MEDI-CAL PLANNING Consider these statistics: 43% of Americans who turned age 65 in 1990 will enter a nursing home at some point in their lives. Further statistics from the New England Journal of Medicine indicate that 52% of all women and 33% of all men who are now 65 will spend their last years in a nursing home. A recent study showed that the cost of a private nursing home room in California for the year 2010 costs an average of $91,250  annually.  The cost of a semi-private room is even higher. The average stay of a resident in a nursing home is 2.5 years. Thus, the average expense can total more than $240,000 for a private room over an individual’s lifetime. Another reality is that most of us are living longer, more active lives than our parents or grandparents ever did.  With long-term care costs indicated above, it should come as no surprise that two out of every three families go broke within one year of a prolonged nursing home stay. Options for paying for long-term care are limited.  Medicare is only obligated to pay for 100 days of care in a nursing facility (and in reality, you will be lucky if you can get 25 of those 100 days paid for).   If you cannot afford to pay for care privately, and do not have long-term care insurance in place, then the only other option left is to qualify for Medi-Cal. Medi-Cal (known outside California as “Medicaid”) is a joint federal-state program providing medical assistance to low-income individuals, including those who are 65 or older, disabled or blind.  We at the Law Offices of Patrick McNally are here to help and/or your loved ones qualify for Medi-Cal while protecting your home, your family, and everything you’ve worked for. Specifically, we assist you in 3 areas: Qualifying for Medi-Cal: California Medi-Cal policies review many variables, such as your age, income level, assets, number of dependents, etc., before qualifying you for assistance.  From a financial perspective, Medi-Cal eligibility is determined by the amount of income and resources available to the applicant.  Therefore, Medi-Cal planning may involves the purchasing, transferring, conversion and/or liquidating of assets to enable you or your loved one to qualify under Medi-Cal's tests of income and resources. Specifically, we can: (a)       assist you in preparing the application form and dealing with the county agencies on your behalf.  This prevents unnecessary delays and some denials which are more likely to impact an applicant’s eligibility; (b)       represent you through the appeals process.  Applications are often denied. In many cases, the application is denied incorrectly. When this happens, the denial is challenged through the appeal process. This begins as an administrative hearing, and can be appealed to state court if necessary.  If you have been denied, we can review your case, and if it has been denied in error, we can appeal the denial and represent you through the appeal process. Maximizing the “at-home” spouse’s income when the “ill-spouse” needs to go a residential facility: If your spouse needs to go into a nursing home, the law requires that his/her income (whether from social security/pension etc.) must go towards paying for his/her care in the home.  While the law does allow for an “allowance” to be paid to the “at-home” spouse; this allowance is usually insufficient to meet the “at home” spouse’s on-going expenses.  We assist the “at home” spouse in diverting most if not all of the “ill-spouse’s” income to the “at home” spouse so that s/he can continue to live comfortably at home and not suffer a loss in lifestyle upon the ïll-spouse’s entry into the nursing home. Estate Recovery: When a person who received Medi-Cal benefits dies, California is authorized to collect the cost of those benefits from the person’s estate.  California has become very aggressive recently in trying to recover Medi-Cal dollars through this program. This puts you and your family at risk of losing your assets, your heirlooms, your home, your memories and your lifesavings.  We work with clients to protect their assets before their death.  We also provide services to executors and trustee who are administering an estate/trust where a claim has been filed. We will help your loved one get the nursing home care they deserve while legally protecting your family’s assets so that the spouse and children are left with adequate income and resources.  The changes resulting from California's adoption of the Deficit Reduction Act of 2005 (the "DRA") will result in complex eligibility requirements for those in need of Medi-Cal benefits.  Having an attorney on your side who understands Medi-Cal policies and procedures will increase your chances of qualifying for Medi-Cal, without leaving you vulnerable to loss of assets later.  Our law firm has the experience and the expertise to help avoid the financial ruin associated with the high cost of long-term care.  Contact us today to start the process of understanding the issues surrounding Medi-Cal eligibility and to implement the planning and application process.