By JUDD MATSUNAGA, Esq.
In America, the strongest and richest nation in the world, you’d think that everyone would have sufficient resources to pay for food and medicine, be able keep a roof over their heads, and meet their other basic needs. You would think that everyone, regardless of their race, color, age, or national origin, deserves quality health care.
However, the sad truth is that 45% of Americans over 65 have trouble meeting their basic needs — that’s nearly half of older adults. (Source: www.justiceinaging.org)
Since its inception in 1935, Social Security payments have been instrumental in providing economic security for older adults in the U.S. Additionally, Medicare, which provides health insurance to 66 million people age 65 or older. offers financial protection by helping to cover the cost of medical care, while Medicaid (California’s Medi-Cal) provides additional benefits and cost-sharing assistance to many Medicare beneficiaries with low incomes.
Social Security is called a “cornerstone” of the U.S. social safety net, providing a crucial source of income for millions of Americans. Unfortunately, the “safety net” is full of holes. Over 1 in 10 (10.2%) adults ages 65 and older were living in poverty in 2022, i.e., household income below $14,040 in 2022. In 2025, the poverty level for a single individual is $15,650 annually. For a family of two, it’s $21,150. (Source: www.kff.org, Kaiser Family Foundation, May 21, 2024)
The average Social Security benefit is around $1,900 per month, but millions of retired workers and their spouses receive much less than that. Because of lower wages earned during working years, the poverty rate was higher among people ages 80 and older, women, and people of color. For example, based on the official poverty measure, the share of older Black (17.3%), Hispanic (17.4%) and American Indian or Alaska Native (17.4%) adults with incomes below poverty was more than double the share of older white adults (7.7%).
In 2025, the cost-of-living adjustment (COLA) for Social Security benefits was only 2.5%, despite rising prices just about everywhere. This means that Social Security benefits, including Supplemental Security Income (SSI), will increase by 2.5% starting with payments made in January 2025. This increase translates to an average monthly increase of about $50 for retirement benefits, according to an AARP article.
But COLA adjustments are completely out of touch with the “real world.” The real cost food, gas, health-care, living expenses, etc. are increasing by far more than COLA’s 2.5% increase in 2025. Furthermore, because Part B premiums (up 5.9%) are commonly deducted from Social Security checks, that discrepancy can lead to beneficiaries seeing smaller monthly checks even after cost-of-living increases. If you’re a senior living on Social Security, you might alco be “feeling the pinch.”
To make things worse, California is facing a $12 billion budget deficit. On May 14, Gov. Gavin Newsom outlined his nearly $322 billion state spending plan for the upcoming fiscal year. Newsom wants to help close the deficit by freezing enrollment in state-funded health care programs for the disabled, poor, and elderly, targeting primarily Medi-Cal and In-Home Support Services. A final budget must be signed by June.
The governor proposes the reinstatement of the Medi-Cal asset limit for disabled adults and seniors of $2,000 for an individual or $3,000 for a couple, a restriction that effectively demands extreme poverty in order to continue receiving critical health care.
These policies, if enacted, will slash hundreds of billions in Medicaid funding and undermine Medicare and the Affordable Care Act (ACA). As a result, at least 13.7 million people, including older adults, could have their health and long-term care coverage stripped away.
On a positive note, there are still many steps in the process before this bill becomes law. For those who can see the “writing on the wall,” NOW is the time get a Medi-Cal card!!! Why?
Under the existing law, it’s fairly easy to qualify for Medi-Cal since they removed the Asset Test on Jan. 1, 2024. You can keep your home and savings and still get a Medi-Cal card before they make it almost impossible to qualify.
“Say, Judd, just how likely is it that the law is changed denying Medi-Cal benefits to seniors and disabled adults?” Very likely. With the coming “tsunami” of baby boomers reaching nursing home age (average: 81years old) in the coming years, the government can’t afford to keep paying for long-term care. So they plan to shift the financial burden of long-term care off the “public sector” and place the cost on the “private sector.” In the not too distant future, workers will be forced to purchase long-term care insurance.
California lawmakers and government think tanks have a plan to eliminate Medi-Cal. “If that’s so,” you might ask, “why did California’s Medi-Cal eliminate the Asset Test on Jan. 1 of 2024? Why are millionaires allowed to get Medi-Cal benefits? It makes no sense.” Here’s my explanation — soon and very soon, they’ll announce that Medi-Cal is out of money to pay for long-term care.
