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Paying for care, making sense of Medi-Cal in home care option.

Good morning, everyone.

Welcome to our webinar.

Paying for care, making sense of Medi-Cal in home care option.

My name is Leanne Godfrey, and I will be hosting our presentation today with our wonderful presenter Lisa Ramsey and she'll be on in just a moment here.

But I wanted to welcome you and also to just say.

For those of you, I don't know, by the way, my name is Leanne Godfrey with Aaron Health management.

We are nurse care management organization, a company based in Orange County.

We also serve in to south LA County and periodically we do these webinars and it's usually a fiduciary approved CEU webinar and we're always welcoming others to attend.

You don't have to be a fiduciary; we open this up to other people as well so we really do have a varied background for our presentation here today.

So welcome all of you.

We're still having people popping on, but I wanted to get going on time.

We are really fortunate to have Lisa Ramsey here today.

She has been involved in Medi-Cal and the helping of people get the benefits that they need for 30.

Years over 30 years.

And for almost 19 of those years, she's had her own company helping people and her employees, helping people to get the benefits that they need.

So we're very we're very glad to have Lisa here today.

It's an hour-long class and we're going to be going for the full amount.

We may go over a little bit in terms of questions and answers, so if you want to keep on with us.

After 9:00 o'clock, please feel free.

I will keep my eye on the clock to see when nine o'clock hits.

If you're a fiduciary, you need to be on for that hour, but after that if you want to draw off, certainly feel free. To do that, we usually go over and when we have a lot of questions. Anybody who was registered as of about 5. O'clock last night would. Have received a PDF of our PowerPoint that we're using here today and so you should have that to make notes on.

This is a little bit of a different presentation here today.

Earlier this year, Lisa made a presentation on a California based conference, and it was a.

Conference so she has a video for probably about 30 minutes of content here today the video goes pretty quickly so you will get a link to that video when we send out everybody information within seven days of today's presentation, you'll get information about that.

I know you'll be able to watch that Video again, you'll be able to watch the taping of this web and are here today.

You'll get a copy of that as well, so you can share that you can share Lisa’s video from the conference that she did, but it's just a little bit of a different fun way to get the information to you today, but.

Then she'll come on after the video.

I'll share some updates about Medi-Cal and then we'll have time for questions and answers.

For those of you who are fiduciaries, a little bit of housekeeping.

Here again, please try and stay on for the hour if you can.

We don't have a survey that goes out so don't wait for a survey to come afterwards.

It won't be coming but we what we do.

Is take the attendance report.

We see how long you've been on the call, and then we'll send your certificate out within one week of this web and are usually.

As before, one week actually.

OK, So what else?

Do we have here?

I think that that's about it.

I'm going to forward us, and if the technology gods are with me today, we'll be able to see everything.

OK.

But again, our presenter is Lisa Ramsey and she'll have a little bio in this video.

That's going to start in just a couple of moments.

Here, and you'll be able to ask her questions of her late.

For an up course we have objectives as we have the CE component to our presentation here today, we always have to have objectives.

So in terms of those objectives, it's going to be to understand the standard Medi-Cal spousal asset limits and improvement in Parliament impoverishment rolls.

Wow, that's a tough one.

Sharing of cost calculations.

Exempt, non-exempt and unavailable assets will be discussed, and we're also going to talk about how the home and community based services waiver works as.

It relates to.

Couples in the community.

When one of the spouses requires a nursing home level of care, so those are the kinds of things that will.

Be going those.

Have been sent to the state and those have been the approved.

Objectives for today.

Lisa, in her presentation, also has a couple of different objectives, so you'll.

Have lots of objectives.

Today so I am going to.

Let's see hang on one second here, I'm going to flip over to a different screen here so we can watch the video of Lisa, and then we'll be back on.

But hang on, there's a lot of information here, so I'll see you on the other side in just about 30 minutes, thanks.

Hi, my name is Lisa Ramsey and I'm the founder and CEO of Medi-Cal Consulting services.

I started Medi-Cal consulting services from my kitchen table over 18 years ago.

The experience I acquired as a consultant from 2 significant nursing home corporations and as a Medi-Cal worker in two counties makes me one of the leading experts in this field.

I'm passionate about the knowledge.

I've been blessed with, and I love providing in depth Medi-Cal eligibility, training, and consulting services to health facilities throughout California.

Holding seminars for seniors and caregivers to assist in understanding the long-term care options is one of the things that I love about being an advocate.

What separates my company from others is our group of former Medi-Cal workers who have the information to survey the circumstance and answer questions this has done at no expense to the consumer.

