The new law provides for the following:
- Medi-Cal recovery applies only to those who are 55 years or older, were in nursing homes or participated in home and community based services;
- Avoids recovery against the estates of surviving spouses or registered domestic partners. This is a big change because before the state could recover against spouses and domestic partners;
- Restricts the amount of interest the states can assess on liens. Before the interest rate was 7% a year, now it will drop dramatically to 0.55%;
- Limits recovery to assets that are subject to probate only. This is another big change because if it the assets were in a revocable living trust, it was subject to recovery;
- Requires the state to provide to a beneficiary a copy of the Medi-Cal expenses that may be recoverable; and
- Requires the state to waive the claim on a substantial hardship when the estate is subject to recovery on a homestead of modest values.
So, what is still subject to Medi-Cal recovery:
- Even though the state can no longer recover for basic health services, e.g. doctor’s visits, prescription drugs or managed care reimbursements – it can recover for services that are related to nursing home care or home based services for those who are 55 and older or if the beneficiary is permanently institutionalized.[1]
- Recovery is limited to services required to be recovered under federal laws, for example:
- Home and Community Based Services;
- Intermediate care for developmentally disabled;
- Related hospital and prescription drug services given to a person who is receiving nursing facility services and home and community based services;
- Nursing home care.
Medi-Cal planning is planning for those who want assistance paying the high cost of nursing home care – which cost an average of $10,000 - $15,000/month – and, at the same time, maintain their assets. This planning is for everyone regardless of income level.
Ivette M. Santaella, partner at the law firm of Santaella Legal Group, APC, located in the tri-valley areas of San Ramon, Danville and Dublin, can assist you with this valuable and growing area of elder law.
[1] Permanently institutionalized means any person – regardless of age – who are inpatients in a nursing facility or other medical institution who must pay a share of cost for their care and who, after notice of a hearing, the state has determined cannot be expected to be discharged and sent home.