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ANALYZING A MEDI-CAL ESTATE CLAIM

ANALYZING A MEDI-CAL ESTATE CLAIM. EXEMPTIONS FROM RECOVERY. Spouse (while alive) Minor (under age 21) BLIND OR DISABLED CHILD Any age Does not have to be an heir Does not have to be living in the property SSI or SSA Proof of award letter and birth certificate

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ANALYZING A MEDI-CAL ESTATE CLAIM

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  1. ANALYZING A MEDI-CAL ESTATE CLAIM

  2. EXEMPTIONS FROM RECOVERY • Spouse (while alive) • Minor (under age 21) • BLIND OR DISABLED CHILD • Any age • Does not have to be an heir • Does not have to be living in the property • SSI or SSA • Proof of award letter and birth certificate • Establishing Disability through DSS • Current: DSS process/Form MC 223 • Future: New disability regulation package (R-14-04)

  3. AMOUNT OF THE CLAIM 1) Amount of the Claim: • Amount of the claim or value of the estate whichever is less • Joint tenancies • Tenancies in common • Deduct outstanding mortgages, burial costs, etc. • Proportionate Share • Review Itemized Billing • IHSS exempt as of 9/1/00 • BUCHOLTZ (benefits paid prior to 10/1/93 joint tenancies, living trusts)

  4. VALUE OF ESTATE ESTATE = All real and personal property and other assets in which the decedent had any legal title or interest at the time of death (to the extent of such interest) 1. Name on the property at the time of death 2. Property transferred during life 3. Annuities purchased on or after September 1, 2004 4. Life Estate • Irrevocable transfer with retention of life estate (immune) • Revocable "transfer" with retention of life estate (not) • Life Insurance or retirement accounts that name the estate as the beneficiary or revert to the estate

  5. HARDSHIP CRITERIATitle 22 CCR Section 50963 1. OTHER FACTORS • Elimination of "factors including, but not limited to" 2. PUBLIC BENEFITS • Receipt of inheritance would enable applicant to discontinue public assistance or medical assistance 3. BUSINESS • Estate is part of income-producing business, including working ranch or farm, and recovery would result in losing primary source of income

  6. Hardship Criteria Continued… • AGED, BLIND OR DISABLED LIVING IN THE HOME • An aged, blind or disabled applicant has lived in decedent's home at least one year prior to decedent's death and continues to reside there. • Applicant unable to obtain financing • Applicant must apply for financing not to exceed proportionate share • Applicant shall provide denial notice from financial institution

  7. Hardship Criteria Continued… 5. CAREGIVER • Applicant provided care for two or more years that prevented or delayed admission to medical or long term care institution • Applicant resided in home while care provided • Applicant continues to reside in home • Applicant must provide written medical documentation of care from health care provider • Documentation must show level and duration of care delayed or prevented placement Practice tip: Gather documentation while providing care

  8. Hardship Criteria Continued… 6. NO CONSIDERATION • When the applicant transferred the property to the applicant for no consideration 7. EQUITY NEEDED • When the equity in the property is needed by the applicant to make the property habitable, or to acquire the necessities of life, such as food, shelter or medical care

  9. California Advocates for Nursing Home Reform Medi-Cal Changes: Deficit Reduction Act of 2005

  10. Income First Rule • ACWDL 06-12 gives instruction to Administrative Law Judges to implement rule • Applies to Fair Hearing requests beginning March 1, 2006 • Income from institutionalized spouse must be allocated before increase in the CSRA can be granted • Does not apply to 3100 petition court-ordered increases in the CSRA

  11. Look-Back Period • DRA requires 60 mo. look-back • Policy and Regulations most likely not finalized until 2008 • Possible phase in, e.g., 1/08= 30 mo., 2/08= 31 mo., etc. • Hardship criteria will be promulgated to conform to federal law • According to DHS rule will not be applied retroactively • California continues to operate under 30 mo. look-back

  12. Transfer of Assets • Partial months will now be counted • Multiple transfers will be accumulated • DHS plans to limit the ability to transfer the home • According to DHS rule will not be applied retroactively • California continues to operate under old law

  13. Home Equity Provisions • Allows states to increase the equity limit from 500k to up to 750k • Hardship waiver criteria will be developed • Not likely to go into effect until late 2007 or later • Law is likely to impact beneficiaries who became eligible after 1/1/06 • Watch for Reverse Mortgages, RAMs, and lines of credit

  14. Counting Months of Ineligibility • Period of ineligibility will not begin until beneficiary is: • otherwise eligible for Medi-Cal but for the period of ineligibility and • would otherwise be receiving institutional level of care • Beneficiary can no longer wait out the period of ineligibility • California continues to operate under old law

  15. Documentation of Citizenship • Provisions only apply to citizens • Immigrants may still apply for Medi-Cal as before • Citizen recipients of SSI and Medicare not affected • DHS issued draft All County letter in July 06 • California continues to operate under old rules

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