1. Medi-Cal in an age of Trumpcare
Presented by Brian O’Toole, Esq.

2. Health Care policy touches on all of these topics.
Impolite Topics
Money
Religion
Sex
Politics
Health Care policy touches on all of these topics.

3. What is Medi-Cal?
A federal-state program established in 1965 to help low-income individuals pay for medical care.
An entitlement program:
No caps on spending or enrollment

4. Types of Medi-Cal Affordable Care Act Traditional Medi-Cal
Eligibility is based on limited income.
Medicare recipients are not eligible
CA reimbursed 90% - 100% by federal government
Eligibility is based on limited assets.
Medicare recipients are eligible.
CA reimbursed 50% by federal government

5. Who uses Medi-Cal Adults and Children Elderly and Disabled
84% of Medi-Cal enrollees
40% of expenditures
16% of Medi-Cal enrollees
60% of expenditures

6. Medi-Cal for the Elderly
Medicare provides hospital, doctor, and pharmaceutical coverage.
100 days of rehab coverage at a skilled nursing facility.
*Rechargable*
Medi-Cal may be used to supplement Medicare coverage.
Unlimited custodial coverage at a skilled nursing facility.

7. Enrollment Bias
The 50% Medi-Cal federal reimbursement creates a bias for states to ease Medi-Cal eligibility restrictions.
Since 2006, California has been “working on” implementing federal law that punishes gifting assets with Medi-Cal ineligibility.
Until then, a Californian may transfer $8,514.00/person/day and not incur Medi-Cal ineligibility.
**Coordinate any Medi-Cal asset protection strategy with a qualified attorney**

8. Political Response Block Grants
Give the states a block grant of money to administer their Medi-Cal programs as they see fit.
From the State’s perspective:
The good: The state legislature and governor have freedom to allocate resources as they like.
The bad/ugly: Substantial reduction in contribution from the federal government.

9. Political Response (Part 2)
If states are going to receive a block grant then why not implement “single payer” at the state level?
(Proposed and shelved in the CA Legislature)
The good: Everyone has health insurance.
The bad/ugly: CA Legislative analysis estimates that the cost is $200 billion. $400 billion total less $200 billion in existing federal, state and local funds.

10. Political Response (Part 3)
Look for “Medicare-for-all” to be a rallying point for the next Democratic presidential nominee.
Bernie Sanders, Kamala Harris, Elizabeth Warren have cosponsored legislation already.

11. Question and Answer

12. Presented by Brian O’Toole
Thank You!
Presented by Brian O’Toole
2835 Mitchell Drive, Suite 105
Walnut Creek, CA 94598
(925)

13. Slides and Handouts can be found online at www. EldercareAnswers
Slides and Handouts can be found online at Up next: Evaluating Capacity in Older Adults by Eric Freitag