By JUDD MATSUNAGA, Esq.
“You want free medical care? You’re going to have to spend every penny you have to get it,” said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform (CANHR). “Thousands and thousands of people have become impoverished to afford nursing home care,” McGinnis said. (Source: www.usnews.com, July 20, 2021)
NOT ANYMORE – In case you missed it, Assembly Bill (AB) 133 includes the elimination of Medi-Cal’s asset test! The asset test elimination will be phased in over 2.5 years. First, as of July 1, 2022, the state will raise the asset limit in the Medi-Cal programs serving older adults and people with disabilities to $130,000 for an individual and $65,000 for each additional family member.
This huge increase will allow many people to get on or stay on Medi-Cal without having to impoverish themselves. Persons on these Medi-Cal programs will be able to save money for an emergency, for retirement, for a down payment on a car, or for any needs a person may have. This is a huge win, and one that California Health Advocates have been working on for a long time.
The old Medi-Cal asset test had set an asset limit of $2,000 for an individual and $3,000 for a couple for adults over age 65. This limit has not been raised since 1989 and has blocked thousands of people from receiving Medi-Cal. Families have been prevented from saving money for a new roof, new car or any type of emergency, and promotes financial instability – but not anymore.
After Jan. 1, 2024, the state will eliminate the asset test completely. Financial criteria for Medi-Cal benefits will be based solely on income. These changes will expand access to Medi-Cal for approximately 18,000 new beneficiaries. Officials estimate it will cost the state roughly $200 million a year once fully implemented because of the increased enrollment.
This means that if you applied for and were denied Medi-Cal benefits anytime between January to May 2022 because the person did not meet the current asset limit of $2,000 for an individual and $3,000 for a couple, they may re-apply for Medi-Cal and submit bank statements or other documents that demonstrate they are below the new asset limit of $130,000 after July 1, 2022.
Assets that are counted include cash, money in a banking account, more than one vehicle, or a home or land that the person does not live in. A home is exempt as an asset if the Medi-Cal applicant or recipient lives in the home. Other assets that are not counted include one vehicle or personal item, such as a television, or other household items. These rules will continue under the asset limit increase in July 2022.
After January 2024, the ownership of a home, other real property, more than one vehicle, or the amount of money and savings in a banking account, will not be taken into account for Medi-Cal benefits. However, the changes to the Medi-Cal asset limits will not affect Medi-Cal estate recovery rules. So it’s still extremely important to protect those assets from estate recovery.
“But Judd, what does this mean to me?” If you never end up in a nursing home, perhaps nothing. However, as you age, you’re at a greater risk of injuries and disabilities that may make long-term care necessary. A Prudential Research Report (2010) found that about 70% of Americans over the age of 65 will need long-term care services during their lifetime.
Disabilities affect 2 in 5 adults over the age of 65, according to the Centers for Disease Control and Prevention (CDC). Between 2015 and 2065, the National Center for Health Statistics expects the number of older people with physical or cognitive disabilities to grow by almost 150%, from 6.3 million to 15.7 million. (Source: www.consumeraffairs.com, Jan. 27, 2022)
I sincerely hope you (and ME) are fortunate enough to be part of the 30% of Americans who never need long-term care. But even if you don’t, this new law could be GREAT NEWS if your income is low enough. If you or anyone you know is living on fixed income, e.g., Social Security, and having trouble making ends meet, financial help of an additional $2,000-$4,000 per month may be just around the corner.
Here’s how it works. The first requirement to get financial help is low income. If you’re single and earn close to $1,500-$2,000 or less per month, or around $2,000-$2,500 or less per month if you’re married, you may be eligible. Second, there must be a “need” for supportive services. In other words, if you’re as strong as you were when you were 40, you probably won’t get any money. Can you use help with the following:
(1) 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; changing bed linen; changing light bulbs.
(2) 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.
(3) 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.
(4) 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.
(5) 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; shampooing, applying conditioner, and drying hair; shaving; fingernail/toenail care; and washing/drying hands.
(6) 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
(7) 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 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 64.) 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.
The last major step is to qualify for Medi-Cal. But the new law made that a whole lot easier. You no longer have to spend all your money to qualify. And even if you have more than $130,000 in savings, there are still ways to legally “spend down” or “stack gift” the excess money to qualify for Medi-Cal benefits.
“But Judd, I don’t want to go to a nursing home.” I understand — I wouldn’t want too either. I’m talking about you living in your own home and qualifying for Medi-Cal in order to get In-Home Supportive Services (IHSS). IHSS is a county program that will pay to keep you at home. 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.
Here’s the good part — you can elect to have them pay a family member, e.g., 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 IP’s are relatives of the client.
“Is that legal?” you ask. You bet!!! All you have to do is first qualify for Medi-Cal. With the elimination of Medi-Cal’s asset test, qualifying for Medi-Cal is now much easier. You don’t have to be penniless; you can still keep your home (even if it’s worth $1,000,000 or more). The key is protecting your home from a future Medi-Cal Recovery Claim after your death. That’s why you should consult with an experienced Medi-Cal planning attorney.
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.