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What Is the Difference Between Medicare and Medi-Cal When It Comes to Paying for Long-Term Care?


Last updated 12/17/2020 at 8:03am

While there are a variety of ways to pay for long-term care, it is important to plan ahead to ensure that you have enough resources available to fund the care you need and the lifestyle you desire as you age.

Long-term care refers to medical and non-medical care for a person who has a chronic illness or disability. The need for long-term care, also known as custodial care, occurs when you need medical care but you are unlikely to get any better. For example, as we age, our bodies simply start to wear out and fall apart. This may result in limited mobility, loss of independence, and the need for assistance with everyday activities such as dressing, bathing, and eating. Or, we may need help with everyday activities due to diminished mental abilities, confusion, and dementia.

Most often, long-term care is non-medical in nature and assists with activities of daily living like dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living, or in nursing homes.

What Is the Difference Between Medicare and Medi-Cal When Paying for Care?

There is a very large difference between Medicare and Medi-Cal, and people confuse the two all the time. So which program is which and what do they cover?

In general terms, Medicare provides coverage to people over the age of 65 and is similar to regular health insurance. Since Medicare is a federal program, benefits and requirements are universal for all states. An individual must have been hospitalized for at least three days and three nights before transferring to a nursing or rehabilitative facility, and the move must be made within 30 days of the hospital stay. In a sense, Medicare pays for an acute occurrence and the rehabilitation from it. Since Medicare coverage is not intended for custodial care or long-term care, the patient must demonstrate a need for skilled care, in-home or in a care facility, and show that progress is being made toward recovery. If qualified, Medicare will cover a total of 100 days, the first 20 days paid in full and the next 80 days with a co-pay.

On the other hand, Medi-Cal is a state-run entity intended for those in financial need with different rules and qualifiers which vary from state to state. Just as wills and trusts are subject to the specifics of state law, so must certain criteria be met to be eligible for benefits. In nearly all states, the patient would need to spend down his/her assets to around $2000, although some states exempt certain assets - such as your house and car- up to a predetermined value. Any subsequent income the patient gets, including social security, goes first to paying for long-term care.

Unlike Medicare, Medi-Cal does offer long-term care coverage but not all facilities are Medi-Cal approved. Due to the small percentage of nursing homes which offer Medi-Cal approved housing, and possible waiting lists, it is best to explore all options with an elder law attorney. Likewise, Medi-Cal approved nursing homes are crowded, so it would be wise to check out a number of facilities in person ahead of time.

Because roadblocks and complications like these are common when it comes to finding and securing long-term care, investigating and understanding your options, and implementing preparations before a crisis occurs is the prudent course of action to take. It is important that you look at all of your choices, as you will have more control over decisions and be able to stay independent if you do.

At our firm, we work with families every day to explore such options and implement the best legal strategies to preserve assets without jeopardizing the ability to qualify for Medi-Cal-benefits in the future if they are needed. If you would like to learn more about these options, we invite you to give our office a call at 800-244-8814 to schedule a consultation.

– Robert Galliano, Attorney at Law, Copenbarger & Copenbarger, LLP

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