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California Advocates for Nursing Home Reform

California Advocates for Nursing Home Reform. Medi-Cal & Long Term Care. CANHR Services . Consumer Hotline: (800) 474-1116 Lawyer Referral Service Pre-Placement Services: www.nursinghomeguide.org www.residentialcareguide.org Website: www.canhr.org Legal Services Support

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California Advocates for Nursing Home Reform

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  1. California Advocates for Nursing Home Reform Medi-Cal & Long Term Care

  2. CANHR Services • Consumer Hotline: (800) 474-1116 • Lawyer Referral Service • Pre-Placement Services: www.nursinghomeguide.org www.residentialcareguide.org • Website: www.canhr.org • Legal Services Support • Legislative Advocacy • Legal Information Network • Family Council Organizing

  3. Aged & Disabled Federal Poverty Level Program Mrs. Jones wants no Share of cost Medi-Cal: • If income was $1,250 she would not be eligible • $1,250 • $20Deduction • $1,230 • - $125 Medicare • $1,105 > $1,081= SOC • - 600Maintenace Need Allowance • $505 Share of Cost $300 Pension + $900 SSA $1,200 - $20 Deduction $1,180 - $125 Medicare $1,055 < $1,081= No Share of Cost Unearned Income Unearned Income

  4. Overview of Medi-Cal for Long Term Care

  5. Share of Cost Deductions Johnson v. Rank: • Copy of prescription & bill to facility • Facility deducts from that month’s SOC and bills resident for the remaining SOC • $600 SOC • 50 (non-covered) • $550 Remaining SOC • Hunt v. Kizer: • Unpaid medical bills for which beneficiary is legally responsible • Original documentation showing billing statement is an outstanding balance • Take bills to County Welfare Office for Hunt v. Kizer deduction • SOC is adjusted to reflect cost

  6. Medi-Cal Assets Exempt • Whole Life Insurance • (face value $1,500 or less) • Term Life Insurance • Burial Plot • Prepaid Irrevocable Burial Plan • $1,500 Designated Burial Funds • Pension Funds/IRAs/ Annuities (work-related only) • $2,000 Cash Reserve • CSRA: $101,640 (2007) • Home • Other Real Property • Business Property • Household Goods and • Personal Effects • Jewelry • Single • Spouse • One Car

  7. Medi-Cal Assets Non-Exempt: • Cash (over limit) • Non-compliant annuities • Stocks • Other Real Property • Bonds • Trust Principal • Notes Receivable Convert Spend Down Transfer30 (36) month rule

  8. Transfer of Assets- Sample #1 Date of Transfer v. Date of Application: March 15: $11,000 to daughter May 1: 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: ineligible April: ineligible May: eligible * APPR for 2007

  9. Transfer of Assets- Sample #2 Multiple Transfers: Total Amount = $18,000 March 15: $6,000 to Joe March 15: $6,000 to Sue March 15: $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

  10. 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

  11. Income Less than MMMNA Spousal Income: John (NF) Mary (Home) $2,500/month $500/month MMMNA Calculation: $2,541* MMMNA - 500 Mary’s Income $2,041 Spousal Allocation John’s Share of Cost: $2,500 John’s income - 2,041 Allocation to Mary $459 SOC (minus $35) *MMMNA for 2007

  12. Community Spouse Resource Allowance (CSRA) Assets of Spouses: John (NF) Mary (At home) $75,000 (J/T CD) + $75,000 (Mary’s SP) $150,000 Total Assets Calculation with CSRA: $150,000 Total Assets - 101,640* Minus CSRA - 2,000 John’s reserve $46,360 Over CSRA * CSRA for 2007

  13. Increase in CSRA Spousal Income & Assets: John (NF) Mary (At Home) $1,500/Month $500/Month $50,000 IRA $30,000 IRA Other Spousal Assets: $150,000 In other joint assets - 101,640* CSRA for 2007 - 2,000 John’s cash reserve $46,360 Above CSRA Options: • Spend down • File for increase in MMMNA • File Court Order • Retain excess assets/income

  14. 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

  15. 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

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