By JUDD MATSUNAGA, Esq.
In my last article, “Inflation Is A-Coming” (March 19, 2022), we saw how inflation is actually a hidden tax on people’s savings. Although American retirees have just received a 2022 Social Security increase, i.e., a 5.9% cost-of-living adjustment (COLA), the cost of Medicare surcharges has increased at a faster pace, leaving a net decline of benefits for many.
Now, many families in the Rafu Shimpo community are just plain rich. To rich people, the record high cost of food and gas is more or less an inconvenience. However, there are also many families in the Rafu Shimpo community who are not rich. To those living on fixed incomes, having to pay record high prices for food and gas is more than just an inconvenience, it’s about survival.
Somehow, ending my last article advising seniors who are struggling to make ends meet to make sure their saving deposits are FDIC-insured seemed grossly inadequate. So I thought long and hard about something to write that would be more beneficial. Then, about 6:00 in the morning, it dawned on me — what if there was a way to double or even triple your income? Who wouldn’t want that?
“Who do I have to rob?” you might ask. Nobody. Everything I’m about to share is perfectly legal. It’s a way for seniors to put government dollars in their pocket to help pay for the higher cost of food, gas, medications, etc. There are basically only three requirements for this to work: (1) low income; (2) a “need” for supportive services; and (3) to qualify for Medi-Cal.
Here’s how it works: As an example, let’s continue to use Tak, the retired plumber. Tak is 85 years old and single. The first requirement mentioned above is low income. Since Tak worked for himself (and got paid in cash for most of his jobs), he only receives $1,482 per month in Social Security income. (Generally, you earn close to $1,500 per month if you’re single, or around $2,000 per month if you’re married.)
Second, because Tak is “slowing down” in his old age, there’s a “need” for supportive services, i.e., the second requirement. There are nine different categories of services that will qualify: domestic, heavy cleaning, related services, personal care, accompaniment to medical appointments, yard hazard abatement, teaching and demonstration, paramedical services, and protective supervision.
Domestic Services includes a wide variety of household chores and tasks such as: sweeping, vacuuming, and washing/waxing floors; washing kitchen counters and sinks; cleaning the bathroom; storing food and supplies; taking out garbage; dusting and picking up; cleaning oven and stove; cleaning and defrosting refrigerator; bringing in fuel for heating or cooking purposes from a fuel bin in the yard; changing bed linen; changing light bulbs; and wheelchair cleaning and changing/recharging wheelchair batteries.
Personal Care Services include the following activities: ambulation, bathing, oral hygiene, and grooming, routine bed bath, bowel and bladder care, dressing, repositioning, menstrual care, feeding, respiration assistance, assistance with prosthetic devices, and assistance with self-administration of medication.
Ambulation includes such tasks as: assisting the recipient with walking or moving from place to place inside the home, including to and from the bathroom; climbing or descending stairs; moving and retrieving assistive devices, such as a cane, walker, or wheelchair, etc.; and washing/drying hands before and after performing these tasks. Ambulation also includes assistance to/from the front door to the car (including getting in and out of the car) for medical accompaniment and/or alternative resource.
Bathing includes such tasks as: cleaning the body in a tub or shower; obtaining water/supplies and putting them away; turning on/off faucets and adjusting water temperature; assisting with getting in/out of tub or shower; assistance with reaching all parts of the body for washing, rinsing, drying, and applying lotion, powder, deodorant; and washing/drying hands.
Oral Hygiene includes such tasks as: applying toothpaste, brushing teeth, rinsing mouth,
caring for dentures, flossing, and washing/drying hands. Grooming includes such tasks as: combing/brushing hair; hair trimming when the recipient cannot get to the barber/salon; shampooing, applying conditioner, and drying hair; shaving; fingernail/toenail care when these services are not assessed as “paramedical” services for the recipient; and washing/drying hands.
Routine Bed-Bath includes such tasks as: cleaning basin or other materials used for bed
sponge baths and putting them away; obtaining water and supplies; washing, rinsing, and drying body; applying lotion, powder, and deodorant; and washing/drying hands before and after bathing.
Bowel and Bladder Care includes such tasks as: assisting with using, emptying, and cleaning bedpans/bedside commodes, urinals, ostomy, enema, and/or catheter receptacles; application of diapers; positioning for diaper changes; managing clothing; changing disposable barrier pads; putting on/taking off disposable gloves; wiping and cleaning recipient; assisting with getting on/off commode or toilet; and washing/drying hands.
The last major step is that Tak has to qualify for Medi-Cal. Qualifying for Medi-Cal may be the easier than you think. Beginning on July 1, 2022, a new law makes qualifying for Medi-Cal much easier. Tak can have up to $130,000 (up from $2,000) in savings and qualify for Medi-Cal. If Tak has more in savings, there are still ways to legally “spend-down” or “stack-gift” the excess money to qualify for Medi-Cal benefits.
Once Tak has Medi-Cal he can qualify for In-Home-Supportive-Services (IHSS). IHSS is a county program that will pay to keep you at home. Services almost always need to be provided in your own home, or the home of a relative (such as a son or a daughter). Here’s the good part — you can elect to have them pay a family member, e.e., your daughter, for helping you live at home.
That’s right, IHSS will pay friends, family members and in some instances, spouses, for help with housework, meal preparation, and personal care. In addition, most IHSS recipients can hire, fire, and supervise their own care givers under the Independent Provider (IP) mode of service. In fact, most IPs are relatives of the client.
Right now, Tak’s adult daughter does much of the household chores, e.g., cooking, cleaning, shopping, etc. — unpaid. With IHSS, Tak elects to have his daughter be the Independent Provider (IP). IHSS will pay his daughter up to $3,200 per month to help pay for his care. What’s more, Tak still keeps his $1,482/mo income from Social Security, potentially tripling his income!!!
“Is that legal?” you ask. You bet!!! All you have to do is first qualify for Medi-Cal. With the help of an experienced elder law attorney, qualifying for Medi-Cal usually isn’t a problem. You can still keep your home, even if it’s worth $750,000 or more and it’s “free and clear.” The key is protecting your home from a future Medi-Cal recovery claim after your death. That’s why you need an attorney.
“But Judd, I don’t want to go to a nursing home.” I understand — I wouldn’t want to either. I’m talking about you living in your own home and qualifying for Medi-Cal in order to get In-Home-Supportive-Services. The goal of the IHSS program is to allow you to live safely in your own home and avoid the need for out-of-home care, i.e., nursing homes. But guess what — if you ever need to go to a nursing home in the future, you’re already qualified for Medi-Cal to pay.
In conclusion, remember that a diagnosis of a specific condition is generally not enough to show “need.” For example, the fact that an applicant has diabetes is not enough to show need. So the applicant will want to explain if and how the diabetes causes difficulty seeing, walking, eating, etc.
IHSS will send a county social worker out to the house to determine the applicant’s “level of ability and dependence upon verbal or physical assistance by another.” The assessment will evaluate the applicant’s physical, cognitive, and emotional impairments and determine if the applicant has a functional limitation that can be supported by an IHSS-covered service.
The more categories you need help with, e.g., domestic services, personal care services, etc. listed above, the more money you get. (I can claim I need help with many of them, and I’m only 63.) In other words, if you proudly stick out your chest and declare “I don’t need any help,” you won’t get any money. So, if there ever was a time to “monku, monku, monku,” this is it.
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.