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. The applicable application date for spousal impoverishment provisions. To help you understand. How this is applied? I'd like to tell. You a little story. This is about Romeo and Juliet. They've been married over 60 years and they've lived in the same home. They raised their children in since they married. Romeo is 82 years old. He's retired after 50 years working in the aerospace industry. His beloved spouse. Juliet is 80 years old and recently her health has declined. They have $80,000 in a savings account and $25,000 in a CD account. Juliet has been diagnosed with Parkinson's disease and needs Medi-Cal to help pay for her care. Julia can qualify for Medi-Cal under the spousal impoverishment rules, which will allow Romeo to keep all of their assets since their total amount of assets is below the current Community spouse resource allowance of $130,380, then their income would be verified to calculate whether or not they would be assessed to share a cost. The minimum resource allowance is intended to protect these couples that have limited resources. Remember, this amount can be increased. In addition to the Community spouse resource allowance, the well spouse is allowed to retain additional income without having to pay all of their income towards the share cost. The well spouse is allowed. To retain all of their income, their income is only verified at time of application to assess if their income is below the minimum monthly maintenance. Needs allowance which is 3260 for 2021. If their income is below the minimum monthly maintenance needs allowance then they may receive an allocation from the ill spouses income to bring their income up to that amount of 3260. If the well spouses. Income exceeds the minimum monthly maintenance needs allowance. They will not be. Eligible for any allocation of their spouses income. The well spouse. Can have unlimited income and it will not be required to give up any of their income ever. Here is an example of how income is used to calculate a shared. Cost for an elderly couple with one spouse in a long term care nursing facility. Romeo has a monthly pension of $1200 and he also receives $900 in Social Security for a total of $2100. Juliet receives Social Security of $900. Since Romeo is the well spouse, he is allowed to retain at least a minimum amount of monthly income of $3260.00. Romeo can keep his monthly income of $2100 in this circumstance and he will receive an allocation of Juliet. Income of $900. Month to bring his income up to $3000, which is well below the threshold of 3260. Therefore, Juliette will have no share costs while residing in a long term care nursing facility. These rules allow. For the well spouse to. Retain the community assets and income. So they don't become. Impoverished Weather ill spouse is receiving the care they now require In most cases, once the ill spouse becomes well enough to go home, they were unable to continue the Medi-Cal benefits in the community due to the strict guidelines imposed on community based applicants. Remember, in my previous example, the monthly maintenance needs for an elderly couple in the community under the age blind and disabled traditional Medi-Cal program. Is $934. So once you it was well enough to go home. The Medi-Cal share cost would increase to 2066 dollars, making their benefits not feasible. In November of 2017, Medi-Cal issued all County Welfare Director's letter 17, dash 25 that implemented a waiver program called Home and Community based Services. Program married couples in the community can utilize the spousal impartial rules normally reserved only for long term care applicants and qualify for Medi-Cal while in the community. In most cases they would be eligible with a zero share cost. These rulings make life changing services possible to married couples in the community, such as in home supportive services and the assisted Living Waiver Program. For more information on these programs, check out Medi-Cal Consulting Services YouTube channel. There's a number of videos that are helpful and informative. Now, as you can see, the home community based services benefits couples in the community so that when the eligible spouse goes in and out of long term care, the level of care would not change and the couple will not be as affected as they were prior to the implementation of these rulings. In order for an L spouse to be deemed to be at nursing home level of care, a doctor's authorization is required. You're probably now wondering how can people who need long term care level of care apply for this program? We're going to need to fill out an application at their local Medi-Cal office and provide evidence of their developmental disability. An appropriate level of need for services be determined. Eligible for services have an appropriate living situation and other information is also required. They can also have trained agencies such as Medi-Cal consulting services, assisting them with becoming eligible if the applicant has not yet received a needs assess. Sent by the waiver program or the county eligibility worker must obtain documentation that the ill spouse meets the nursing facility level of care requirement through the D8C S MC604 mbed this doctors verification form is required in order to apply. The spousal impoverishment provisions. If the doctors verification is necessary, counties must provide the form to the applicant as soon as the request for IHS S or a CBS is made, the spousal impoverishment provisions must be applied to home community based services. Spouses who request I HSS and provide a completed doctors. Verification form indicating a need for nursing facility level of care for at least 30 consecutive days. Any Unsuccess request is adequate. Likewise, any requests for home community based services must trigger the doctors verification process. The date the doctor determines the ill spouse needs nursing home level of care determines when the applicant will be eligible for services under the waiver program. The MC 604. YMMV form and the needs assessment serve different functions and are not interchangeable. Both