1. California Advocates for Nursing Home Reform Medi-Cal & Long Term Care

2. CANHR Services Consumer Hotline: (800) 474-1116 Lawyer Referral Service Pre-Placement Services: www.nursinghomeguide.org www.residentialcareguide.org Website: www.canhr.orgwww.canhr.org Legal Services Support Legislative Advocacy Legal Information Network Family Council Organizing

3. Aged & Disabled Federal Poverty Level Program $300 Pension + $900 SSA $1,200 - $20 Deduction $1,180 - $125 Medicare $1,055 < $1,081= No Share of Cost If income was $1,250 she would not be eligible $1,250 - $20 Deduction $1,230 - $125 Medicare $1,105 > $1,081= SOC - 600 Maintenace Need Allowance $505 Share of Cost Unearned Income Mrs. Jones wants no Share of cost Medi-Cal:

4. Overview of Medi-Cal for Long Term Care

5. Share of Cost Deductions Johnson v. Rank: $600SOC - 50 (non-covered) $550Remaining SOC 1.Copy of prescription & bill to facility 2.Facility deducts from that month’s SOC and bills resident for the remaining SOC Hunt v. Kizer: 1.Unpaid medical bills for which beneficiary is legally responsible 2.Original documentation showing billing statement is an outstanding balance 3.Take bills to County Welfare Office for Hunt v. Kizer deduction 4.SOC is adjusted to reflect cost

6. Medi-Cal Assets Whole Life InsuranceWhole Life Insurance (face value $1,500 or less) Term Life InsuranceTerm Life Insurance Burial PlotBurial Plot Prepaid Irrevocable Burial PlanPrepaid Irrevocable Burial Plan $1,500 Designated Burial Funds$1,500 Designated Burial Funds Pension Funds/IRAs/ Annuities (work-related only)Pension Funds/IRAs/ Annuities (work-related only) $2,000 Cash Reserve$2,000 Cash Reserve CSRA: $101,640 (2007)CSRA: $101,640 (2007) Exempt HomeHome Other Real PropertyOther Real Property Business PropertyBusiness Property Household Goods andHousehold Goods and Personal Effects Personal Effects JewelryJewelry SingleSingle SpouseSpouse One CarOne Car

7. Medi-Cal Assets Non-Exempt: Cash (over limit) Cash (over limit) Non-compliant annuities Non-compliant annuities Stocks Stocks Other Real Property Other Real Property Bonds Bonds Trust Principal Trust Principal Notes Receivable Notes Receivable Convert Spend Down Transfer 30 (36) month rule

8. Transfer of Assets- Sample #1 * APPR for 2007 Date of Transfer v. Date of Application: March 15:$11,000 to daughter May 1: Apply for Medi-Cal Period of Ineligibility: $11,000 ÷ APPR ($5,101)* = 2.15 Months $11,000 ÷ APPR ($5,101)* = 2.15 Months 2 months = period of ineligibility 2 months = period of ineligibility When does period start to run: March: ineligible April:ineligible May:eligible

9. Transfer of Assets- Sample #2 * APPR for 2007 Multiple Transfers: Total Amount = $18,000 March 15:$6,000 to Joe March 15:$6,000 to Sue March 15:$6,000 to Amy Period of Ineligibility: $6,000 ÷ APPR ($5,101)* = 1.17 month 1 month = period of ineligibility 1 month = period of ineligibility How Calculated: Each transfer calculated separately Transfer periods run concurrently March: ineligible April:eligible

10. When Transfer Penalties Do Not Apply  Asset is Exempt  Transferred to blind or disabled child (not a minor)  Intended to transfer for fair market value or valuable consideration  Denial of eligibility would result in undue hardship

11. Income Less than MMMNA *MMMNA for 2007 Spousal Income: John (NF) Mary (Home) John (NF) Mary (Home) $2,500/month $500/month $2,500/month $500/month MMMNA Calculation: $2,541* MMMNA - 500 Mary’s Income $2,041 Spousal Allocation $2,041 Spousal Allocation John’s Share of Cost: $2,500 John’s income - 2,041 Allocation to Mary $459 SOC (minus $35) $459 SOC (minus $35)

12. Community Spouse Resource Allowance (CSRA) Assets of Spouses: John (NF) Mary (At home) $75,000(J/T CD) $75,000(J/T CD) + $75,000(Mary’s SP) $150,000Total Assets $150,000Total Assets Calculation with CSRA: $150,000 Total Assets $150,000 Total Assets - 101,640* Minus CSRA - 101,640* Minus CSRA - 2,000 John’s reserve - 2,000 John’s reserve $46,360 Over CSRA $46,360 Over CSRA * CSRA for 2007

13. Increase in CSRA Spousal Income & Assets: John (NF) Mary (At Home) $1,500/Month $500/Month $50,000 IRA $30,000 IRA Other Spousal Assets: $150,000 In other joint assets - 101,640* CSRA for 2007 - 101,640* CSRA for 2007 - 2,000 John’s cash reserve $46,360 Above CSRA $46,360 Above CSRAOptions: Spend down Spend down File for increase in MMMNA File for increase in MMMNA File Court Order File Court Order Retain excess assets/income Retain excess assets/income

14. When Home Is Exempt Exempt relative lives in homeExempt relative lives in home SpouseSpouse Minor or dependent relativeMinor or dependent relative Sibling, son or daughter has livedSibling, son or daughter has lived there at least 1 year prior to NF there at least 1 year prior to NF entry & continues to live there entry & continues to live there Legal obstacles prevent sale of homeLegal obstacles prevent sale of home Beneficiary intends to return homeBeneficiary intends to return home

15. To Whom Can the Home Be Transferred? A Spouse A minor, blind or disabled child A sibling with an equity interest who has lived in the home for 1 year prior to B’s entry into NF A son or daughter, who lived there 2 years prior to B’s entry into NF and provided care To anyone as long as property was exempt at the time of transfer *Review DHS Forms 7077 and 7102