What is Long-Term Care?

What are Activities of Daily Living?

There are 5 basic categories of ADLs:

1. Personal Hygiene
The ability to perform consistent bathing/showering, grooming, nail care, and oral care.

2. Dressing
Making appropriate clothing choices and physically dressing and undressing oneself.

3. Eating
The ability to feed oneself but not necessarily the skill to prepare food.

4. Maintaining Continence
The ability to use a restroom including getting on and off the toilet and cleaning oneself.

5. Transferring/Mobility
The ability to stand from a sitting position, to get in and out of bed and to walk independently from one location to another.

What are Instrumental Activities of Daily Living (IADLs)?

1. Basic Communication Skills
The ability to operate a regular phone, mobile phone, personal computer and other devices for essential communication

2. Transportation
The ability to drive oneself, arrange rides or use public transportation.

3. Meal Preparation
The ability to plan meals, cook, clean up, and safely use kitchen tools

4. Shopping
The ability to make appropriate food and clothing purchase decisions.

5. Housework
The ability to maintain a clean and orderly residence including doing laundry, washing dishes, dusting, vacuuming, etc.

6. Managing Medications
The ability to take the correct amount of medicine at the correct time, follow doctor’s prescription, manage refills, etc.

7. Managing Personal Finances
The ability to manage expenses, operate within a budget, write checks, pay bills, avoid scams, etc.

What is an ADL Assessment and what is it for?

Assessing or measuring the patient’s capacity to perform ADLs and IADLs is necessary to determine the appropriate care and financial support under the Medi-Cal Long Term Care program. Case managers use the above listed ADLs and IADLs and evaluate Medi-Cal applicants based on these metrics – “No help needed”, “some help needed”, or “total help needed”.
If the applicant needs help with three or more activities of daily living, then the highest level of care will be approved for either nursing home eligibility or for care at home. Care at home would then be paid for, in part or fully by Medi-Cal.

Incidentally, a physician’s confirmed diagnosis of “severe dementia” for Alzheimer’s and other dementia patients may serve as a supporting document to the ADL assessment and trigger the same kind of financial aid.

Check out these additional resources from our blog to understand the processes, requirements and benefits of the Medi-Cal for Long Term Care program for seniors.

• Medi-Cal For Long Term Care – Income Limits
• Assisted Living in California – What You Need to Know
• Medi-Cal for Seniors: Guide to Asset Limits

What’s next?

Now that you have a basic knowledge of ADLs and IADLs, get in touch with our team at Crider Law if you wish to have an assessment of ADLs (also called a geriatric assessment) for yourself or your loved one and determine eligibility for assistance under the Medi-Cal program.

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Medi-Cal is a joint federal-state program that provides health insurance to low-income Californians, including seniors and persons with disabilities. Medicaid programs like Medi-Cal are funded by federal and state funds and are administered by individual states.

What is a Medi-Cal Asset Test?

A Medi-Cal Asset Test is a process for determining eligibility for Medi-Cal benefits by evaluating an applicant’s assets. The purpose of the Asset Test is to limit access to Medi-Cal to only those who do not have sufficient resources to pay for their own long-term care. The idea is that if people have substantial assets, they could use these to pay for the care they need.

Who Is Subject to Medi-Cal Asset Testing?

All applicants need to declare their assets as part of the Medi-Cal review process. The following categories of seniors and persons with disabilities are subject to asset testing to qualify for Medi-Cal:

1. SSI Recipients
Those who receive Supplemental Security Income (SSI). SSI is for people with low incomes who are 65 or older, as well as blind or disabled people of any age. SSI eligibility is conditioned on a maximum asset limit.

2. SSI Eligible
Those who would otherwise meet the income and resource requirements of SSI or other benefit programs but do not receive cash assistance.

3. Below Poverty
Seniors and persons with disabilities with incomes less than 100% of the federal poverty limit (FPL).

4. Medically Needy
Seniors and persons with disabilities who have high medical expenses and who meet all eligibility requirements for Medi-Cal except for income.

What are Medi-Cal Asset Limits?

To be eligible for Medi-Cal under any of these categories, applicants must meet, among other requirements. Seniors and persons with disabilities cannot have more than $2,000 in assets for an individual or $3,000 for a couple, if both are applying for Medi-Cal for long-term care.