may be required for an individual requesting in home care, depending on the timing of the request for services and their individual circumstances. The purpose of the doctors verification form is to verify that the individual requires a nursing facility level of care for at least 30 consecutive days. In the absence of. In home care and support services, and typically will be used in cases where there has not yet been a need success. The doctors verification form is completed by a medical doctor using their medical judgment as to whether nursing facility, level of care is needed and the date when it was first needed by the individual. It is one of the two criteria’s to start the application for spousal impoverishment provisions. In contrast, the needs assessment is completed. At the individuals home, hospital or rehabilitation. And is conducted by a social worker or eligibility Screener who makes a clinical determination based on a functional index scale as stated in all county welfare directors. Letters 17, dash 25. Once determined eligible using the spousal impoverishment provisions, the HCBS spouse remains eligible. Aside from a change in circumstance unless and until the request for HCBS is denied. Request may be denied because the individual did not meet the clinical standard for the waiver. Once this fully executed form has been submitted to Medi-Cal along with the application for Medi-Cal benefits, that county eligibility worker is mandated to process the application within 45 days. Although this program has been available here in California since 2017, Mini Counties struggle and understanding how to administer the benefits. If you need assistance in getting your county to process these benefits, please reach out to Medi-Cal consulting services for assistance in resolving the issue. I'm a little extra time to share with you two additional rulings that are often used to assist long term care residents with the cost of needed care or services. The first is a program called Hunt versus Kizer. You may have heard about it as it's. Been around since 1989 Hunt versus Kizer allows beneficiaries to use old unpaid medical bills, for which the beneficiary is still legally responsible to reduce the monthly Medicare cost. The share cost will be changed to reflect the cost of the outstanding balance. This is not automatic and should be discussed with the eligibility worker at the time of application or anytime thereafter. If you have difficulties in getting your request processed, please reach out to Medi-Cal consulting services for assistance. This can be helpful. When you have a resident who has come in and out of your facility and they have an outstanding balance, for example, the resident left owing $10,000, they have a $2000 share costs and are now back in long term care. Once Medi-Cal has processed the hunt versus Kizer request. The residents share costs will be zeroed out for five consecutive months to cover the outstanding balance of $10,000. Lastly, another program available to assist long Term Care residents with needed services is called Johnson versus rank under the Johnson versus ranked settlement. Beneficiaries may use their share cost. To pay for medically necessary supplies, equipment, or services not covered under the Medi-Cal program. A doctor's order is required to show medical necessity and must be put in the beneficiaries record at the facility. This prescription must be a part of the physicians plan of care. After a copy of the prescription and the bill is presented to the facility, the facility will deduct their fee from that month. Share a cost. And build a resident for the remaining share of cost if needed. Not Neil. This is extremely helpful in covering the cost of certain items like eyeglasses, dentures or hearing aids when they are misplaced. This can also be used to pay for the cost of specialized equipment needed to offer a better quality of life for the resident. Each waiver has its own focus and services, and an individual may be a better fit under one waiver than another. An annual renewal the Eqb spouse, community, spouse, beneficiary, representative, administrator or care coordinator, he'd only confirmed continued take participation just as an institutionalized spouse would confirm. Continued institutionalization on their renewal forms as long as the period of HCBS. Participation or institutionalization continues. There's no need to reverify the nursing facility level of care. Thank you for your attention today. I hope you enjoyed the information I presented. This is a very confusing and complex topic and so I wanted to leave plenty of time for questions and address them accordingly. OK, lots of great details in there, so we're going to move on to the next portion here where Lisa is going to pop in for us here and share a few other details about her presentation here. She's got some updates. So Lisa, I'm going to put you. On video here if that's OK. Are you there oh good. OK. Now, oh, there you are good. Hey good morning. High is your brain swimming from all of that great information. Hold on to your seats cause I've got some more knowledge to share. Now let's talk a little bit more about Medi-Cal, including how to actually apply the current application process. Is being changed. They're actually integrating a new portal for all the 58 counties. This is huge. In the past they had three separate systems depending on which county you are applying in, so they're integrating all of those into one system. They had expected to roll it out. By this time, but unfortunately there's been some kinks. But right now. All the C4 counties are currently using the new cal soft system. That website is benefits calcomm Assos 2 plus application is widely used by all counties. If you wanted to complete a paper application. Next slide. Now when initiating application and you're trying to assist someone in doing that. Process you gotta keep a few things in mind. First of all, anyone can assist someone and initiate an application on their behalf. This means anyone? Who has specific knowledge of the applicants affairs in their needs for Medi-Cal be a friend relative or someone