Over 55? Be Cautious with Medi-Cal!

Some time back, feels like about a year, I got mass mailings from Medi-Cal, inviting people to sign up, saying that many more people would be eligible than know they are. Which struck me as uncharacteristic of Medi-Cal, which (I had heard, maybe wrongly) had a reputation of obstructing applicants and being generally miserly or tardy with payments, to the point that many health providers refuse to take Medi-Cal patients. And now they want to hand out coverage?

Recently I received another mailing from Medi-Cal, which may explain this anomaly. This one comes from the Estate Reimbursement division, addressed to me because I am the executor of a will of someone who received Medi-Cal benefits. It turns out that if, after the age of 55, you received any treatment that Medi-Cal paid for, then at your death, your estate is liable for reimbursement to the state for whatever that treatment cost. There are certain exemptions — for example, if your spouse survives you, they won't take anything until the spouse dies, at which time they will come back again. They won't go after the inheritance of minor children. They won't try to get any reimbursement if they think it will cause severe hardship.

I think I would have remembered if the solicitation mailing had mentioned that very salient fact. I've asked around, and nobody I know realized that Medi-Cal did this. Most people refused to believe it. But here it is, from the California Department of Health Services web site's "Estate Recovery Program."

The Medi-Cal program pays for medical services and premiums, including payments to managed care plans, for people who are unable to pay for their own care. Upon death, the decedent’s estate or any recipient of the decedent’s estate may have to pay the costs of care back under federal and state law. Repayment will come from the assets of the deceased Medi-Cal member and will not exceed the asset value.

Now this, it seems to me, is extremely deceptive, if not consciously deceitful, if most people over 55 don't realize that whenever they use Medi-Cal, they are shifting the burden of the entire medical cost to their children or other heirs — and no one ever told them about this hidden take-back.

Besides saying "BUYER BEWARE", I'd add "USER BEWARE". Most times we don't have all the details available, or we choose not to read them all. Really, who has time? (Do you read all the words in a manual when you buy a new product? I only read what I need to, in order to use it.) This doesn't mean that every system, including MediCal is out to deceive us.

The problem remains that those who NEED financial help with health treatment, don't have many options besides MediCal. Because I have Medicare and MediCal, I'm on a Senior MediCal Advantage program with Kaiser. I only pay $1.20 for prescriptions. If you know of other health resources for low income people without MediCal, please share these. People with resources to leave to heirs would be able to pay for health insurance, but choose not to. Maybe they need those resources for daily costs of food, shelter, or institutional living. But then when they die, they leave an inheritance which is used to pay their MediCal debt. Is there a way around this? I don't know, but maybe someone does.

It really is impossible to know all the details of every kind of service we sign up for. I just discovered a resource yesterday that's listed in the Senior Directory in three different places, but with no details about what services they provide. It would take too much space. I only discovered this resource because a friend was going to attend a meeting there, and invited me to go. Hopefully all disabled people know about the Disability Services and Legal Center. This resource would have been a great help to a friend who waited 3 years before receiving SSI benefits, and even then the amount was only $600. So for someone unable to work, and needing shelter, this resulted in her having to do "work trades" for a room. All of these have been at the mercy of those who took advantage of a disabled person without financial resources.

For seniors, there is a resource that I didn't know about. That is Senior Advocacy Services. The way I found out about it was that I gave a friend a ride to her appointment. She wanted to get advice on whether she should sign up for MediCal. https://senioradvocacyservices.org/

When I took her to drop off her MediCal forms at Human Services, I discovered yet another resource for low income people ~FREE SMART phones from Assurance! She came out of the appointment with a new one in a box. FREE phone and FREE SERVICE. I'm sure there are details that she wasn't told about. But that's not the responsibility of the worker. It's my friend's responsibility, if she decides to use this phone. I think it must be a limited amount of minutes and data, but that makes sense.I did some research, and found that there are several companies that provide a FREE Phone and FREE service. I got mine with FREEDOM POP. Now I have to figure out how to use it, since I've never had a smart phone! (I'm hoping it will make me smarter.)