What are Real Property Assets?

“Real Property” is land, buildings, mobile homes which are taxed as real property, life estates in real property, mortgages, promissory notes, and deeds of trust. These are considered “countable assets” when assessing for Medi-Cal eligibility.

What are the Exemptions to Real Property Assets?

1. Principal Residence
Property used as a home is exempt (not counted in determining eligibility for Medi-Cal). When an applicant or beneficiary is absent from the house for any reason, including institutionalization, the home will remain exempt if the applicant or beneficiary intends to return home someday.

The home also continues to be exempt if the applicant’s or beneficiary’s spouse or dependent relative continues to live in it. Money received from the sale of the home can be exempt for six months if the money is going to be used for the purchase of another home.

2. Other Real Property
Real property value up to $6,000 of the equity value in non-business real estate (excluding the home), mortgages, deeds of trust, or other promissory notes may be exempt. In order to receive this exemption, the property must produce an annual income of 6 percent of the net market value or current face value.

3. Real Property Used in a Business or Trade
Real estate used in a trade or business is exempt regardless of its equity and whether it produces income.

What are Personal Property Assets?

“Personal property” is any kind of liquid or non-liquid asset, i.e., cars, jewelry, stocks, bonds, financial institution accounts, boats, trucks, trailers, etc. Property that is not counted in determining your eligibility is called “exempt” or “unavailable” property.

What are the Personal Property Exemptions?

1. One Motor Vehicle

2. Personal Property Used In a Trade or Business

3. Personal Effects
This includes clothing, heirlooms, weddings and engagement rings, and other jewelry with a net value of under $100.

4. Household Items

5.IRAs, KEOGHs and Other Work-related Pension Plans
These funds are exempt if the family member whose name it is in does not want Medi-Cal. If held in the name of a person who wants Medi-Cal and payments of principal and interest are being received, the balance is considered unavailable and it is not counted.

6. Irrevocable Burial Trusts or Irrevocable Prepaid Burial Contracts

7. One Revocable Burial Fund
Or revocable prepaid burial contract with a value of up to $1,500 plus accrued interest per person.

8. Burial Space

9. Musical Instruments

10. Recreation Items
Including TVs, VCRs, computers, guns, collections, etc.

11. Livestock, Poultry, or Crops

12. Insurance Policies
Countable property equal to the amount of benefits paid under a state-certified, long-term care insurance policy. Each person may have life insurance policies with a combined face value of $1,500 or less accrued interest and dividends.

What is a Property Reserve?

Property Reserve is all of your countable property (property which is not exempt or unavailable). Your countable property must not exceed the property reserve limit. Any amount over the property reserve limit will make you and/or your family ineligible for Medi-Cal. To be eligible for Medi-Cal, your countable property may not exceed the following property reserve limits:

How To Reduce Your Property Reserve

Here are nine allowable expenses and adjustments that you can do to reduce non-exempt property without incurring a period of ineligibility for nursing facility level of care:

1. Pay Medical Bills
2. Buy Home Furnishings
3. Pay Off Home Mortgage
4. Buy Clothes
5. Spend on Home Repairs
6. Pay Off Car Loan
7. Pay Off Outstanding Debts
8. Liquidate non-liquid assets such as obtaining the cash surrender value on non-exempt life insurance policies, list property for sale with a qualified broker etc.
9. Borrow against excess property to cover the cost of medical care or request the medical provider to place a lien against the property to cover the cost of the care.

Important Note:

To be eligible for Medi-Cal you may reduce your property to the property reserve limit before the end of the month in which you are requesting Medi-Cal. Read the related blog on Medi-Cal For Long-term Care Income Limits for more guidance on Medi-Cal’s financial qualifications.

What’s next?

If you need help with qualifying for Medi-Cal benefits for long-term care, contact us today to schedule your free consultation. We’d love to meet with you!

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The Cost of Assisted Living

Second to Hawaii, California is the most expensive state to retire in according to the U.S. Census 2019 cost of living index. And finding the best assisted living facility that meets your budget and care needs in the Golden State is quite challenging.

According to Genworth’s Cost of Care Survey the average cost of assisted living in California in 2020 is $4,500 per month. The cost ranges from $3,175 to $5,853 per month based on where in the state the assisted living community is located.

