
Deduction
$1,230
- $125 Medicare
$1,105 > $1,081= SOC
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600 Maintenace Need Allowance
$505 Share of Cost
Overview of Medi-Cal
for Long Term Care
Share of Cost Deductions
Johnson v. Rank:
$600
SOC
- 50 (non-covered)
$550
Remaining SOC
1.
2.
Copy of prescription & bill to facility
Facility deducts from that month’s SOC
and bills resident for the remaining SOC
Hunt v. Kizer:
1.
Unpaid medical bills for which beneficiary is legally responsible
2.
Original documentation showing billing statement is an
outstanding balance
3.
Take bills to County Welfare Office for Hunt v. Kizer deduction
4.
SOC is adjusted to reflect cost
Medi-Cal Assets
Exempt
•Home
•Whole Life Insurance
•Other Real Property
(face value $1,500 or less)
•Business Property
•Term Life Insurance
•Household Goods and
•Burial Plot
Personal Effects
•Jewelry
•Single
•Spouse
•One Car
•Prepaid Irrevocable Burial Plan
•$1,500 Designated Burial Funds
•Pension Funds/IRAs/ Annuities
(work-related only)
•$2,000 Cash Reserve
•CSRA: $101,640 (2007)
Medi-Cal Assets
Non-Exempt:
• Cash (over limit)
• Non-compliant annuities
• Stocks
• Other Real Property
• Bonds
• Trust Principal
• Notes Receivable
Convert
Spend Down
Transfer
30 (36) month rule
Transfer of Assets- Sample #1
Date of Transfer v. Date of Application:
March 15:
May 1:
$11,000 to daughter
Apply for Medi-Cal
Period of Ineligibility:
$11,000 ÷ APPR ($5,101)* = 2.15 Months
2 months = period of ineligibility
When does period start to run:
March:
April:
May:
ineligible
ineligible
eligible
* APPR for 2007
Transfer of Assets- Sample #2
Multiple Transfers: Total Amount = $18,000
March 15:
March 15:
March 15:
$6,000 to Joe
$6,000 to Sue
$6,000 to Amy
Period of Ineligibility:
$6,000 ÷ APPR ($5,101)* = 1.17 month
1 month = period of ineligibility
How Calculated:
Each transfer calculated separately Transfer periods
run concurrently
March:
ineligible
April:
eligible
* APPR for 2007
When Transfer Penalties Do Not Apply
 Asset is Exempt
 Transferred to blind or disabled child
(not a minor)
 Intended to transfer for fair market value
or valuable consideration
 Denial of eligibility would result in undue
hardship
Income Less than MMMNA
Spousal Income:
John (NF)
$2,500/month
Mary (Home)
$500/month
MMMNA Calculation:
$2,541* MMMNA
- 500
Mary’s Income
$2,041
Spousal Allocation
John’s Share of Cost:
$2,500
- 2,041
$459
*MMMNA for 2007
John’s income
Allocation to Mary
SOC (minus $35)
Community Spouse
Resource Allowance (CSRA)
Assets of Spouses:
John (NF)
$75,000
+ $75,000
$150,000
Mary (At home)
(J/T CD)
(Mary’s SP)
Total Assets
Calculation with CSRA:
$150,000
- 101,640*
- 2,000
$46,360
Total Assets
Minus CSRA
John’s reserve
Over CSRA
* CSRA for 2007
Increase in CSRA
Spousal Income & Assets:
John (NF)
$1,500/Month
$50,000 IRA
Mary (At Home)
$500/Month
$30,000 IRA
Other Spousal Assets:
$150,000
- 101,640*
- 2,000
$46,360
Options:
In other joint assets
CSRA for 2007
John’s cash reserve
Above CSRA
•Spend down
•File for increase in MMMNA
•File Court Order
•Retain excess assets/income
When Home Is Exempt
•Exempt relative lives in home
•Spouse
•Minor or dependent relative
•Sibling, son or daughter has lived
there at least 1 year prior to NF
entry & continues to live there
•Legal obstacles prevent sale of home
•Beneficiary intends to return home
To Whom Can the Home Be Transferred?
• A Spouse
• A minor, blind or disabled child
• A sibling with an equity interest who has lived
in the home for 1 year prior to B’s entry into NF
• A son or daughter, who lived there 2 years prior
to B’s entry into NF and provided care
• To anyone as long as property was exempt at the
time of transfer
*Review DHS Forms 7077 and 7102