The need for long-term care can come, not only from illness but also from a catastrophic injury. That’s why the potential need for Medicaid cannot be overlooked by anyone. In some situations, the need for assistance with daily activities may lead to long-term care needs, as well. Because health insurance does not always adequately cover the cost of long-term care, Medi-Cal benefits may be necessary. Let our attorneys explain why Medi-Cal planning can help you prepare for nursing home care.
The cost of nursing home care can be expensive
A common mistake many clients make is underestimating the potential costs of long-term care. In California, the average annual cost for long-term care is close to $100,000. Considering the fact that nearly half of all California citizens age 65 and older will need long-term care for approximately five years, paying for this medical necessity will be overwhelming to most families. Typically, Medicare and private health insurance are insufficient to cover the costs of long-term care.
Nursing home violations can cause many problems
The reality is, many nursing homes have instituted operating procedures that are in violation of certain laws, and are often harmful to their residents. Many of these problems are not obvious legal issues that come to the attention of regulating authorities. For this reason, consumers need to know what their rights are, under the law, so they can be better able to ensure they receive the best care available.
California’s Medi-Cal program
Medicaid and nursing homes are connected financially. Nursing homes rely to a large extent on reimbursement from Medi-Cal. Medi-Cal is California’s version of Medicaid, a health insurance program for low-income individuals. Most long-term care facilities in California are Medi-Cal certified, which means they accept reimbursement from the State’s program. In fact, nearly two-thirds of all nursing home residents in California have all, or at least a portion, of their costs paid for by Medi-Cal.
Medicaid discrimination is a common issue
However, the reality is, patients receiving Medi-Cal benefits are often not treated as well because Medi-Cal pays lower rates than most other sources of reimbursement. This is a form of discrimination. According to some experts, Medi-Cal patients are more likely to receive very low-level custodial care. Some nursing homes also attempt to refuse certain types of service, such as rehabilitative services. However, if a facility is Medi-Cal certified, and the care is medically necessary, then the nursing home is required to provide those services.
Poor long-term care planning is another common issue
Under the law, nursing homes are required to develop comprehensive care plans for each and every patient, within seven days after a full assessment of that patient has been completed. Another common issue arises when families are not allowed to be involved in that care plan, or the plan is not followed by the nursing home staff. Furthermore, the care plan must be reviewed every three months, so it can be modified if necessary. This does not always happen, which means an inadequate care plan may be in place.
Refusing to readmit Medicaid patients after hospitalization
It is very common for nursing home patients to be temporarily hospitalized for treatment. Medi-Cal funded nursing homes are required to hold those patients beds for seven days, during which time the nursing come will continue to be paid by Medi-Cal. However, in many cases, the nursing home will refuse to allow the patient to return, hoping that a higher-paying patient will take their place. For example, a nursing home would prefer to serve a Medicare rehab patient, for which they may be paid as much as $600 a day, compared to an average of $186 a day from Medi-Cal. If you find yourself in this situation, contact your Medicaid attorney for assistance. In order to get the care you deserve, you should know your rights, and you must speak up.
How is Medi-Cal planning beneficial?
The purpose of Medicaid benefits is to help low-income individuals pay for medical treatment and services. Because Medicaid is a needs-based benefits program, you must have no more than $2,000 in assets to be eligible. Even though certain assets such as your home are excluded from your countable assets, it is still not that difficult to exhaust your savings before Medicaid will start to cover your long-term care expenses. However, the goal of Medi-Cal planning is to keep you from exhausting all of your resources, while still being eligible for benefits.
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