1.         a. What are the eligibility requirements for Medicaid in your state?  Are they both eligible for Medicaid in your state?

There are many different ways to qualify for Medi-Cal, the Medicaid of California.  Easiest way regardless of citizenship is to be pregnant.  If one is an illegal immigrant, then Medi-Cal is only available under emergency situation or during pregnancy.  Even as a legal immigrant, one must reach 5 years of residency status before full coverage.  Other ways to qualify for Medi-Cal include being 65 and older or under 21.  Other eligible criteria include, disabled, below the 138% Federal Poverty Level.  Being a participant in these programs also makes one eligible for Medi-Cal Calfresh, SSI/SSP, CalWorks, Refugee Assistance, Foster Care or Adoption Assistance Program.

Regarding the case, the husband qualifies base on age and disability.  She likely qualifies too if they both earn less than 138% Federal Poverty Level but since there is limited information regarding their finances, her eligibility is unclear.

b. How much income (Social Security, wages, pension, interest, etc.) is allowed each month (as a Medicaid beneficiary)?

The total amount allowed annually is less than 138% the Federal Poverty Level.  Per the California Department of Health Care Services, this amount comes out to $22,108 per year or $1842.33 per month.

 

c. How much assets are they allowed?   Which possessions count as assets?

The general property limit for two people is 3,000 per California Department of Health Care Services.  There are ways to increase this limit through the court system however.  The following counts as assets per the website California Department of Health Care Services:

Real Property:

• Principal Residence. Property used as a home is exempt (not counted in determining eligibility for Medi-Cal). When an applicant or beneficiary is absent from the house for any reason, including Institutionalization, the home will remain exempt if the applicant or beneficiary intends to return home someday. The home also continues to be exempt if the applicant’s or beneficiary’s spouse or dependent relative continues to live in it. Money received from the sale of the home can be exempt for six months if the money is going to be used for the purchase of another home.

• Other real property. Up to $6,000 of the equity value in non- business real estate (excluding the home), mortgages, deeds of trust, or other promissory notes may be exempt. In order to receive this exemption, the property must produce an annual income of 6 percent of the net market value or current face value.

• Real property used in a business or trade. Real estate used in a trade or business is exempt regardless of its equity and whether it produces income.

• Personal property used in a trade or business.

• One motor vehicle.

• Personal affects. This includes clothing, heirlooms, weddings and engagement rings, and other jewelry with a net value of under $100.

• Household items.

• IRAs, KEOGHs, and other work-related pension plans. These funds are exempt if the family member whose name it is in does not want Medi-Cal. If held in the name of a person who wants Medi-Cal and payments of principal and interest are being received, the balance is considered unavailable and it is not counted.

• Irrevocable burial trusts or irrevocable prepaid burial contracts.

• One revocable burial fund or revocable prepaid burial contract with a value of up to $1,500 plus accrued interest per person.

• Burial space items.

• Musical instruments.

• Recreation items including TVs, VCRs, computers, guns, collection, etc.

• Livestock, poultry, or crops.

• Countable property equal to the amount of benefits paid under a state-certified,

long-term care insurance policy.

• Life insurance policies. Each person may have life insurance policies with a

combined face value of $1,500 or less accrued interest and dividends.

 

2. Assuming eligibility, what benefits are available?  Provide an overview of the assistance programs specific to their needs.  She is considering home care services, an adult day health program, or the possibility of nursing home care.

Medi-Cal provides many services including health care coverage for physical, mental, and dental.  Specifically for this case, Medi-Cal does cover rehabilitation services, long term skilled nursing facilities, and other personal care services.  Medi-Cal also will cover non-emergent transportation, physical and speech therapy, and various medical devices.

B. Share your thoughts:

1. Are the sites user-friendly?  Consider health care literacy standards.  Also contemplate getting the information if you had an age-related limitation such as poor vision, limited hand function due to arthritis, or short-term memory loss.

I was quite disappointed that the Medi-Cal website was rather difficult to navigate.  Trying to find eligibility was rather difficult.  There were many links and topics on the website however the basic information such as eligibility or limitation were near impossible to find.  Only way, I was able to locate these information was through google search and link myself to the correct page.  Even after locating the correct information, the jargon was written rather convoluted.  One great service available is counselors who can help determine a person’s eligibility and assist in sign up.