At Senior Care Advocates, we provide senior help and advocacy. That means we will always give you the truth whether you want to hear it or not! A question we get regularly is, “why can’t I just do the Medi-Cal application myself?” Our response is always the same, “You can, but we don’t generally advise it.” Again, we will always inform you of your rights and options but give you our recommendations as well. This is because we have over thirty years of experience advocating for seniors and have seen the obstacles out there and how the system does not seem to support them very well.
Can you afford the risk of denial? Medi-Cal has up to 45 days to issue an approval or denial, and in most cases, they take that long. Sometimes even longer. When you are unaware of your rights, you can end up paying the private pay rate, or what we refer to as the retail rate, and it is not necessary. Skilled nursing is almost $12,000 per month now and if you cannot afford that rate, what would you do? Side note: We do not recommend allowing the skilled nursing staff to apply for you either. Our experience is that most will complete the basic paperwork, and a couple of weeks later you receive a Request for Verifications for all the required information that should have been provided with the application. The notice gives you 10 days to comply, or they deny the application. The well-intended employee has unknowingly set you up to pay the retail rate and lose a month or two of benefits. This is because they almost never ask you for financial information, only income. This is because they need to determine the Share of Cost, which is what they will bill you while the application is pending. In most cases, this is a bad choice.
Do you have full access to your loved one’s financial, legal, medical, and insurance information? You will need it for Medi-Cal to approve an application. What if you do not? Do you know your rights and options? We do.
This is your monthly co-pay, or deductible if you will. Medi-Cal gets it wrong almost half the time. How would you know if they got it correct or not? Many people pay too much and do not know it.
What will they benefit from the most, your presence or your clerical ability?
We know how to protect the estate and guarantee you will never have to repay the state.
Why risk it by doing it yourself?
We receive calls every month from people who have been wrongfully denied, and we fix what is broken. The cost of care is extremely high, but the cost of a denial can be staggering. Why take that chance? Contact us for help right now.
There is a lot of buzz about the recent changes that took effect on July 1st of this year. Many feel they were long overdue since these regulations had not been updated since 1989.
Last year, Medi-Cal officials provided the new regulations to the public, and we reviewed them and performed our due diligence. As a result, I offer the following:
In many cases, potential applicants will retitle assets thinking they can qualify without the assets in their name. When done properly and within Medi-Cal regulations, this can be done without a Period of Ineligibility, or POI. If done incorrectly, a POI can be assessed, and they must wait up to 30 months to begin receiving benefits. The transfer penalty does not apply when the person is not in a skilled nursing home, but they should seek counsel from a Medi-Cal expert to consider how and when transfers are made, in the event they enter a skilled nursing home down the road. That is because they are still subject to the lookback period.
The rules for exempt and nonexempt assets will also remain the same.
California has no income limits for most programs.
These rules did not change. California’s Medi-Cal system has the right to be reimbursed for most services provided. This is completely avoidable with proper planning!
Although it is now easier to get qualified for benefits, people need to understand about Medi-Cal Estate Recovery. The state is entitled to reimbursement for the payments they made during the Medi-Cal recipient’s lifetime and can put a lien on any assets not protected. So, as an example: A person dies with $50,000 in the bank because they can have up to $130,000, but that $50,000 is subject to Estate Recovery, so the state will now get a larger payback since the old figure was only $2,000.
Hire an expert to develop a strategy to protect all that you have worked so hard for! Better yet, call us for a no-cost consultation at (559) 227-7322, or contact us by email.