By the end of this presentation, you should be able to identify traditional versus magic Medi-Cal.

Understand how income effects share costs described exempt, non-exempt and unavailable assets as well as understand the HCBS waiver as it relates to couples in the community.

When one of the spouses requires nursing home level of care.

Medicaid was signed into law in 1965 by President Lyndon B Johnson and authorized Title 19 of the Social Security Act, which also produced Medicare.

Medicaid does not provide health care directly to individuals.

Instead, it covers the cost of their health care services.

Individual states decide on who qualifies for coverage.

The type of coverage and the process of paying health care workers and hospitals.

That is because each state is responsible to oversee and administer its own Medicaid program.

The federal government matches state spending, and the matching rate varies by state.

From above, the statutory minimum of 50% to limit of 83% states are not required to participate in.

Medicaid, although all states do.

The program is the largest source of funding.

For health-related services.

For uninsured or underinsured individuals in the United States.

Total Medicaid spending came to 613.5 billion in 2019, accounting for 16% of the nation's health care bill. The federal government paid 64 1/2% of the bill.

While individual states paid 35 1/2%.

Since each state is responsible for managing their version of the federal Medicaid program they all have their own set of rules and regulations.

California Medicaid Health Care program is called Medi-Cal.

Medi-Cal provides health coverage for the uninsured or under insured throughout California, including special programs.

For the aged, blind, disabled young adults and children, pregnant women, persons in a skilled nursing or intermediate care home and persons in the breast and cervical cancer treatment program.

People receiving federally.

Funded cash assistance programs, such as Cow Works.

SPS aside or in home, supportive services are also eligible. Around 13.3 million people have enrolled in Medi-Cal as of January 2018. Over the years, the Medi-Cal programs have changed and evolved. However, the noise of bad information continues.

Medi-Cal can be the help we need to take.

Care of our.

Loved ones, but this health is often overlooked.

Why is it overlooked?

Why is it not utilized for many Medi-Cal is ignored because there's plenty of bad information.

The misinformation keeps circling around and around.

We have heard the inaccurate information so often.

And from so many sources that many potential applicants think the inaccuracies must be true.

Let's quiet the noise and take a look at one of the exciting ways Medi-Cal has evolved.

In 2010, President Barack Obama signed the Affordable Care Act into law and expanded the Medi-Cal program to include a new program called modified adjusted gross income, also known as Magi Medi-Cal

The goal of the Affordable Care Act is to give more Americans access to affordable, quality health insurance.

This new program.

Was created to allow coverage for those who were uninsured or underinsured. Normally these were applicants between the ages of 21 and 64 who are not eligible for traditional Medi-Cal.

Applicants qualify for matching many counts solely based on their income.

Assets are not an eligibility factor for those whose income is too high.

They can enroll in health care plans through Covered California Covered California is a health insurance marketplace. You can go to coveredca.com to enroll in purchase.

Parents, whether you qualify for Medi-Cal through the traditional Medi-Cal program or the Magi Medi-Cal, it's all the same Medi-Cal program with the identical benefits.

Only the qualification process is different. If you are over 64 years of age or on Medicare, you will be assessed under traditional Medi-Cal.

Traditional Medi-Cal determines if you qualify according to your assets.

Now I would like to take this opportunity to put any misinformation to rest.

There are no.

Income limits to qualify for traditional Medi-Cal allow me to say that one more time there are no income limits to qualify for traditional Medi-Cal.

Contradictory to the misinformation in the industry.

If you are currently receiving Medicare, there are no income limits to qualify for Medi-Cal.

Although depending on your.

Income you may have what is known as a.

Share of cost.

Share cost is calculated according to your income and the Medi-Cal program in which you qualify.

Share cost is like a monthly deductible, except it is the monthly amount that Medi-Cal has decided that beneficiaries committed to pay towards their Medi-Cal expenses.

Share cost is based dependent on their income and the program they qualify for.

When the share cost is medical month, the rest of any Medi-Cal expenses will be built to Medi-Cal.

Another difference between share costs and monthly deductible is if the applicant does not have any Medi-Cal expenses in a given month.

They do not have to pay the share cost in that month.

The share cost is paid directly to the providers who have provided the service, not to Medi-Cal their traditional Medi-Cal program has a monthly maintenance need for a married couple in the community of $934.

As a means.

Tested program traditional Medi-Cal imposes asset limits in order to qualify in certain perspective applicants.

Some assets are counted in summer.

Not many count classifieds assets in three categories.

Exempt nonexempt and unavailable.

Some examples.

