For some families, there may come a time when you need to consider whether a loved one would benefit from hospice care. Hospice care focuses on caring, instead of curing, medical ailments and providing end-of-life care, most often within the patient’s home. In many cases, it will be the patient’s friends and family who will serve as the primary caregivers and decision makers with regard to the care of their terminally ill loved one. Members of the hospice team usually make regular visits to evaluate the patient and provide additional medical care or services as required. Fortunately, hospice care is covered under different Medi-Cal assistance programs.
Have a plan for paying for Medi-Cal assistance hospice care
You can pay for hospice care in a variety of ways. The most common methods for covering the cost of hospice care services include Medicare, Medi-Cal, private insurance, TRICARE (health benefit program for military personnel), private pay and charitable care programs. If you intend to seek Medi-Cal assistance to pay for hospice care, it is wise to have a plan. Your elder law attorney can help you start your Medicare planning.
You don’t have to be sick to plan ahead
A common mistake people make is believing that you must be sick to plan for future long-term care or hospice care. That is not always the case because serious injuries can also result in the need for long-term care or hospice care. According to reports, more than 2/3 of the over 65 population will need some form of long-term health care and, ultimately, will seek hospice care services.
For this reason, Medi-Cal planning is a good idea for everyone who could potentially need Medi-Cal assistance. In some situations, people are admitted to nursing homes as opposed to receiving in-home hospice care. There are different ways that someone’s situation could change making the need for hospice care an unexpected reality.
Why advance Medi-Cal planning can be useful
The purpose of Medi-Cal benefits is to help low-income residents in California pay for their medical care. Since Medi-Cal is a needs-based program, its recipients must have less than $2,000 in total assets. Consequently, the goal of Medi-Cal planning is to eliminate the need to exhaust all of your resources so you can become or remain eligible for benefits.
Also, if a Medi-Cal applicant gives away property just prior to submitting their application for Medi-Cal benefits, a transfer of property at that point could be seen as fraudulent. That would result in a delay of your benefits or even denial. On the other hand, if you engage in proper Medi-Cal planning, you can avoid the appearance of fraudulent transfers.
What you need to know about qualifying for Medi-Cal
If you already qualify for Medi-Cal, then your coverage should include hospice care if you ever need it. There are certain groups of people who automatically qualify for Medi-Cal, such as SSI recipients, participants in the CalWORKs (California’s Temporary Assistance to Needy Families) program, people enrolled in California’s refugee programs, and children in the California foster care system.
Medi-Cal places limitations on income and assets
Another way many people qualify for Medi-Cal is based on their limited income. Pursuant to the Affordable Care Act, the income limit for Medi-Cal is now 138% of the Federal Poverty Level (FPL). That equates to about $16,100 for an individual and $32,900 for a family of four. While the Affordable Care Act has done away with the asset test for most Medi-Cal applicants, if you are elderly or disabled, you will still need to have minimal assets in order to qualify for Medi-Cal. The limits are $2,000 for an individual and $3,000 for a couple. Not every asset will be counted towards that limit, however. For instance, your residence will not be counted if your spouse still lives there. Also one vehicle, personal belongings, and small burial or life insurance policies are typically not counted towards your asset limit.
Sharing the cost Medi-Cal
If you have surplus income preventing you from qualifying for Medi-Cal, but your health care expenses are still very high, including the cost of hospice care, then you may qualify for a program called Share of Cost (SOC) Medi-Cal. SOC Medi-Cal allows recipients to spend only a set portion of their income towards their medical expenses every month, while Medi-Cal pays the remainder of the incurred expenses. The portion that the Medi-Cal recipient pays is referred to as his or her share of cost.
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