When I had a hip replacement many years ago, I was very surprised at "check out" that I owed nothing. It was
covered because I was on this program. If I had owed money for the surgery, I would still be in debt because I couldn't have paid it. My entire "estate" consists of an 1997 vehicle, with 267,000 miles on it, a $50 computer and a camera that's not worth more than $50.

On another note, I owe the IRS over $10,000, (for over 10 years) and regularly get invoices from them. They go in the "round" file. The only ones I respond to are the certified letters, as I was advised to by an ex IRS agent. I've written to them, telling them that I'm on SS of under $1200 a month with no way to pay my debt. I don't have a credit card or savings. During my last phone conversation, I was told that I would continue to receive invoices, and that if my financial position ever improved to contact them. That was several years ago.

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Posted in reply to the post by comodin:

...Now this, it seems to me, is extremely deceptive, if not consciously deceitful, if most people over 55 don't realize that whenever they use Medi-Cal, they are shifting the burden of the entire medical cost to their children or other heirs — and no one ever told them about this hidden take-back.

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I think there are pretty strict rules about Medi-Cal eligibility. Definitely low income and I think a limit of the total assets you can have. Do you think it is fair under our current system to have someone get subsidized or free health care to enable them to leave the money that they saved to their heirs, rather than paying for it themselves?

Universal and free health care would be my strong preference, but until then we are foced to abide by the existing rules. The rules are complicated, but the reimbursement from inheritance is not hidden. It's also not horribly expensive because Medi-Cal is an insurance program and the costs are primarily the cost of the insurance premiums that the state pays.

Ron

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Posted in reply to the post by comodin:

...The Medi-Cal program pays for medical services and premiums, including payments to managed care plans, for people who are unable to pay for their own care. Upon death, the decedent’s estate or any recipient of the decedent’s estate may have to pay the costs of care back under federal and state law. Repayment will come from the assets of the deceased Medi-Cal member and will not exceed the asset value...

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It is true that MediCal tries to recover funds it expends on treatment for its recipients; if spouse or dependents continue to live in the house they don't seek recovery. Also, if the Medi-Cal recipient sells the house before death, there is no recovery. I'm not sure what happens if the spouse or dependents sell the house, but I think there would be no recovery.

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Posted in reply to the post by comodin:

... It turns out that if, after the age of 55, you received any treatment that Medi-Cal paid for, then at your death, your estate is liable for reimbursement to the state for whatever that treatment cost. There are certain exemptions — for example, if your spouse survives you, they won't take anything until the spouse dies, at which time they will come back again...

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Another resource for seniors who are not on SSI, but who live or eat alone, and whose income is $1296mo or less, is food stamps, or CalFresh, as it is now known.

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Posted in reply to the post by Shandi:

...For seniors, there is a resource that I didn't know about. That is Senior Advocacy Services. The way I found out about it was that I gave a friend a ride to her appointment. She wanted to get advice on whether she should sign up for MediCal. https://senioradvocacyservices.org/...

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Yes, and when I checked I can get $15 in food stamps with SS of $1180.

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Posted in reply to the post by Tinkerbell:

Another resource for seniors who are not on SSI, but who live or eat alone, and whose income is $1296mo or less, is food stamps, or CalFresh, as it is now known.

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under stand medical is not low cost or free ,it is a for profit ,insurance scheme after too many years of
persons not paying total inflated healthcare cost ,can you say hidden death tax ,current mandated
insurance ,by law is another big ins co money grab ,ups rates for customers and forced compliance
Single payer is the real solution,even with its downsides./womb too tomb big corp/gov/grab
as seen with so called reasonable college loans ,legal slavery for the life of citazen. THINK.

