Medi-Cal Qualification Guide

Medi-Cal is a California State program, which is designed to pay nursing home costs for qualified individuals. It is funded by the State of California and by the Federal Medicaid program. The following is our 2012 California Medi-Cal Quick Reference Guide, which briefly describes some of the State of California’s commonly referenced Medi-Cal monetary eligibility requirements. This guide is not comprehensive, and you are encouraged to refer to our website, or contact us at our office, for further explanations of Medi-Cal qualification requirements.

2012 California Medi-Cal Quick Reference Guide

Community Spouse Resource Allowance (CSRA)
– $113,640 – This is the amount that the community, or (at home) well spouse can retain in liquid assets. This amount does not include exempt assets, such as the home and qualified accounts, such as IRA’s.

Minimum Monthly Maintenance Needs Allowance (MMMNA)
– $2,841 – This is the minimum amount of income the well spouse can keep.

Average Private Pay Rate (APPR) or Divestment Penalty Divisor 
– $7092 – This is the amount the State pays to nursing homes on the Medi-Cal program, minus a share of cost by the applicant. This figure is also used to calculate penalty periods of ineligibility for Medi-Cal.

Applicant Resource Allowance
– $2,000 – The applicant, whether a spouse or single person, can keep this amount in cash, checking, etc.

Monthly Personal Needs Allowance
– $35 – The amount of non-exempt liquid assets the ill person, whether a spouse or single, is allowed to keep.

The Home: In addition, the applicant’s home can easily be established as an “exempt asset” for qualification for Medi-Cal. In other words, you can keep your home and apply for Medi-Cal. The home is usually the applicant’s most valuable asset, and through proper estate planning, steps can be taken to protect the home from a State lien after the Medi-Cal recipient dies.

Spending Down and Gifting of Assets: The State allows the Medi-Cal applicant to spend down their assets in order to meet qualification requirements.

The State also allows for gifting of assets in order to meet qualification requirements. However, any gifting must be done pursuant to the regulations, and preferably with the help of an elder law attorney. If gifting is not done correctly, long periods of ineligibility for Medi-Cal. qualification can be created.
Proper Estate Planning: Your chances for Medi-Cal qualification can be greatly enhanced through proper and timely planning. The estate planning documents, such as the Revocable Living Trust and Financial Durable Powers of Attorney should be in place and updated to include elder law asset protection language. This specialized language, among other things, will allow for transfers of assets under the Medi-Cal regulations to family members and to others who are also the Trustees or Attorneys in Fact under these documents. This Medi-Cal planning can be utilized if the older person loses mental capacity. Unfortunately, most estate planning documents do not contain this specialized language, which can adversely affect the Medi-Cal qualification of the applicant who has lost mental capacity. Additionally, the documents can usually be amended by going to court, but this process can be expensive. Proper and timely estate planning is strongly recommended.

This reference guide is not comprehensive, and does not include all of the eligibility requirements. In addition there are legal methods within the Medi-Cal regulations, not mentioned here, which allow for increasing the CSRA and MMMNA referenced above. Your elder law attorney can help you with this.