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California Advocates for Nursing Home Reform. Medi-Cal & Long Term Care. CANHR Services . Consumer Hotline: (800) 474-1116 Lawyer Referral Service Pre-Placement Services: www.nursinghomeguide.org www.residentialcareguide.org Website: www.canhr.org Legal Services Support

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California Advocates for Nursing Home Reform


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canhr services
CANHR Services
  • Consumer Hotline: (800) 474-1116
  • Lawyer Referral Service
  • Pre-Placement Services:

www.nursinghomeguide.org www.residentialcareguide.org

  • Website: www.canhr.org
  • Legal Services Support
  • Legislative Advocacy
  • Legal Information Network
  • Family Council Organizing
aged disabled federal poverty level program
Aged & Disabled Federal Poverty Level Program

Mrs. Jones wants no

Share of cost Medi-Cal:

  • If income was $1,250 she would not be eligible
  • $1,250
  • $20Deduction
  • $1,230
  • - $125 Medicare
  • $1,105 > $1,081= SOC
  • - 600Maintenace Need Allowance
  • $505 Share of Cost

$300 Pension

+ $900 SSA

$1,200

- $20 Deduction

$1,180

- $125 Medicare

$1,055 < $1,081=

No Share of Cost

Unearned Income

Unearned Income

share of cost deductions
Share of Cost Deductions

Johnson v. Rank:

  • Copy of prescription & bill to facility
  • Facility deducts from that month’s SOC

and bills resident for the remaining SOC

  • $600 SOC
  • 50 (non-covered)
  • $550 Remaining SOC
  • Hunt v. Kizer:
  • Unpaid medical bills for which beneficiary is legally responsible
  • Original documentation showing billing statement is an outstanding balance
  • Take bills to County Welfare Office for Hunt v. Kizer deduction
  • SOC is adjusted to reflect cost
medi cal assets
Medi-Cal Assets

Exempt

  • Whole Life Insurance
  • (face value $1,500 or less)
  • Term Life Insurance
  • Burial Plot
  • Prepaid Irrevocable Burial Plan
  • $1,500 Designated Burial Funds
  • Pension Funds/IRAs/ Annuities (work-related only)
  • $2,000 Cash Reserve
  • CSRA: $101,640 (2007)
  • Home
  • Other Real Property
  • Business Property
  • Household Goods and
  • Personal Effects
  • Jewelry
    • Single
    • Spouse
  • One Car
medi cal assets7
Medi-Cal Assets

Non-Exempt:

  • Cash (over limit)
  • Non-compliant annuities
  • Stocks
  • Other Real Property
  • Bonds
  • Trust Principal
  • Notes Receivable

Convert

Spend Down

Transfer30 (36) month rule

transfer of assets sample 1
Transfer of Assets- Sample #1

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

2 months = period of ineligibility

When does period start to run:

March: ineligible

April: ineligible

May: eligible

* APPR for 2007

transfer of assets sample 2
Transfer of Assets- Sample #2

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

How Calculated:

Each transfer calculated separately Transfer periods

run concurrently

March: ineligible

April: eligible

* APPR for 2007

when transfer penalties do not apply
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
income less than mmmna
Income Less than MMMNA

Spousal Income:

John (NF) Mary (Home)

$2,500/month $500/month

MMMNA Calculation:

$2,541* MMMNA

- 500 Mary’s Income

$2,041 Spousal Allocation

John’s Share of Cost:

$2,500 John’s income

- 2,041 Allocation to Mary

$459 SOC (minus $35)

*MMMNA for 2007

community spouse resource allowance csra
Community Spouse Resource Allowance (CSRA)

Assets of Spouses:

John (NF)

Mary (At home)

$75,000 (J/T CD)

+ $75,000 (Mary’s SP)

$150,000 Total Assets

Calculation with CSRA:

$150,000 Total Assets

- 101,640* Minus CSRA

- 2,000 John’s reserve

$46,360 Over CSRA

* CSRA for 2007

increase in csra
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

- 2,000 John’s cash reserve

$46,360 Above CSRA

Options:

  • Spend down
  • File for increase in MMMNA
  • File Court Order
  • Retain excess assets/income
when home is exempt
When Home Is Exempt
  • Exempt relative lives in home
    • Spouse
    • Minor or dependent relative
    • Sibling, son or daughter has lived
  • there at least 1 year prior to NF
  • entry & continues to live there
  • Legal obstacles prevent sale of home
  • Beneficiary intends to return home
to whom can the home be transferred
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