They’ll blame it on the millionaires who took advantage of the “no asset test” law and took benefits that they didn’t really need. Without Medi-Cal (Medicaid), Americans will be forced to buy long-term care insurance. And if you don’t buy LTC insurance privately on your own, you’ll get state-sponsored insurance. And just like Social Security, the premiums will be deducted from your paycheck.
Here’s my point — “when life gives you lemons, make lemonade.” If you’re retired and living off Social Security, qualify for a Medi-Cal card NOW. Even if you’re still healthy and independent, all seniors should consider getting a Medi-Cal card while they’re still available. It’s like having long-term care insurance without having to pay the expensive premiums. And, you don’t need to pass a physical exam.
Under current California law, you may qualify for Medi-Cal even if you have a million dollars in the bank and own your home (still exempt), even if you don’t need help or assistance at this time. You don’t lose your Medicare by qualifying for Medi-Cal, i.e., you keep the same doctors and become “Medi-Medi.”
Furthermore, no more “out-of-pocket” doctor co-pays, or prescription medication costs. If the government eliminates Medi-Cal benefits in the future, there’s a good chance you’ll be “grandfathered” in.
If you have a loved one currently in a nursing home and privately paying $10,000 or more per month — STOP! Get Medi-Cal to pay the high cost of long-term care. But in order for Medi-Cal to pay, you have to be in a licensed Medi-Cal facility, e.g., Kei-Ai (the old Keiro), Hollenbeck, Atherton, etc. are all licensed Medi-Cal facilities.
However, Medi-Cal will not pay for retirement homes, board and care, or assisted living (unless they accept the Assisted Living Waiver (ALW) program).
If you have an elderly parent still at home, you might say, “Mom doesn’t want to go to a nursing home.” I don’t blame her. But chances are, as she grows older, she’s depending on her adult children to help her more and more, e.g., drive to the doctor, pay the bills, etc. More often than not, the adult care-giving child is helping mom out UNPAID.
Why not get money from In-Home-Supportive-Services (IHSS) so that Mom can continue to live in her own home?
IHSS is a county program designed to allow you to live safely in your own home and avoid the need for out-of-home care, i.e., nursing homes. Services almost always need to be provided in your own home, or the home of a relative. 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 adult children to help Mom with housework, meal preparation, and personal care, etc.
To be eligible for IHSS, a person must be enrolled in Medi-Cal. Since the current law makes it easy to qualify Mom for Medi-Cal, the trick now is getting the most money from IHSS.
IHSS will not pay for 24/7 home care. It’s designed to help pay for part-time home care. 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, the more money you get.
In other words, if Mom proudly sticks out her chest and says, “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.
Remember, there’s a limit on how much IHSS will pay. So even if Mom is bed-bound and can’t do anything, IHSS puts a cap on benefits paid. The maximum numbers of hours is 283 per month. They will pay the city or county’s minimum wage, approximately $17 per hour. If you get maximum hours in Los Angeles, for example, that’s $4,811 per month!!! That’s “nothing to sneeze at.”
Here’s the good part — you get to pick the “care provider.” You can elect to have IHSS pay a home care agency, or a family member, e.g., your daughter. That’s right! IHSS will pay your adult child to help you live at home, e.g., domestic services such as housework, personal care services such as bathing, ambulation around the house, etc.
Perhaps the biggest obstacle to seniors qualifying for IHSS is income. Income and income from assets, such as income from property, will continue to be counted. IHSS is generally not available to seniors making more than $1,677 per month, or couples making more than $2,269 per month.
If you are slightly over this amount, $200-$500 per month, there are ways to lower your income by purchasing a supplemental dental plan or vision plan in order to qualify for IHSS.
Please keep in mind that the current law eliminating Medi-Cal’s Asset Test will not affect Medi-Cal’s estate recovery rules. Federal law requires Medi-Cal agencies to recoup payments for certain Medi-Cal benefits, long-term care, and home and community-based services for some Medi-Cal beneficiaries. Those recovery rules will continue to apply. Under the old law, the only way to avoid recovery is to have nothing left in your estate at the time of death.
But they’ve changed the law regarding Estate Recovery. As of 2017. California limits estate recovery to those estates that are subject to probate under California law. This is great news! Now you have DOUBLE the advantages for making your Revocable Living Trust: (1) Avoiding the legal nightmare called probate; and (2) Protecting your home from a Medi-Cal estate recovery claim.
Judd Matsunaga, Esq., is the found-ing 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 Foun-tain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.