Medi-Cal sometimes pays for care in nursing homes and other health care services. This section explains the Medi-Cal program, its eligibility requirements and special words that Medi-Cal uses.
It also explains how to ask the Court to help you qualify for Medi-Cal. Asking the Court for help can be faster and less expensive than going through the state’s process. But, the process is not easy. You may need a lawyer to help you.
Click on a topic to learn more:
- What Is Medi-cal?
- How Can I Apply for Medi-cal?
- Can I Get Medi-cal?
- Does Medi-cal Pay for Nursing Home Care?
- Does Medi-cal Pay for Other Health Services?
- How Does Medi-cal Decide If I Am Financially Needy?
- Does Medi-cal Count All My Assets?
- How Do I Calculate the Value of My Insurance, Real Property and Car?
- Do I Have to Count My House?
- Do I Count Assets Held in Trust?
- What Is a “well Spouse”?
- What Is a Community Spouse’s Minimum Monthly Maintenance Needs Allowance (Mmmna)?
- Can the Community Spouse’s Resource Allowance (Csra) Be Increased?
- What Is a Fair Hearing?
- What Is Share of Cost?
- What Can I Deduct from My Income?
- Can I Still Qualify for Medi-cal If I Give Away Assets?
- Can Someone Else Give Away Assets for Me If I Become Incapacitated?
- Can the State Place a Lien on My Property?
- Does the State Have a Deadline to Make a Claim against My Estate?
- How Much Can the State Make a Claim For?
- What If I Need a Lawyer to Help Me with Medi-cal?
- Can the Court Help Me Qualify for Medi-cal?
- Related Laws and Guidelines
WHAT IS MEDI-CAL?
Medi-Cal provides medical services for financially needy people in California.
HOW CAN I APPLY FOR MEDI-CAL?
In Orange County, you can get Medi-Cal applications and information from the Social Services Agency .
CAN I GET MEDI-CAL?
Medi-Cal is for California residents who are US citizens and financially needy and:
- permanently disabled or blind, or
- 65 years old or older.
DOES MEDI-CAL PAY FOR NURSING HOME CARE?
Yes. If a doctor says you have a medical need for nursing home care, Medi-Cal pays for you to go to a nursing home they have a contract with.
DOES MEDI-CAL PAY FOR OTHER HEALTH SERVICES?
Yes. Medi-Cal can pay for:
- prescription drugs,
- physician visits,
- adult day health care services,
- some dental care,
- ambulance services,
- x-ray and laboratory costs,
- orthopedic devices,
- eyeglasses, and
- hearing aids.
HOW DOES MEDI-CAL DECIDE IF I AM FINANCIALLY NEEDY?
If you are single, you can have up to $2,000 in assets. If you are married, your spouse can have up to $90,660 in assets.
Medi-Cal calls these assets the Community Spouse’s Resource Allowance (CSRA) and calls your spouse the well spouse, or Community Spouse.
DOES MEDI-CAL COUNT ALL MY ASSETS?
No. Medi-Cal usually doesn’t count:
- your income and your spouse’s income
- your house (see below)
- one car
- household furnishings and other personal things
- wedding, engagement and heirloom jewelry
- burial plots and pre-paid, irrevocable burial contracts
- up to $1,500 in a revocable burial trust
- funds in your or your spouse’s IRA, 401(k), or similar account
- life insurance policies valued at $1,500 or less
- some annuity contracts
All other assets usually count.
HOW DO I CALCULATE THE VALUE OF MY INSURANCE, REAL PROPERTY AND CAR?
The value of your life insurance is its cash surrender or fair market value.
The value of your real estate is based on its property tax assessment value.
Medi-Cal calculates the value of your automobiles based on 2% of the automobiles’ value according to DMV.
DO I HAVE TO COUNT MY HOUSE?
Not always. Your house doesn’t count if:
- you say in writing, or ask someone else to say in writing, that you plan on going back to your house;
- your spouse, child (under age 21), or other dependent relative lives in your house;
- your sibling (who owns part of your house), or your child (who has lived in your house for at least a year before you went to the nursing home) lives in your house;
- you have tried to sell your home but have not been able to because of legal problems (you must show evidence that you have tried); or
- your home is a multiple dwelling unit and you live in one of the units.
DO I COUNT ASSETS HELD IN TRUST?
If you have a revocable trust that you or your spouse created, the trust is counted as part of your assets.
If you have an irrevocable trust, it is more complicated. Talk to a lawyer.
WHAT IS A “WELL SPOUSE”?
A well spouse, or Community Spouse,
- does not live in a skilled nursing facility (like a nursing home), and
- does not receive Medi-Cal benefits.
If you are in a nursing home, you are called the institutionalized, or ill spouse.
WHAT IS A COMMUNITY SPOUSE’S MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA)?
For 2003, the MMMNA was $2,267 per month. The MMMNA can be adjusted annually by a cost of living increase. If your spouse’s monthly income is less than the MMMNA, s/he can keep some of your monthly income up to the full MMMNA amount.
CAN THE COMMUNITY SPOUSE’S RESOURCE ALLOWANCE (CSRA) BE INCREASED?
Yes. If the well spouse’s income is less than the MMMNA, s/he can keep assets up to the allowable amount. But, you must get a court order or have a fair hearing to authorize this increase.
WHAT IS A FAIR HEARING?
If Medi-Cal denies you benefits, you can appeal. You must appeal within 90 days of being denied benefits. There will be a fair hearing with an administrative law judge.
