The Differences Between Medicare and Medi-Cal, Part 2.

So, last week we looked at the Medicare program, and what it covered.  Today we look at Medi-Cal (which is California’s version of the Federal Medicaid program).

Medi-Cal is a program that is jointly funded by the Federal and State governments.  It is designed (among other things) to help seniors pay for long term medical care.  Although Medi-Cal recipients may receive Medicare, the Medi-Cal program is not related to the Medicare program.

 

1. Medi-Cal Eligibility

Social Security Insurance (SSI) and other categorically-related recipients are automatically eligible. Others, whose income would make them ineligible for public benefits, may also qualify as “medically needy” if their income and resources fall are within the Medi-Cal limits.  Limits for 2013 is $2,000 for a single individual, and 115,920 for a married couple.

 

2. What Does Medi-Cal Cover?

Generally, the costs of staying in a skilled nursing facility (SNF) is covered by Medi-Cal, provided that a physician certfies that the care is “medically necessary.”  Medi-Cal also pays for other “medically necessary” health care services.  In addition to the costs of a SNF, these include things such as some prescriptions not otherwise covered by the Medicare Part D program, some types of in-home care, physician visits, some dental care, ambulance services, some medical equipment, etc.  In addition, any costs, which exceed the patient’s “Share of Cost” (which we will discuss next week) are also covered.

 

If the individual qualifies for Medi-Cal, s/he does not need private “medigap” or HMO insurance to pay for costs, though if such insurance is carried, the premiums are deducted from income when computing the share of cost, and therefore costs the beneficiary nothing. If the HMO coverage includes drug benefits, maintaining the HMO coverage may become more important , as the beneficiary will continue to receive drug benefits from the HMO, which may be more comprehensive than the Medicare Part D coverage.

 

3.  Okay – So What About My Assets?

Most people are not aware that there is a difference between eligibility and qualificiation.  As explained above, eligibility is based on medical need.  Qualification is based on assets.  Next week we will take a look at how Medi-Cal looks at your income, what the “Share of Cost” is, and how Desert Elder Law helps its clients qualify for Medi-Cal by ensuring that a client’s resources fall within the established Medi-Cal limits.

David L. Lynch, an attorney with over seventeen years of experience as a litigator and transactional attorney, established Desert Elder Law in 2010. After moving to Rancho Mirage, Mr. Lynch was inspired by personal events to apply his unique skills to the needs of seniors struggling with the complexities of California’s Medi-Cal system. His goal for his clients is to help them obtain the benefits they are entitled to while also protecting their home and assets to the greatest extent possible. Prior to founding Desert Elder Law, Mr. Lynch practiced both as a sole practitioner and as an associate with a “Top Twenty” law firm as ranked by The American Lawyer magazine.