THE BENEFITS OF MEDI-CAL

Medi-Cal is California’s version of the federal Medicaid program, a partnership between states and the federal government. Medi-Cal is paid for by federal, state, and county funding sources and is generally available to any person or family whose income falls below 138 percent of the federal poverty level (FPL).

For a single person, the annual income threshold is $18,755; for a family of four, it is $38,295. Anyone receiving Supplemental Security Income (SSI) from the Social Security Administration (SSA) automatically receives Medi-Cal benefits. 

Others who can qualify are 65 or older, 21 or younger, blind, disabled, pregnant, in a skilled nursing home, on refugee status, a parent of an age-eligible child, have been screened for breast and or cervical cancer.

If you believe you qualify for Medi-Cal and need help in receiving benefits, or otherwise have questions about or difficulties with the program, contact The Elder & Disability Law Firm, APC. We proudly serve clients throughout Southern California, including Redlands, Riverside, Rancho Cucamonga, and Palm Springs.

WHAT IS MEDI-CAL?

Medi-Cal is California’s version of Medicaid. Medi-Cal is a massive program made up of many separate programs designed to assist Californians in various family and medical situations. 

The Medicaid Act of 1965 limited the program to those receiving cash assistance such as SSI. The Affordable Care Act (ACA) of 2010 expanded coverage to non-elderly individuals and families whose income does not exceed 138 percent of the FPL.

However, there is also an asset threshold. An individual cannot have more than $2,000 in assets, a couple no more than $3,000. One’s home, furnishings, and vehicle are excluded from the calculation, along with some concessions for life insurance and burial plots.

There is also an asset “look-back” period to verify an applicant has not transferred assets to a spouse or family member to avoid going over the threshold. In California, the look-back period is two-and-a-half years. If you transfer, say, $5,000 in a stock portfolio to a non-applicant spouse within the prior two-and-a-half years, that could well be counted toward your assets, even if it is in someone else’s name.

However, as of July 1, 2022, the asset limit for some Medi-Cal programs, except those based on SSI, will go up to $130,000 for an individual and $195,000 for a couple. These higher-limit Medi-Cal programs generally include seniors, people with disabilities, individuals in nursing facilities, and other specialty groups. 

WHAT DOES MEDI-CAL PROVIDE?

Medi-Cal is a comprehensive health, rehabilitative and long-term care program that encompasses many benefits, including but not limited to:

Primary Medical Care: Check-ups, doctor’s visits, prescriptions, screenings, and tests.

Emergency Services: Ambulance services and emergency room services.

Outpatient (Ambulatory) Services: Hospital outpatient and outpatient clinic services, surgery including anesthesiology, podiatry, chiropractic services, podiatry, treatment therapies such as chemotherapy, radiation therapy, and dialysis and hemodialysis.

Hospital Services: Inpatient hospital services including surgery and anesthesiology, organ and tissue transplants.

Maternity and Newborn Care: Prenatal care, delivery and postpartum care, midwife services.

Mental Health and Substance Abuse Services:  Outpatient and inpatient mental health services, outpatient substance use disorder services, voluntary inpatient detoxification.

Physical and Occupational Therapy: Physical therapy, occupational therapy, acupuncture, cardiac rehabilitation, pulmonary rehabilitation, medical equipment, orthotics/prostheses, hearing aids, home health services.

Laboratory Services: X-rays, MRIs, and other lab tests.

Pediatric Services: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for individuals under the age of 21. EPSDT provides periodic screenings to determine health care needs. In addition to the standard Medi-Cal benefits, a beneficiary under the age of 21 may receive extended services as medically necessary. 

Dental and Vision Care: Eye exams every 24 months plus eyeglasses or contact lenses. Dental services include dentures and implants.

Long-Term Services: Skilled Nursing Facility services (91+ days), personal care services, Self-Directed Personal Assistance Services, Home and Community-Based Services.

Transportation Services: Transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies; non-emergency ambulance, and van service.

HOW AN ATTORNEY CAN HELP

There are different qualifications for Medi-Cal. You should check with a knowledgeable attorney if you wish to apply for Medi-Cal benefits to confirm your eligibility and determine the best path to qualification.

To qualify, for instance, you may have to do some asset planning to slip in under the mandated asset threshold. Also, when a Medi-Cal recipient 55 or older passes away, Medi-Cal can recoup the costs of the benefits provided through what is called “estate recovery.” This can be somewhat averted through a Medi-Cal trust. An attorney can help with that, too.

For all your Medi-Cal questions and needs in Redlands, California, or nearby Palm Springs, Riverside, or Rancho Cucamonga, contact The Elder & Disability Law Firm, APC. Our attorneys are well versed in Medi-Cal requirements and regulations, and we can help you receive the benefits you need and deserve.