Medi-Cal is a health care assistance program that extends health care services to U.S. citizens based on their income or financial need. Medi-Cal programs are run independently by each state. Therefore, Medi-Cal benefits and eligibility requirements differ from one state to the next. Patients with Medi-Cal generally pay a small co-pay, if anything at all, for health care. A common question many clients have is: Will Medi-Cal pay for in home health care.
In home nursing care
Each state provides long-term care for eligible individuals, who live at home, but requiring nursing care. Typically, Medi-Cal in home care strictly provides medical care, and it runs out when the medical condition stabilizes. However, there are waiver programs that can be used, to help keep individuals out of nursing homes for as long as possible. Although these programs are not technically part of Medi-Cal, they are usually funded by Medi-Cal through certain waiver programs. These programs are referred to as “Home and Community-Based Services” (HCBS).
What do Home and Community-Based Services programs provide?
Waiver programs can provide much more than just medical care. In addition to nursing care and physical therapy, the HCBS programs can offer personal care services to assist with normal “activities of daily living” (ADLs). ADLs include eating, bathing and dressing. HCBS programs can also provide homemaker services, like cooking, cleaning and laundry services, as well as meal delivery. Adult day service centers and transportation to and from medical care and other services, may also be available. If minor modifications to a home, such as widening a doorway to accommodate a wheelchair, or assistive devices and medical equipment, are needed, those expenses may also be covered.
Who is eligible for a waiver program?
Determining eligibility for an HCBS waiver program, is a two-step process. First, the program analyzes the need for medical care and assistance with activities of daily living. Usually, the need must be extensive enough that, without in-home care, the applicant would need to move into a nursing home.
The next part of the analysis is financial need. The applicant must have low income and very few assets. The good news is, the income and asset levels are not as low as those required to be eligible for Medi-Cal coverage. In fact, in some states, the limits are two or three times higher than Medi-Cal limits. In some states, the assets belonging solely to the applicant’s spouse are not counted for determining eligibility.
If you have questions regarding in home care, or any other Medi-Cal issues, please contact the Schomer Law Group either online or by calling us at (310) 337-7696.