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Posted in reply to the post by comodin:

Some time back, feels like about a year, I got mass mailings from Medi-Cal, inviting people to sign up, saying that many more people would be eligible than know they are. Which struck me as uncharacteristic of Medi-Cal, which (I had heard, maybe wrongly) had a reputation of obstructing applicants and being generally miserly or tardy with payments, to the point that many health providers refuse to take Medi-Cal patients. And now they want to hand out coverage?

Recently I received another mailing from Medi-Cal, which may explain this anomaly. This one comes from the Estate Reimbursement division, addressed to me because I am the executor of a will of someone who received Medi-Cal benefits. It turns out that if, after the age of 55, you received any treatment that Medi-Cal paid for, then at your death, your estate is liable for reimbursement to the state for whatever that treatment cost. There are certain exemptions —...

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I did a little legwork on this for a friend in another state. It seems that the Medicaid Asset limit was eliminated in 2014 with the start of the ACA (though perhaps not for folks going into long-term care). Scroll down for more details on what I found. I've included related topics on the different programs for the disabled and ill, because these questions often arise - especially for those in the 29 month SSDI wait period for Medicare benefits.

warm regards, Stephanie
xxx

Disclaimer: I am only a human being who's heard and read dozens of stories about these topics. I am not a professional, but an interested observer. Please check out everything with your trusted legal and financial advisors before taking any leaps. You may want to contact your employer's human resources department, an accountant, an elder care attorney and the Social Security Administration (at least to find out if you have enough work quarters and what your disability income rate would be).

Also, this is USA specific and will possibly change if the ACA changes.

SSI & SSDI
Just to clarify - there are two different social security programs for the disabled - Supplemental Security Income (SSI) and Social Security Income (SSDI).

SSI is both needs and assets based, you must meet the disability requirements and have low assets:
SSI Resources Limits for 2016: Individual $2,000, Couple $3,000
https://www.ssa.gov/news/press/factsheets/colafacts2016.html

SSDI has no needs or asset requirements, but does require that a certain number of work quarters in a certain time period. Many teachers and public employees have separate disability insurance systems and work earnings aren't credited to Social Security. Also, people who work under the table, for a spouse's/family business or work at home may not have enough earnings credited to be eligible SSDI.

MEDICAID AND MEDICARE
Once SSI is approved, income starts immediately and usually Medicaid coverage does too (no separate application process in most states).

With SSDI there's a 5-month wait period after disability date for income and a further 24 month wait for Medicare coverage after that.

MEDICAID ASSET RESTRICTIONS ELIMINATED, BUT MAYBE NOT FOR DUAL-ELIGIBLES AND LONG-TERM CARE
Medicaid has income restrictions, but not asset restrictions, thanks to the ACA:
One small, but critical, aspect of the Medicaid expansion is the elimination of the Medicaid asset limit. This provision will allow millions of low-income families to both get the health coverage they need and maintain or build a modest savings cushion. The Medicaid expansion has been rejected by half of the states but the elimination of the asset test applies to all states, not only those that have adopted the expansion. States will still have discretion to impose limits on elderly and disabled beneficiaries, but the majority of Medicaid enrollees will now be able to save freely.

Hello 2014, Goodbye Medicaid Asset Limit
By Aleta Sprague
JAN. 2, 2014
https://www.newamerica.org/asset-bui...d-asset-limit/
Essentially, the Medicaid expansion under the ACA will broaden Medicaid eligibility for low-income, non-elderly adults without regard to assets. A major exception for that age group are those with incomes above the threshold but with high out-of-pocket medical costs. Such individuals will be required to spend their assets down to the existing asset limit, which varies by state and is typically a few thousand dollars.
There are a few other caveats. Existing rules, including the asset tests, will continue to apply for individuals obtaining Medicaid eligibility through another program (e.g. foster care children, or SSI/SSDI recipients) and the elderly.