Home care (hiring a professional health care assistant to serve in an elderly patient’s private residence) costs an average of $28/hour according to the same survey.

The Agencies Govern Assisted Living Facilities and Services

Residential Care Facilities for the Elderly (RCFEs) in California encompass Assisted Living, Memory Care, and Continuing Care Retirement Communities (CCRCs), RCFEs are licensed, monitored and regulated by the U.S. Department of Health and Human Services and the California Department of Social Services. The California Department of Public Health inspects properties once every five years. However, if the facility has frequent complaints or poor inspection results, it will be inspected annually.

The Rules and Regulations for RCFEs

RCFEs are governed by the California Code of Regulations Title 22, the RCFE Act which establishes additional statutory requirements in many of the same areas as Title 22. The Evaluator Manual is used for the application and enforcement of laws, policies, and procedures.

Additional rules governing Continuing Care Retirement Communities are found in the Health and Safety Code and in the Evaluator Manual for RCFEs with Continuing Care.

There are also new laws which are not yet reflected in the regulations. Although the state has not yet updated the regulations to reflect these new laws, the statutory requirements are in effect and being enforced throughout the state.

Paying for the cost of Assisted Living

With proper Medi-Cal Planning, qualified elderly residents may be eligible for Medi-Cal program, which is funded by the federal and state government. The state’s version of Medicaid is known as Medi-Cal and provides California’s eligible seniors with vital health insurance coverage and a safety net for long-term care when they have exhausted their own financial resources.

How is Medi-Cal different from Medicare? Medi-Cal is a state program while Medicare is a federal health insurance benefit. Medicare covers many healthcare expenses including in-patient and out-patient care and may provide prescription drug coverage. It does not, however, cover long-term care for the elderly care like Medi-Cal.

Learn how you can qualify for Medi-Cal – the specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.

Downloadable PDF’s of Assisted Living Regulations

• http://www.cdss.ca.gov/getinfo/pdf/rcfe1.PDF
  
• http://www.cdss.ca.gov/getinfo/pdf/rcfe2.PDF
  
• http://www.cdss.ca.gov/getinfo/pdf/rcfe3.PDF
  
• http://www.cdss.ca.gov/getinfo/pdf/rcfe4.PDF

What’s next?

Refer to our Nursing Home Checklist to help you decide which assisted living community or facility is right for you or your loved one. It is also worthwhile to check on linked resources in this article for the state’s requirements on staff training, inspections, residents’ rights and more. Knowing the requirements helps you determine whether the communities you are considering are up to the state’s standards of care.

If you need expert advice on Elder Care and Medi-Cal Planning, schedule your free consultation with our legal team at Crider Law.

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Eligibility for these programs is determined by several criteria that include income levels, marital status, medical need, disability, and so on. The table below provides a quick reference for seniors to ascertain the long term care benefits they may be eligible for under the Medi-Cal program.

APRIL 2021 – MARCH 2022 Medi-Cal Long Term Care Eligibility
[click to zoom on the table]

What is “Share of Cost” ?

What defines “Income”?

Employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends are considered countable income when determining eligibility for Medi-Cal Long Term Care Benefits. It is worth noting that Covid-19 stimulus checks (both previous and subsequent payments) are not considered income and therefore do not affect eligibility.

For married couples with only one spouse applying for Medi-Cal, only the income of the applicant is counted and the income of the non-applicant spouse is disregarded. To be clear, income is counted differently when just one spouse of a married couple applies for regular Medi-Cal. In this situation, the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility.

What are considered “Assets”?

Cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate (with the exemption of your home residence) are considered countable assets.

Assets that are exempt from being counted are personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary place of residence. Incidentally, there is no maximum home equity value limit under Medi-Cal unlike in most states.

IMPORTANT: When applying for Medi-Cal, it is important to note that California has a Look-Back Period of 30 months preceding the application date (most states have a 60-month look-back). Reviewers will check on your application to ensure no assets were sold or given away under fair market value during this timeframe. Violators will incur penalties.

What’s Next?

Whether it’s your first time to file a claim, pursuing an appeal or just want to learn more about your entitlements under the Medi-Cal Long Term Care program, we will support you every step of the way.

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