Many couples are surprised to learn that Medi-Cal benefits are more readily attainable than they thought. Often times the healthy spouse can no longer care for a spouse who has been diagnosed with a major illness such as Alzheimer’s or dementia or who has had a catastrophic incident such as a stroke.
The healthy spouse faces the daunting prospect of how to pay for skilled nursing charges, maintain and pay the home mortgage, bills, insurance and other monthly needs. This can place an enormous financial pressure on the healthy spouse. This is the time when most spouses learn about Medi-Cal and how the State of California can assist with the nursing home bills.
The ill spouse either enters the Skilled Nursing Facility directly from the home or through discharge from a hospital. Medicare and generally all Medicare HMO’s will pay for up to a maximum of 100 days of care, often with a co-pay for days 21-100. After that, the couple must privately pay for the care at a cost of $4800 to $15,000 per month, depending on the care needs.
Medi-Cal is the state version of Medicaid and the eligibility rules are strict. The rules and eligibility requirements in California are much different than in other states. The rules change constantly, but are probably more beneficial than you think. It is critical to know the rules and what is required to become eligible for Medi-Cal. A healthy spouse may keep $101,640 in that spouse’s name alone, plus their house, a car and much more. The ill spouse can keep up to $2,000 in their name alone.
Often, there are obstacles to overcome to become eligible for Medi-Cal benefits. This migh
t involve having more than one car, excess whole life insurance, too many assets, separate property, inheritances etc. These obstacles are often easily overcome. However, sometimes the court’s intervention is required. Furthermore, certain actions can be taken in order to prevent or minimize Medi-Cal from seeking reimbursement for the ill spouse’s care paid through the Medi-Cal program. Obstacles, whether small or large, often take time to resolve, so it’s important to start early. Time is of the essence and advance preparation is key.
For more information, please visit our website at www.janemcnamara.com .