Of nonexempt assets.

Include cash.

Checking savings.

Stocks, bonds.

Credit union

In real estate which is not being properly utilized according to Medicare regulations.

Some examples of exempt assets include the principal residence.

One vehicle

Some life insurance policies.

Personal belongings

Household furnishings.

Preneed arrangements.

And tax deferred retirement accounts.

California does not have a maximum home equity value limit like the majority of other states, so.

At this time there's no limit to what your principal residence can be worth.

Available assets occur when the owner of the asset is considered incapacitated and there is no legal authority in place, such as a power of attorney or conservatorship, and no other entity has access to the asset.

Also, an asset can be considered unavailable if someone is making a good faith effort to sell or liquidate the asset.

The traditional Medi-Cal program has different asset limits depending on which program you qualify for. An elderly married couple in the community is allowed $3000.00 of countable resources, so for example.

A married couple with $4000 in a bank account would be over the asset limit and be required to spend down their bank account to below $3000 to be eligible for assistance while living in the community.

The government realized that many people would not be eligible or they.

Would have a high share cost.

Making the service is not feasible or there would be over the stringent asset limit.

So the HCBS waiver was signed into law.

The spousal impoverishment provisions were meant to assist couples with care costs were only available.

Unused for skilled nursing facility care.

In 2017, Medi-Cal made those impoverishment provisions available to couples who wanted to remain at home through the Asds waiver.

The spousal impoverishment provisions, when applied, can make in home care much more accessible.

These spousal rules are specifically for those couples.

Where one spouse has become a null and needs assistance, it's possible to have the Medi-Cal benefits applied to the ill spouse and the resources and income remain available to the well, spouse.

The HCBS waiver means the couple does not have to use up all of their resources and income to pay for the care of the ill spouse and leave the well, spouse impoverished the home and community based services waiver is a Medi-Cal program that in general provides assistance with skill development, respite transportation.

And other services to help support the individual and their caregiver. Section 1915. C Home and community based services waiver provide opportunities for Medi-Cal beneficiaries to receive services in their own home or community.

Medicare has really evolved with the HCBS waiver.

These programs serve a variety of targeted population groups, such as people with mental illnesses, intellectual disabilities and or physical disabilities.

Qubes first became available in 1983 when Ronald Reagan signed into law in Congress. Passed provisions added section 1915 C to the Social Security Act, giving states the option to receive a waiver of Medicaid rules governing institutionalized care.

The Supreme Court case Olmsted versus LC 1999 found unnecessary institutionalization to be a violation of the civil rights established by the Americans with Disabilities Act of 1990. That service be provided in the least restrictive environment almost that allowed that states.

Would be in compliance with the Americans with Disability Act if they could demonstrate that they had a comprehensive working plan to move people with disabilities into less restrictive.

Settings this provision, along with Centers for Medicare and Medicaid Services guidance on Homestead compliance, lead to rapid adoption by the states of the HCBS waiver within broad federal guidelines, states can develop home and community based services waivers to meet the needs of people who prefer to get long term care services.

And supports in their home or community rather than in an institutional setting.

In 2009, nearly 1,000,000 individuals were receiving services under Medicaid HCBS waivers. More than 800,000 people nationwide have been waiting, sometimes several years. This creates gaps and services due to variation state to state population based inadequacy's state.

Based Inadequacy's and race based inadequacy.

Population based inadequacy's are when half the states spend 2 times as much money on institutional care as they do on this program.

Will need states spend more than 50% of their federal money on HCBS. Iowa spends 10% of its money, while Washington, Minnesota, and Oregon spend 70%.

Race faced inadequacy's occur for many reasons. One in particular is due to the increase in admissions and communities of color and decrease in white populations in communities.

With lower earning.

Populations access to HTTPS is also limited prior to the implementation of this waiver.

There was community based Medi-Cal under the traditional Medi-Cal probe.

When a married couple needed assistance in caring for an ailing spouse, Medi-Cal only allowed a community based maintenance need for a couple of $934 and an asset limit of $3000.00 of countable assets. These stringent regulations prevented most married couples from receiving.

Any assistance when in home care was?

Needed. This caused many unnecessary long term care residents to remain in the nursing home facilities or become institutionalized. For example, if a married couple has a total of $3000 in combined countable income under these regulations, they would have a shared cost of 2016.

$6 a month. This would make Medi-Cal not feasible for this couple in the Community, so this couple with a combined total of $3000 in countable income would have a shared cost of 2066 while in the Community, and if their countable assets were below $3000.

However, they would not be eligible if their assets were over the stringent asset limit of $3000.00 of countable resources.

Although if the one spouse was in long term care then their asset limit would greatly increase to $130,380 of countable resources.

That's currently for 2021. Keep in mind that this is a minimum and not a maximum. This generous asset limit can even be increased.

The court proceeding.

In the past, most married couples registered domestic partners in same sex.

Couples were unable to utilize the benefits through community based Medi-Cal.

When one of the spouses became ill and required nursing home level of care, either their assets were well over the limit of 3000 of the Campbell asset limit or their share.

Cost was too high to be of any benefit.

The spousal impoverishment provisions also apply to registered domestic partners.

All common welfare directors. Letter 12. Dash 36 establishes that the full array of spousal protections that are available to married opposite sex couples extend to the same sex spouses and registered domestic partners.

Specifically, the rules regarding the amount of income and property a community spouse may retain when their spouse becomes institutionalized.

Medi-Cal becomes necessary when one of the spouses registered, domestic partners or same sex couples becomes ill and requires the nursing home level of care also.

Known as custodial care.

Medi-Cal has a program called Long Term Care.

When a Medi-Cal applicant enters a skilled nursing facility.

Long term care rules apply to determine the month of long term.

Care status who?

Is in the Medi-Cal family budget unit and how to treat the income, property, and proper budgeting.

For recognized couples with one spouse and long-term care, there are two sets of rules, the Medicare catastrophic Coverage Act and the Community property income rules.

Which rules apply?

It depends on the date the individual entered.

The long-term care facility and applied for Medi-Cal these regulations define.

New terms such as Community, spouse, institutionalized.

Mouse continuous period of institutionalization and allow the institutionalized spouse to allocate income and property to the community. Spouse at home without considering the state Community property and income laws. Assembly Bill 641 allows counties to implement the Medicare catastrophic.

Coverage ACT rules to same-sex spouses and registered domestic partners. Effective January 1st, 2012.

Medicare applicants who entered a long-term care facility prior to September 30th, 1989 fall under the states. Equal Division of Community property and income rule.

Under these rules.

Terms such as long-term care status, separate and Community property and spouse at home, all applying long term care.

Medi-Cal has specific guidelines which include the spousal impoverishment rules, the Medi-Cal spousal impoverishment rules are designed to prevent the impoverishment.

Of one spouse when the other spouse applies for long term care. Medi-Cal or home and community based services, the expense of nursing home care which can range from 7000 to 10,000 a.

Month or more.

Can rapidly deplete the lifetime savings of the elderly couples.

In 1988

Congress enacted provisions to prevent what has come to be known as spousal impoverishment, leaving a spouse who is still living at home in the community with little or no income or resources.

These provisions help ensure that this situation will not occur and that Community spouses are.

Able to live out their lives with independence and dignity.

Under the Medicaid spousal impoverishment provisions, a certain amount of the couples combined resources is protected for the spouse living in the community.

Depending on how much of their own income the community spouse actually has a certain amount of income belonging to the spouse in the institution can also be set aside for the community spouse.

Is use.

This means that certain individuals can be eligible for Medi-Cal with more generous income and asset limits, enabling them to access services without depleting all of their resources, and this will ensure share cost goes down.

Federal law specifies that certain programs be considered before others.

When Medic eligibility is determined or redetermine as they are annual.

Add application annual renewal are when a change of circumstances is reported, the applicants Medi-Cal eligibility must be determined by progressing through the Medi-Cal hierarchy outlined in Al County welfare director Letters 17 Dash 03. The applicant may not be eligible for some programs.

After the screening, eligibility must be determined for each program where the applicant has potential Medi-Cal ability.

When an applicant is eligible for more than one Medi-Cal program and one is more beneficial than the individual should be placed in the Medi-Cal program that is most beneficial for them unless the individual requests otherwise.

Additionally, other home community based services individuals can transfer property to themselves.

Under these spousal impoverishment rules, Medi-Cal allows the spouse registered domestic partner same-sex couple who is not receiving Medi-Cal.

Referring to them as the well, spouse.

The well spouse is allowed to retain additional assets and income without compromising the eligibility for the ill spouse. Currently, the well spouse individual is allowed to retain a community spouse resource allowance of $130,380 in countable assets.

All county welfare directors letters 17 dash 25 requires that the county eligibility worker to apply the spousal impoverishment provisions in the first month when both of the following exists.

The request for either home community based services or in home supportive services has been made and the individual meets a nursing facility level of care as determined by a doctor or an assessment by the home community based services, waiver or program.

The date that both these criteria are met is known as.