Elder Law & Medi-Cal Definitions

Community Spouse:

The spouse who does not need long-term or nursing home care. This spouse continues to live in the community.

Countable Assets:

Assets that are not exempt are countable. This includes, but is not limited to, checking and savings accounts, CDs, money markets, stocks, mutual funds, and second cars.

Deficit Reduction Act of 2005:

A federal law passed by Congress in 2006 makes pre-planning for Medi-Cal eligibility more important than it was previously. This is because the penalties for transfers will not begin until a person enters the nursing home and is otherwise eligible for Medi-Cal coverage. Use of an Irrevocable Living Trust as a part of this pre-planning is becoming more popular.

Division of Assets:

This is the name commonly used for the Spousal Impoverishment provisions of the Medicare Catastrophic Act of 1988. It applies only to couples. Their countable assets are divided in two, with the community spouse allowed to keep one-half of the total, up to a certain amount. The other half of the assets must be spent down.

Estate Recovery:

When the Medi-Cal recipient dies, the state may (and often does) seize remaining assets to reimburse the state for the Medi-Cal benefits paid during their lifetime. In many cases, this includes the recipient’s primary residence if they don’t have a surviving spouse. This provides a cost effective way to offset state and Federal costs. You should consult with a qualified professional to analyze your particular situation and protect your home.

Exempt Assets:

Exempt assets are assets which do not count against your monthly resource limit. The list of “exempt assets” may differ slightly from state to state.

Look-Back Period:

If you transfer assets to another individual (spouses excluded) within a certain period of time before you apply for benefits, that gift may disqualify you from receiving Medi-Cal benefits. This period of time is called a look-back period. It is based on a formula that takes the amount of assets transferred and divides that number by the average cost of nursing home care in your state. The resulting number equals the amount of months that the applicant will have to wait until benefits may be received. Under the Deficit Reduction Act, this rule applies to any gifts you make within 5 years of the application.

Medi-Cal:

Medi-Cal is a joint federal and state program that provides medical assistance to low-income persons who are elderly, blind or disabled. However, unless you are among the minority who has long-term care insurance, most individuals contemplating paying thousands of dollars out-of-pocket every month for long-term nursing home care face the possibility of exhausting all available assets and using up their lifetime savings before being able to qualify for Medi-Cal. A qualified Elder Law Attorney can help your family by using a variety of strategies to help you qualify for Medi-Cal while preserving assets and savings for heirs.

Medi-Cal Triggers:

The special language in a Living Trust that gives the trustee the authority to do certain types of planning, even though the person applying for Medi-Cal is not capable of signing the documents or personally doing the planning.

Medicare:

A federally funded health insurance program designed for Americans 65 years of age and older. It provides a limited long-term care component. Based on certain criteria, Medicare may pay for nursing home expenses, but with a high deductible, for up to a maximum of 100 days.