Bye-Bye Medicaid Asset Test
Austin Frakt
April 13, 2010
https://theincidentaleconomist.com/w...id-asset-test/

DUAL ELIGIBLE BENEFICIARIES (MEDICAID AND MEDICARE)
About 9 million people in the United States are covered by both Medicare and Medicaid, including low-income seniors and younger people with disabilities. These dual eligible beneficiaries have complex and often costly health care needs…

Dual Eligible
https://kff.org/tag/dual-eligible/
Medicaid provides health coverage to more than 4.6 million low-income seniors, nearly all of whom are also enrolled in Medicare. Medicaid also provides coverage to 3.7 million people with disabilities who are enrolled in Medicare. In total, 8.3 million people are "dually eligible" and enrolled in both Medicaid and Medicare, composing more than 17% of all Medicaid enrollees. Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.

Dual Eligibles – Medicaid and Medicare coverage
Seniors & Medicare and Medicaid Enrollees
https://www.medicaid.gov/medicaid-chip-program-information/by-population/medicare-medicaid-enrollees-dual-eligibles/seniors-and-medicare-and-medicaid-enrollees.html

MEDICAID, ASSETS AND LONG-TERM CARE
Also, if you're thinking of going into long-term care or have parent(s) who may need it, the asset spend down rules are stringent and worth planning for years in advance:

In order to be eligible for Medicaid, applicants must have no more than $2,000 in "countable" assets (the dollar figure may be slightly more, depending on the state). Applicants for Medicaid and their spouses may protect savings by spending them on non-countable assets. The following are examples of such expenditures:
prepaying funeral expenses
paying off a mortgage
making repairs to a home
replacing an old automobile
updating home furnishings
paying for more care at home
buying a new home

In the case of married couples, it is often important that any spend-down steps be taken only after the unhealthy spouse moves to a nursing home if this would affect the community spouse's resource allowance.

Spending Down Assets to Qualify for Medicaid
https://www.elderlawanswers.com/spending-down-assets-to-qualify-for-medicaid-12003

Social Security and medical coverage is extremely complex and worth planning for while you are well enough and have the time and focus to do it.

Someone else at Wacco reminded me of the Sonoma elder law expert Len Tillem who writes for the local papers and has recorded shows - archives available at their website - https://www.lentillem.com

I sent them my questions (see below-below) and partner David Brown’s response was illuminating.

Hope others find this helpful too,
Stephanie

-----Original Message-----
From: David Brown
To: Sent: Mon, Jun 20, 2016 9:11 am
Subject: Re: Form Submission - Contact Form - MediCal eligibility - asset limits

Stephanie,

You get Medi-Cal under the ACA if you don't have other insurance and your income is low enough to qualify. When you're 65, you get Medicare, which qualifies as insurance under the ACA. Thus, in order to get ACA Medi-Cal you have to be under age 65.

Keep in mind that you can qualify for Medi-Cal while on Medicare, just not under the ACA, but under the old rules, which say you can have only $2,000 in countable assets. Under the ACA, however, there's no resource limit for eligibility, so you can have more than $2,000 in countable assets.

The way to understand this is that the Medicaid expansion under ACA did nothing to change the prior Medi-Cal programs, but just added on a new Medi-Cal benefit for persons of low income who don't have other medical insurance.

David


On Sun, Jun 19, 2016 at 7:28 AM, Squarespace wrote:
Name: Stephanie
Email Address:
Subject: MediCal eligibility - asset limits
Message: I have questions about asset limits for Medi-Cal eligibility. Are there different requirements for elders than others?

Low-income, non-elderly folks seem to be treated differently since 2014, because the ACA. (see below)

What age makes one an elder? Age 55 when the Estate Recovery Program goes into effect? Age 65 when Medicare goes into effect? Or when one is headed toward long-term care?

What about the disabled in California? Can they get Medi-Cal while waiting for Medicare to kick in after the 29-month wait period for SSDI? Continue to get MediCal afterwards (dual eligibility)?

Thank you for unknotting this knotty problem!