Long Term care (LTC) is a specialized Medi-Cal program that provides benefits for paying all or part of the medical expenses incurred by an individual who has been in a hospital (receiving acute care) or a Skilled Nursing Facility (SNF) for over 30 days and is expected to remain at least 30 more days.
Who is eligible for Long Term Care Medi-Cal?
Single individual with property/resources of $2000 and under are eligible.
For a married individual with a spouse still living at home, the spouse at home may keep a predetermined amount of community property/resources. This amount is established by the State and it is referred to as the Community Spouse Resource Allowance (CSRA). Although the Community Spouse Resource Allowance may change annually, the only time the property/resources would be reevaluated is if the person leaves the facility and then reenters. The Community Spouse Resource Allowance may be increased by an Administrative Law Judge through the appeals process. The institutionalized spouse may keep up to $2000 of the countable property in their name.
Income of Long Term Care Medi-Cal Beneficiary
When determining if the long term care beneficiary will be responsible for any medical expenses each month, a long term care maintenance need of $35.00 is deducted from the gross monthly income of the individual residing in the facility. The remainder of the income is considered the Medi-cal Share of Cost (SOC), which, like a deductible, is paid to the facility monthly. The facility bills Medi-Cal for the balance. A married individual can allocate all or part of their monthly income to the spouse at home. The allocation amount is based on the Minimum Monthly Maintenance Needs Allowance (MMMNA) which is an amount predetermined by the State, and reevaluated annually to reflect increases in income. The Spouse at homes gross income is subtracted from this amount to determine how much can be allocated to them.
The Medi-Cal program pays for medical care for some persons whose savings and income are too low for them to be able to pay for their own care. In turn, the person or their estate may be required to pay the medical care costs back to Medi-Cal. When notification of a Medi-Cal recipient’s death is received, the Department of Health Services will determine whether or not the cost of services must be repaid. This decision will be based on how much was paid by Medi-Cal and what is left in the estate of the deceased Medi-Cal beneficiary. Regardless of what is owed, the Department will never collect more that the value of the assets owned by the person who received Medi-Cal at the time of his/her death. The Department of Health Services cannot require reimbursement under the following circumstances:
During the lifetime of a surviving spouse.
For Medi-Cal services provided before the beneficiary’s 55th birthday, unless the beneficiary is institutionalized.
If the Medi-Cal beneficiary is survived by a child under 21 years old.
If the Medi-Cal beneficiary is survived by a child who is blind or disabled (as defined by the Federal Social Security Act).
Beneficiaries receiving assistance through a Medicare Savings Program only are exempt from Estate Recovery.
A Resident's Rights In A Nursing Home
When you are admitted to a nursing home, you keep all your basic human and civil rights and liberties. Federal and State regulations list nursing home residents' rights in detail, and require the Department of Health Services' staff that inspects your nursing home to decide whether this home is protecting and promoting your rights.
For additional information about your rights as a resident in a nursing home or for a list of the Licensing and Certification District Offices in Orange County, please click here. For information regarding Long Term Care facilities in your area you may wish to contact the California Healthcare Foundation, however the Orange County Social Services Agency does not make any recommendations or referrals in this area.
How Do I Apply for Long Term Care Medi-Cal?
For information on how to obtain a Medi-Cal application for Skilled Nursing, please contact the Medi-Cal Specialization Regional Centre at:
Information for Long Term Care Facilities & Providers
The Medi-Cal Long Term Care Facility Admission and Discharge Notification form (MC 171 ) can be faxed to 714-940-3916 or mailed to: