Frequently Asked Questions
What does Medi-Cal Consulting Services, Inc do?
Medi-Cal Consulting Services, Inc. prides itself on being a free resource for individuals and medical professionals with Medi-Cal eligibility questions. For our paid clients, we act as the authorized representative, working with the county on the behalf of our applicant. We ensure the county processes the application per Medi-Cal regulations.
Who can apply for Medi-Cal?
Medi-Cal initially looks for linkage to the Medi-Cal program. Linkage is automatic for anyone over the age of 65, under the age of 21, deemed disabled by Social Security Administration, or pregnant.
Can I apply for Medi-Cal if I own a home?
A primary home is considered to be an exempt asset if there is an intention to return home. (Intention – does not imply that it is reasonable or possible to return home, only that the applicant desires to return home)
Can I make too much money to qualify?
There is no income limit for ‘traditional’ Medi-Cal. Income is used to base monthly Share of Cost (Amount Medi-Cal determines you must pay towards any medical expense). However, there are many programs under the umbrella of Medi-Cal, some programs have income limits.
Will Medi-Cal take my home if I apply for Medi-Cal?
Medi-Cal does not take the home. However, the State of California participates in an estate recovery program. Upon the death of the applicant and spouse, Medi-Cal has the option of placing a lien on the estate of the deceased. MCS, Inc can advise of ways to safeguard your home.
Does Medi-Cal retroactively approve benefits?
Once approved, Medi-Cal eligibility goes back to the first day of the month of application. Also, you can request retroactive benefits up to the 3 months prior to the application month. Please note in order to receive approval for retroactive months, applicant will need to be eligible for the requested months.
Who can sign the application?
If possible, the applicant’s signature is always recommended. However, if the applicant is unable to physically sign but is aware, he/she can mark with an ‘X’ and anyone can witness the signature. If the applicant is unaware (unable to make decisions) anyone having knowledge of the applicant’s circumstances can apply and sign on his/her behalf.
How much money can I have?
The Medi-Cal asset limit for an individual is $148,620 of countable assets. The Medi-Cal asset limit for a married couple in the community (not nursing home) is $195,000 of countable assets. The Medi-Cal asset limit for a married couple where one spouse is the community, and one spouse is in a nursing home is $123,000 (2018 limit) of countable assets for the spouse at home not requesting Medi-Cal plus $2,000 for the spouse in the nursing home. Remember your primary home and one vehicle are considered exempt assets.
What if my assets are listed in a trust?
Most often trusts are written to avoid the probate process upon death and to determine how assets are to be distributed. Assets listed in the trust are still subject to the evaluation process.
What kind of proof do I need to give to Medi-Cal?
The following will need to be submitted:
Social Security and/or Medicare card
Health Insurance Cards (front and back)
Current Bank Statements (all pages)
Property Tax Statement
Verification of Income
Life Insurance Policies
Proof of California residency
*If items listed above are unavailable, alternate verification may be provided.
If I sign the application, am I financially responsible for anything?
By signing the Medi-Cal application, you are not taking any financial responsibility for the applicant. You are only attesting that the information is correct to the best of your knowledge.
What is a Share of Cost?
The Share of Cost is the monthly amount that Medi-Cal has determined the beneficiary will need to pay towards their medical expenses. Once the monthly Share of Cost is met the remainder of any medical expenses will be billed to Medi-Cal. It is similar to a deductible. If there are no medical expenses, no Share of Cost is paid. Share of Cost is paid directly to providers.
Will Medi-Cal take my mom’s Social Security check?
No, income will continue to be received as usual. Medi-Cal uses the amount of income to determine the Share of Cost (SOC). Once the SOC has been determined it is listed as part of the Medi-Cal benefits. It is up to the provider of any medical services to collect the SOC, before billing any amount to Medi-Cal. If any SOC needs to be collected, it will be done so at the time services are rendered.
What is In Home Support Services (IHSS)?
IHSS is a Medi-Cal program that pays (minus Share of Cost) for care giving services in the home. IHSS recipients must be Medi-Cal participants and be determined by an IHSS social worker to have a need for assistance.
ALWP is a Medi-Cal program that will assist with the expense of an Assisted Living facility. The facility list is limited. ALWP participants must be eligible for Medi-Cal with a zero Share of Cost and be in need of care.
Medi-Cal does have programs (QMB, SLMB and Q1) that will pay your Medicare Part B premium. These programs are income based and do not require the applicant to meet all Medi-Cal qualifications.
No, you do not have to spend all your money. Not all types of assets are considered ‘countable’. IRAs, annuities and some life insurance plans may not count toward asset limits. MCS, Inc can assist you in determining which assets count.
Medi-Cal has a ’30-month look back’ to see if anything has been gifted, transferred or sold. This does not mean that you cannot give, sell or transfer assets. If assets have been gifted, sold or transferred they will be reviewed to see if done so properly. MCS, Inc advises its paid clients on these Medi-Cal regulations.