WHAT IS SHARE OF COST?
Share of Cost is the amount you must pay for your medical costs or nursing care. It is like an insurance co-pay for your monthly medical costs.
The amount of your Share of Cost is your total monthly income minus the “maintenance needs standard.” Medi-Cal pays for the remaining cost of services.
The “maintenance needs standard” is $35.00 if you are single, elderly, or disabled and living in a skilled nursing facility. If you are not living in a skilled nursing facility, it is $600.00.
WHAT CAN I DEDUCT FROM MY INCOME?
You can use your income to pay for:
- Prescribed medical care and medical insurance premiums not covered by Medi-Cal
- Your spouse’s MMMNA (see MMMNA, above)
- Expenses for your rental property
CAN I STILL QUALIFY FOR MEDI-CAL IF I GIVE AWAY ASSETS?
You can give away exempt assets to anyone at any time. (See examples of exempt assets in Does Medi-Cal count all my assets? above.)
You can give away non-exempt assets (the assets Medi-Cal counts) to your:
- child who is under 21, blind, or totally or permanently disabled; or
- sibling or child who lived in your house before you moved into a skilled nursing facility.
If you give away non-exempt assets to anyone else, you will not get Medi-Cal for a period of time. This is called the penalty period, starting from the day you gave the gift.
The greater the value of the assets you gave away, the longer the penalty period. After the penalty period is over, you may still be able to give away assets and qualify for Medi-Cal.
CAN SOMEONE ELSE GIVE AWAY ASSETS FOR ME IF I BECOME INCAPACITATED?
Yes. If you have a Durable Power of Attorney, you can authorize your agent to make gifts for you. Otherwise, the Court can make gifts on your behalf.
CAN THE STATE PLACE A LIEN ON MY PROPERTY?
No. The State cannot place a lien on your property unless your house is for sale and does not count in deciding if you qualify for Medi-Cal.
But, after you and your spouse die, Medi-Cal can make a claim against your estate and ask to be reimbursed for benefits it paid.
DOES THE STATE HAVE A DEADLINE TO MAKE A CLAIM AGAINST MY ESTATE?
Yes. The State has four months to file a claim after getting written notice of your death or your spouse’s death and a copy of the death certificate. The State cannot make a claim against your estate if you are survived by a minor, disabled or blind child.
HOW MUCH CAN THE STATE MAKE A CLAIM FOR?
The State cannot ask for more than the amount it paid for your medical services after you were 55 years old plus the amount the State paid for nursing home care at any age.
The State cannot ask for more than the value of your estate at the time of your death. If you do not have any assets in your estate at the time of your death, the State cannot claim anything. The assets included in your estate are any assets you had legal title to or had an interest in at the time of your death.
WHAT IF I NEED A LAWYER TO HELP ME WITH MEDI-CAL?
Look in the phone book or ask your local senior center to refer you to an experienced Elder Law attorney. Or, contact a lawyer referral service for a referral and low-cost consultation. A list of lawyer referral services can be found on the Self-Help Resources webpage.
CAN THE COURT HELP ME QUALIFY FOR MEDI-CAL?
Maybe. If you want to increase the Community Spouse Resource Allowance (CSRA), the Community Spouse Monthly Income Allowance, and/or give away assets, you or your spouse can ask (petition) the Court for help. The Court will approve your Petition only if it is in the best interest of the Medi-Cal recipient.
THERE ARE 2 KINDS OF PETITIONS YOU CAN SUBMIT TO THE COURT:
Use 2580 Petition (Probate Code Section 2580 ), if a conservatorship has been established for the person getting or applying for Medi-Cal. (Click to visit pages on this website about conservatorships.)
Use the 3100 Petition (Probate Code Section 3100 ), if:
- There is no conservatorship,
- The assets are at least partly the property of the person getting Medi-Cal and his or her spouse, and
- You are the spouse, or
- You are the spouse’s conservator or guardian ad litem.
Sometimes the 3100 Petition allows you to include property owned solely by the person getting Medi-Cal.
This can be difficult to do on your own. Talk to a lawyer with experience in Medi-Cal. Ask the lawyer about your options and the consequences of pursuing them.
RELATED LAWS AND GUIDELINES
See the 42 USC 1396r-5 code page for the information and specific code sections referred to below.
To ask for a CSRA (Community Spouse's Resource Allowance) increase, read:
42 USC 1396r-5(f) Medi-Cal federal rules and state regulations
50490.5(b)(2) California Department of Health Services draft regulations
The above sections say the Court can increase CSRA to support the community spouse.
Section 42 USC 1396r-5(e)(2)(c) says if the spouse’s income is below the MMMNA amount, s/he can keep his or her assets (or the applicant’s assets) up to the MMMNA amount.
To ask for a Community Spouse Monthly Income Allowance Increase, read section 42 USC 1396r-5(d)(5).
The federal law says the Medi-Cal monthly income allowance for the well spouse cannot be less than the amount ordered by the Court. The Court is free to decide on a reasonable amount.
But, state law says increases decided at a fair hearing must be determined based on fixed guidelines. The Court can choose to use spousal support provisions from California Probate Code section 6540 and the California Family Law Code as guidelines.
To make a gift ("transfer of assets") to your spouse, find information on this 42 USC Sec. 1396p code page where section 42 USC 1396p(c)(2)(B)(1) addresses transfers or gifts of assets to the community spouse.