Stays in a skilled nursing facility or convalescent hospital can easily exceed $100,000 per year. Most seniors believe that Medicare pays for the cost of skilled nursing. This is only true in limited circumstances. First, the senior must be admitted to a hospital for at least three days prior to being transferred to the skilled nursing facility. Once in the skilled nursing facility, Medicare only pays for the first 20 days of care. There is a share of cost between Medicare and the senior for the next 80 days of care. After 100 days of care, Medicare will no longer pay for the cost of a long-term stay in a skilled nursing facility.
Long-Term Care Medi-Cal
For those seniors who qualify, Long Term Care Medi-Cal will pay for the cost of skilled nursing. For unmarried seniors, the amount of non-exempt assets cannot exceed $2000. Exempt resources include a residence, one car, IRA and other retirement plans, life insurance with a cash value less than $1,500, prepaid burial plans and personal jewelry, furniture, furnishings, and clothing. All other assets, such as savings accounts, money market accounts, certificates of deposit, annuities, vacation homes and rental properties are included when determining eligibility. All income other than a $35 personal needs allowance is used to help pay for nursing home costs. For instance, if the unmarried senior’s income is $2,000 per month, the first $35 would be set aside for personal needs and the remaining $1,965 would be paid to the skilled nursing facility. The Department of Health Services would pay the difference between the $1,965 and the amount charged by the skilled nursing facility.
For married couples, the rules for qualification are somewhat different. The spouse who is not in the nursing home, known as the community spouse, can retain a Community Spouse Resource Allowance or CSRA. For 2018, the CSRA is $123,600. He or she can also retain the exempt resources described above. For 2018, the community spouse can retain some or all of the institutionalized spouse’s (spouse in the nursing home) income until their combined income reaches $3,090. This amount is known as the Minimum Monthly Maintenance Needs Allowance or MMMNA. If the community spouse’s income exceeds this amount, he or she cannot retain any of the institutionalized spouse’s income and it will all be paid to the skilled nursing facility.
If an unmarried senior or married couple has assets in excess of these limits, they will not be able to qualify for Long-Term Care Medi-Cal; however, with proper planning eligibility can be achieved. Our webpage entitled “Crisis Planning” discusses how to achieve Long-Term Care Medi-Cal eligibility when the senior is already in the nursing home or about to be transferred there. Advance asset preservation and eligibility planning are much easier and less stressful than trying to plan for immediate eligibility. For this reason, we strongly recommend you begin the planning process as early as possible. This is especially true where there is a history of Alzheimer’s disease, dementia, Parkinson’s disease, stroke, or heart disease in the family. Call our office to schedule an appointment to learn more about Long-Term Care Medi-Cal and asset preservation planning.
Very Limited Availability of Government Assistance for In-Home or Assisted Living Facility Care
There is very limited availability of government assistance for seniors wanting caregiver services in the home or in an Assisted Living Facility. If the senior can qualify for Community Medi-Cal, he or she may be able to help pay for in-home caregivers through a program called In-Home Supportive Services (IHSS). The services available, however, do not include 24-hour care and there are strict income limitations that preclude many seniors from qualifying for Community Medi-Cal. Call our office to schedule an appointment to learn more about Community Medi-Cal and In-Home Supportive Services.
For those seniors who are veterans and served during a time of war, they may be eligible for Veterans Aid and Attendance benefits or enhanced pension. Aid and Attendance benefits can provide additional income for the veteran, a widow of a veteran, or a married couple where at least one spouse was a veteran, to pay for caregivers in the home or at an Assisted Living Facility. For 2018, the maximum monthly benefit for a widow of a veteran is $1,176. The maximum monthly benefit for an unmarried veteran is $1,830. The maximum monthly benefit for a married couple where one spouse is a veteran is $2,169. The requirements for eligibility for this benefit are similar to qualifying for Long Term Care Medi-Cal Aid, but there are also important differences. See our webpage entitled “Planning for Veteran’s Aid and Attendance” for more information about Aid and Attendance benefits.
In rare circumstances, an unmarried senior or couple needing caregiving services equivalent to that provided in a skilled nursing facility may qualify for one of California’s waiver programs. These programs provide nursing level care in the home or in an Assisted Living Facility.
Our Riverside Attorneys Can Help You with Planning for Long-Term Medi-Cal
Because of the strict eligibility guidelines, early planning is the key to qualifying for Long-Term Medi-Cal when you need it. Our experienced Riverside estate planning attorneys can help you incorporate planning for Long-Term Medi-Cal strategies into your existing estate plan, or into a new plan, to help ensure that your assets are protected if the need for long-term care does become a reality in the future. Call our office at 951-888-1460 or contact us online to schedule an appointment to learn more about these waiver programs.