Medi-Cal Planning

How to Pay for the Nursing Home

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My number one rule is don't go to the nursing home unless absolutely necessary. Nobody wants to go to live at a nursing home. Stay home as long as possible. Sometimes it is just unavoidable. If you must go to the nursing home because it is medically necessary, then there is no reason all of your assets should be used up in the process. Medi-Cal planning is designed to make sure your hard earned assets go to your family and not to the State or the nursing home.

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The cost of the nursing home is now the biggest threat to your hard earned assets. The average cost of care in a Skilled Nursing Facility in California costs $12,000.00 per month and every year that amount goes up. Medical science is constantly developing new treatments that keep our bodies alive, but they can't necessarily keep our brains functioning properly.

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     There are only four ways to pay for a nursing home. They are:

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1. Private Pay

2. Long Term Care Insurance

3. Medicare

4. Medi-Cal

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Private Pay

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You can write the nursing home a check every month until you run out of money. This is not the plan that my client's want. Too often I hear of stories of nursing home social service workers telling the family that they must spend all of their money and then apply for Medi-Cal to pay for the rest of their care. This is incorrect information. With a Medi-Cal plan, you can preserve a great deal, if not all, of your assets and still qualify for Medi-Cal.

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Long Term Care Insurance

Long Term Care Insurance is helpful, but not always the best solution when facing a stay in a nursing home. If you need it and don't already have a policy, you cannot get one. It would be like trying to buy fire insurance for a house that is on fire. If you have a policy, the premiums are expensive and the policy usually only covers three to five years of nursing home care. In many policies, there is a large deductible that must be paid by the policy owner before the insurance will start paying the nursing home. Also, the policy usually won't cover the whole bill of the nursing home. They only will pay so much per day. Usually, the policies don't keep up with inflation. I have clients who are surprised when I review their policy that they will have to pay over $30,000.00 to the nursing home as a deductible and then the policy will only pay $3,500.00 per month when the bill is over $10,000.00 per month.   

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Medicare

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Medicare is the Federal Government's health insurance program that most senior citizens receive at retirement. Medicare only covers certain stays at the nursing home and is geared more towards rehab. Medicare will pay for up to 100 days at a skilled nursing facility in connection with a Medicare supplement insurance policy. However, the patient must continue to improve in their condition or Medicare will stop paying for the stay. If the stay is not for rehab, Medicare will not cover pay the bill.

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The Medi-Cal Program

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Medicaid is a federal health insurance program administered by the states.  Every other state calls their program Medicaid. California calls the Medicaid program "Medi-Cal" because we're special, I guess. Medi-Cal will pay the entire cost for room and board at the nursing home and for most prescription drugs. There are two aspects to Medi-Cal - Qualification and Estate Recovery.

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Medi-Cal Qualification

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California has changed the rules regarding qualifying for Medi-Cal. As of January 1, 2024, Medi-Cal will no longer ask or consider an applicant's assets to determine eligibility. This is great news if you need help paying the $12,000/month Skilled Nursing Facility bills. The most important thing you need to prepare for is Medi-Cal Estate Recovery. Medi-Cal Estate Recovery cannot recover assets that are titled in a Living Trust.

Medi-Cal Estate Recovery 

When a Medi-Cal recipient dies, their estate is subject to Medi-Cal "Estate Recovery". Estate recovery is when Medi-Cal seeks to get repaid from the assets of the Medi-Cal recipient (i.e., the house). Medi-Cal can place a lien on the home and get repaid when the home is sold. On January 1, 2017, Governor Brown of California signed a law that limited California's Medi-Cal estate recovery to the Probate estate of the Medi-Cal recipient. That means that only assets that go through probate can be recovered against by Medi-Cal. If you have a properly funded Revocable Living Trust, the assets in the trust are not recoverable by Medi-Cal.

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