Basic A great deal of misunderstanding and misinformation exists when it comes to qualifying for Medi-Cal for Long Term Care.
We have prepared these FAQ pages with the idea of building your knowledge from the ground up. Complicated questions, involving matching your financial situation against the Medi-Cal eligibility rules, are best answered via a telephone conversation.
1. What is Medi-Cal for Long Term Care? Medi-Cal is California's version of Medicaid, the federal health benefits program. Medi-Cal for Long Term Care is for individuals who need financial help to pay for nursing home stays. Seniors with chronic conditions are the main beneficiaries, but the program can also help those under 65 with debilitating health problems that require 24-hour care.
2. How is Medi-Cal different from Medicare? Many folks initially confuse Medi-Cal with Medicare, which is the federal program that covers catastrophic care for seniors. Medicare will pay hospitalization costs plus a percentage of costs up to a 100 days. It is considered the primary insurance, with the individual's supplemental insurance usually being a private health plan. If you do not have private health insurance, then Medi-Cal can be your supplemental insurance, if you qualify. Medicare does not pay for custodial skilled nursing, which Medi-Cal will if you qualify for eligibility.
3. Who runs the Medi-Cal program?
A three-part bureaucracy runs Medi-Cal: it is a federal program, with California-specific rules and regulations, administered at the county level. A county worker, along with a supervisor, determines eligibility. Occasionally, State Specialists will determine complicated cases.
4. How do you apply? Go to or call your county offices to get answers to questions along with an application packet. The application contains about a dozen forms, including the MC 210, SAWS 1, and DHS 6177. You, as the applicant, can apply yourself or you can have an authorized representative, such as Senior Medi-Benefits, apply for you.
5. How long is the application process? Every county has been given instructions by the State of California to process applications-either grant or deny eligibility in less than 90 days. The simplest applications, with an efficient county, can take about three weeks. Most applications take between 45-90 days.
6. How do you qualify healthwise? An Individual must first qualify to live longer than thirty days at the skilled nursing level of care. This determination Is dependent on the Individuals ability (or Inability) to complete at least four of the six Activities of Daily Living (ADLs) without help. The ADLs are: Transferring (mobility), Bathing, Feeding, Pottying, Dressing, Medicating. If the Individual can't do 3 of the 6 Independently, then he or she qualifies for a skilled nursing bed, and, hence, would have the potential to receive Medi-Cal for LTC benefits.
7. How does immigration status impact Medi-Cal eligibility?
If you have a green card, Naturalization papers and/or a Certificate of US citizenship, you can apply for benefits.
8. How do you qualify financially? Medi-Cal is a needs based program, and the asset parameters, known as the property resource limits, depend upon whether you are a single individual or a married individual with an at home spouse. For a single, unmarried individual, countable assets must not be greater than $2000. For a married individual with an at home spouse, the countable, combined assets can reach up to $115,920.
9. What are countable assets? Checking, savings, CDs, and investment accounts including mutual funds, stocks and bonds; credit union accounts; life insurance policies with face value more than $1500; annuities that are not Medi-Cal friendly; annuities that are not annuitized; automobiles, if there is more than one registered; second homes and non-business properties; accounts held in revocable trusts; promissory notes.
10. What are exempt assets? The primary residence is considered exempt, if the applicant is married with an at-home spouse, of if the applicant is an individual who intends to return home. Other exempt assets include property used in business or trade; preneed burial expenses; life insurance with face value under $1500, IRAs, pensions, and annuities, one automobile, if the beneficiary is receiving periodic payments.
Learn important facts about the program that impacts many elderly Californians: DOWNLOAD PDFA full version of LTC Medi-Cal FAQs.