Medi-Cal Benefit Planning

Medi-Cal is a combined federal and California State program designed to help pay for medical care not covered by Medicare. Medi-Cal is a need-based program and is funded jointly with state and federal Medicaid funds. You need to apply for Medi-Cal and be approved. It is not a benefit you automatically receive like Medicare.

Medi-Cal Recovery

California’s budget bill, SB833 was signed by the Governor Brown in June. The bill incorporates the provisions of SB 33 and includes the most comprehensive Medi-Cal Reform measures since 1993!

No recovery on the estates of surviving spouses.

•Recovery limited to only that required by federal law, i.e., for those 55+ years of age, nursing home facility, home and community based services, etc. or any age if person “permanently institutionalized.”

•Waiver of claim for homesteads of modest value.

•“Estate” limited to probate estate – thus, living trusts, JTs, TODs, etc. will not be subject to recovery.

•Interest on liens will be limited (currently at 7%)

​For specific questions about avoiding recovery or the recovery process, please call us to schedule a complimentary 1 hour consultation at (805) 915-4793

Medi-Cal vs. Medicare

Medicare is a federal insurance program paid out of Social Security deductions. All persons 65 or older who have made Social Security contributions are entitled to the benefits, as well as persons under 65 with disabilities who have been eligible for Social Security disability benefits for at least two years, and persons of any age with end-stage renal disease.

Medicare has several parts including Hospital Insurance (Part A) and Medical Insurance (Part B). Medicare is not based on financial need. Anyone who meets the age, disability and/or coverage requirements is eligible. Medicare does not pay for all medical expenses, and usually must be supplemented with private insurance. After 3 days of prior hospitalization, Medicare will pay up to 100% for the first 20 days of skilled nursing care. For the 21-100 days, the patient will pay a co-payment. The premiums and copayments are increased every year. There will be no Medicare coverage for nursing home care beyond 100 days in any single benefit period.

It should be noted that Medicare only pays for “skilled nursing care,” does not pay for “custodial care” and the average stay in a nursing home under Medicare is usually less than 24 days. Thus, few can look to Medicare to pay for any substantial nursing home costs.

Medi-Cal is a combined federal and California State program designed to help pay for medical care for public assistance recipients and other low-income persons. Although Medi-Cal recipients may receive Medicare, the Medi-Cal program is not related to the Medicare program. Medi-Cal is a need-based program and is funded jointly with state and federal Medicaid funds.

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