Medi-Cal is a state-run program that is available for eligible children and adults with limited income. The eligibility requirements differ in each state, but generally, to be eligible, you must have a low income and limited assets. Aside from the income limitations, those who are blind, disabled, pregnant or over age 65, may also be eligible for Medi-Cal. Yet, there are some individuals who, even with income over the limit, may still be able to receive Medi-Cal benefits. In some situations, the medically needed may be covered by Medi-Cal, as well.
How the Medically Needy Programs Work?
Each state has, what is known as, a “spend-down” period, during which time, the state Medi-Cal agency will analyze an applicant’s income and expenses to determine whether you qualify for Medi-Cal benefits. The Medically Needy Program affects how the “spend down” analysis works. With this program, you are allowed to include your medical expenses in the analysis, in order to reduce your income. In other words, if your state has a 6-month spend down period, then you can establish your medical expenses during that period, in order to satisfy your spend down requirement. It is not necessary to show expenses that were actually paid, just those expenses that were incurred.
Who is eligible for Medi-Cal Medically Needy Programs?
While each state has the choice as to whether to offer medically needy programs to its citizens, they also have the discretion to choose which categories of individuals will be eligible for the program. For instance, your state may choose to offer the Medically Needy Program to the elderly, but not to the disabled. States cannot, however, exclude children or pregnant women, if they decide to offer the program.
California’s Medically Needy Program
California’s Medi-Cal law (§50201) provide the following, with regard to the Medically Needy:
(a) A person’s eligibility shall be determined under the Medically Needy program if that person is any of the following: (1) An aged, blind or disabled person who meets one of the following conditions: (A) Is not eligible for or does not want to receive assistance as a PA or Other PA recipient. (B) Has an application pending for SSI/SSP. (2) A child or family member who is both: (A) Linked to AFDC in accordance with Section 50205. (B) Not eligible for or does not want to receive assistance as a PA or Other PA recipient. (3) A caretaker relative who chooses to be included in a child’s MFBU in accordance with Section 50373 (a)(5)(A) 13 or when all children are PA or other PA.
The Affordable Care Act and Medically Needy Programs
The Affordable Care Act allows states to expand Medi-Cal to low-income adults under the age of 65. Many of the individuals who might have qualified for Medi-Cal under the Medically Needy Program, may now qualify for Medi-Cal more easily under the Affordable Care Act’s new expanded coverage. However, these expansions do not affect the elderly (age 65 and older), so medically needy programs are still very important for them.
If you have questions regarding the Medically Needy Program, or any other Medi-Cal planning needs, please contact the Schomer Law Group either online or by calling us at (301) 337-7696.