California Medi-Cal Eligibility and Estate Recovery Answers

CALIFORNIA MEDI-CAL: FREQUENTLY ASKED QUESTIONS

HOW MUCH DOES SKILLED NURSING HOME CARE NORMALLY COST?
Without Medi-Cal, a skilled nursing home resident can expect to pay between $4,000.00 to $6,000.00 per
month. Depending on location and level of care, nursing home costs range between $48,000 and
$145,000.00 per year. A Medi-Cal recipient often pays only a small fraction of their skilled nursing home
care expenses.

WHEN SHOULD I BEGIN PLANNING FOR MEDI-CAL?
The sooner, the better. Early Medi-Cal qualification planning provides you with more options, including
creating estate planning documents with Medi-Cal planning language to ensure that your appointed agent
can carry out further Medi-Cal planning if you later become incapacitated.

Of course it is never too late for Medi-Cal planning and effective strategies can still be implemented in
emergency situations. However, you might have fewer options available to you.

I AM ALREADY RECEIVING CALIFORNIA MEDI-CAL BENEFITS. CAN I STILL BENEFIT
FROM MEDI-CAL PLANNING?
Absolutely. Medi-Cal planning could potentially reduce or eliminate your “share of cost” co-payment and
protect your assets from Medi-Cal estate recovery. Various asset protection strategies are often even
available for mentally incapacitated Medi-Cal patients.

CAN I MAKE A LARGE GIFT TO IMMEDIATELY QUALIFY FOR MEDI-CAL BENEFITS?
Medi-Cal has strict regulations concerning asset transfers. Improper transfers may result in a significant
“period of ineligibility” during which an individual cannot receive long term care Medi-Cal benefits.
Transfers can also have negative estate and capital gains tax ramifications. Legal advice should be
obtained before making any transfers of assets.

WILL I LOSE MY HOME IF I RECEIVE MEDI-CAL?
Medi-Cal will attempt to recover its expenses from the assets the Medi-Cal beneficiary owns at the time of
his or her death, including the beneficiary’s home. Your home can be protected with effective Medi-Cal
planning.

MY MOTHER HAS BEEN A RESIDENT AT A SKILLED NURSING HOME FOR THE PAST SIX
MONTHS. WILL SHE BE REIMBURSED FOR PAST NURSING HOME EXPENSES?
Medi-Cal benefits can be obtained retroactively for the three months immediately preceding your
application month as long as the eligibility requirements were met for those months. For example, if you
applied in April but met the eligibility requirements in January, the nursing home would reimburse your
expenses above the “share of cost” amount from January forward.

Similarly, if the Medi-Cal eligibility limit is increase through a “3100 Court Petition” or “Administrative Fair
Hearing” procedure, the increased eligibility limit can be applied retroactively to cover the three months
immediately preceding the Medi-Cal application.

IN WHAT AMOUNT MAY MEDI-CAL MAKE A RECOVERY CLAIM AGAINST MY ESTATE?
Recovery is limited to the lesser of

    1.        The total amount of benefits a Medi-Cal beneficiary receive during his or her life

          OR

    2.        The value of the Medi-Cal beneficiary’s estate at the time of their passing

If the Medi-Cal beneficiary dies with no remaining estate, there are no assets for Medi-Cal to recover
against. Transferring assets out of the Medi-Cal beneficiary's name should only be done under the
guidance of a qualified elder law attorney to avoid any potential Medi-Cal transfer penalties.

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