A Way to Stay The first group of options is focused on staying in the RCFE, minimizing disruption to the resident. Perhaps the best route in this regard is SSI (Supplemental Security Income). If an RCFE resident is out of savings and makes less than $1,173 per month, they will qualify for SSI at the board and care rate. The facility will receive $1,039, which it must accept as payment in full for basic services, and the resident will receive $134, which they may use for personal needs.
For more on SSI in RCFEs see CANHR’s fact sheet at http://canhr.org/factsheets/rc... Another alternative for staying in place for military veterans who have run out of money is using the Veterans’ Aid and Attendance benefit. This gives qualifying veterans a modest monthly benefit to help pay for RCFE (or other types of) care. For more on the Aid and Attendance program, see CANHR’s fact sheet at http://canhr.org/factsheets/mi... attendance.htm If the RCFE participates in the Assisted Living Waiver (ALW) program, the resident who has run out of money and qualifies for Medi-Cal benefits should definitely apply. The ALW program is designed to keep RCFE residents out of more expensive nursing homes and pays the facility a range from approximately $50 to $200 per day. The problem is that not many RCFEs participate in the ALW program and there is currently a substantial waitlist to receive the benefit. For more on the ALW program, see CANHR’s fact sheet at http:// canhr.org/factsheets/rcfe_fs/html/fs_alw.htm If there is no benefit or program that will enable the resident to stay in their RCFE, a final option is to simply negotiate with the management for a lower rate. Some facilities may have occupancy shortages and prefer the resident stay at a lower rate than leave altogether. Moving On If the resident cannot stay in the facility despite the foregoing options, they should, of course, consider moving to a less expensive RCFE. This may be a viable alternative for a resident of a high end assisted living facility with a healthy income.
Residents with lower incomes who don’t qualify for SSI have few options. For some residents less dependent on care, they may be able to return to an independent living arrangement by cobbling their care together through family and friends, In-Home Supportive Services, adult day care, or another MediCal-funded Home and Community Based Service (HCBS) program that offers long term services to individuals living at home. For more on eligibility for these programs, see CANHR’s fact sheet at http://www . canhr.org/factsheets/medi-cal_fs/PDFs/FS_Spousal_ Impoverishment_HCBS.pdfFor residents who require a great deal of care and cannot go to an independent living arrangement, their only option may be a nursing home, paid for primarily through Medi-Cal. The big problem for these residents is that nursing homes are very reluctant to admit anyone when Medi-Cal is their primary payment source. Their chances of nursing home admission are much better if they can trigger Medicare coverage through a 3-day qualifying hospital stay - so the only option for an increasing number of RCFE residents is to try to get into a hospital. This is extremely unfortunate for residents and for public policy. A Growing and Vexing Problem The state and federal governments offer little in the way of benefits programs to RCFE residents who have run out of money. For generations, those governments have favored spending on institutional (nursing home) care. In 1999, the U.S. Supreme Court found the bias in favor of institutional spending violated disability discrimination law, which should have ushered a new era of community based alternatives. (Olmstead v. L.C.) While there have been efforts to expand home and community based programs since then, they have not kept pace with the increased demand as the population continues to age. Public spending in California continues to shamefully favor institutional care. Until major changes occur in our policies, RCFE residents who run out of money will continue to have limited options for future care and will often remain precariously unsure of what to do.
In California, 65 percent of nursing home residents rely on Medi-Cal to cover their nursing home expenses. Unfortunately, in some cases, the program can require you to pay all of your income toward care costs, and Medi-Cal has the right to take some of your assets to cover your costs after your death.
To reduce the financial burden, understand the basics of the program and do as much pre-planning as possible.
1. Asset Amounts Are Limited
If you use the Medi-Cal program to pay for nursing home expenses, you are only allowed to have a certain amount of assets. Unfortunately, this threshold has not changed for decades. As of 2017, the asset limit is $2,000 for an individual or $3,000 for a couple.
If you have assets that exceed that amount, they basically need to be liquidated before you can join the program. Unfortunately, you have to be careful about transferring or giving away assets. Before distributing payments to your nursing home, the program looks at the last 60 months of your personal finances to see what you have given away.
2. Some Assets Are Exempt
Luckily, certain assets are exempt. That means you can own them even if they exceed the above threshold. Exempt assets include your primary residence if your spouse lives there or you plan to return there. Possible exempt assets also include one vehicle, some personal belongings, a burial plot and certain life insurance policies.
If you are trying to get below the above asset threshold, you may want to buy some assets on the exempt list.
3. Income May Be Required
If you have an income, you may be required to do cost sharing. That simply means that you contribute some of your income to the cost of your care. Generally, you are only allowed to keep a small amount of money for monthly personal expenses.
4. Well Spouses May Be Allowed to Keep Some of Your Income
If you are married, your spouse may be allowed to keep some of your income. Under the laws related to Medi-Cal, the well spouse is entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA). As of 2017, the allowance is $3,023 per month. If the well spouse's income is less than that amount, he or she can keep part of your income.
For example, a well spouse has a pension of $1,000 and a Social Security payment of $1,100. The spouse going into the nursing home has a
monthly pension of $2,000 and a Social Security Income of $1,200. In this case, the well spouse's income is only $2,100. That is $923 under the MMMNA. The well spouse is entitled to keep that much of the other spouse's income while the rest goes to the Medi-Cal program.
If the situation were turned around, the well spouse would have an income of $3,200 and the spouse on Medi-Cal would have an income of $2,100. In this case, all of the latter spouse's income goes toward Medi-Cal because the well spouse's income meets the MMMNA on its own. The well spouse gets to keep all of his or her income.
Although there is a minimum allowance, there is no income limit imposed on the well spouse.
5. Medi-Cal May Take Your Home After Your Death
When someone who is on Medi-Cal dies, their home passes to their spouse. However, if they do not have a spouse or when the last spouse dies, the program may take the home to cover expenses. Luckily, you can avoid this by transferring ownership of the house.
Medi-Cal rules are complicated, and if you want to pass as many assets to your heirs as possible, you may need to do some pre-planning. To get started, contact the Rosā Law Offices today.