at the care facility where they're now staying. If the applicant has capacity, they're going to be. They're going to need to participate. What that means is they're going to need to sign the application and provide you with the documentation. You can represent them, you can be their voice and you complete the forms and they don't need to talk with anyone or meat. With anybody at the Medi-Cal office, if you're going to do it for them, you can take care of that. You just need to have them sign an authorized representative form, assigning you to assist them. Next slide there. Now, if you're completing an application for someone who doesn't have capacity, you obviously do not want them to sign the application. You don't want them to sign anything if they don't understand what they're signing, and if there's no spouse or power of attorney or conservative, you can ask the county to perform what they call a diligent search. Were there supposed to actually diligently search for the information that's needed in order to process improve this individual application? A diligent search. Can also be used if the spouse African. Both have no capacity. But if the applicant has a spouse, that spouse has to participate as well. Here's some fun facts. The minimum monthly maintenance needs allowance. That's the spouse. Allocation amount can be increased. Currently the Internet is $3260.00. That's the amount that Medi-Cal uses in the calculation. When there's a spouse involved to determine what the share costs will be. For the ill spouse. So if they have large sums of income. And they end up having a large share cost that is not affordable for them to pay. Then they can seek other assistance in increasing that through some court proceedings. Another fun fact is. That a lot of people get confused and thinking that attorney is required in order to qualify for Medi-Cal. And that's not true at all. Attorneys are great help. With a lot of things. And they can't help with medic, how is? Anyone else can as well. The representative payee process. This is a program through the Social Security Office. If you know someone who is struggling to manage their funds or they're having difficulty paying their share of cost because they're having difficulty managing their funds, then you could apply or someone can apply for them. Under the Representative payee program, here's the website here, in the form that's needed and the phone number as well. To call, we recommend if you suspect suspect any fraud that you contact. So security office and report it right. Way there's also adult Protective Services that's available to assist to report things that are going on that you're concerned with. If you're trying to assist someone. So what's new in that account? Wow, there's a lot happening, and as you know, right now we're in a public health emergency. It was first declared January 2020 and it's now been extended a few times, but this last date is they're expecting it to in January 16th of 2022. There's a little. Scuttlebutt saying that it may be extended, but right now. That's the date we have on. Well, during this public health emergency, Medi-Cal mandated not to process any negative act actions on any current Medi-Cal cases. What does this mean for annual review terminations? Well, once here you need to re apply for Medi-Cal. Now we've been in this public health crisis for a couple years now, going on. So redeterminations have become do. But because of the executive order the governor put out Medi-Cal is mandated not to discontinue anybody. Benefits for any reason, unless they die or they request that Medi-Cal be discontinued. So if you haven't completed your andary determination they won't discontinue your benefits until the public health emergency has been lifted. At that time, you're going to need to complete that annual redetermination. If you have questions about that, reach out to us and we can help you how to process that and. Get that going for. You so you don't lose valuable benefits. Some other really. Exciting news is Medi-Cal planning to phase out the asset limit test. So there. Will be no. Limits to how much assets you can have. Effective July. The 1st 2022 and by the way you did hear me right, there will be no asset test. On July 1st of 22 is the first phase and at that time they're going to increase the asset limit, which currently is $2000 for a single individual and $3000.00 for a couple in the community. They're going to increase that to 130,000 with an additional 65,000 for each additional family member. Up to 10 family members. The phase two section, where they fully eliminate it will be July 1st of 2022. Now the first phase of this has been approved by the federal government. They're still looking to get the face to federally approved. If you already have, if you have a loved one or someone you're trying to assist, who may need nursing home level of care centers has a website. It's called nursing home compare and it's a valuable tool you can use to research the nursing homes in your area and find out a lot of information. About them, for example, do they accept Medicare and Medi-Cal? Now this is a federal website, so their Medi-Cal on here is called me. The key, so if they say that the nursing home takes Medicare and Medicaid, that's Medi-Cal. Here in California you can also see how the facility fared out at their last survey, and there's a rating program that seems has developed that rates the facilities like kind of like a star rating like they do with hotels and what have you so you can check. Not out as well, and you can find out how that last survey went for them. I've cooked next page there I've put together some acronyms that Medi-Cal uses just to kind of help you understand as you go through the process and trying to understand what these acronyms stand for. If you have additional questions, I'll stick around for a while as long as you need, but you can always reach out to me at medihelper.com and we're happy to. So back to you man. OK, thank you Lisa. That's wonderful and those are some very significant changes, obviously, so thank you for the heads up on those and wants to come. Just a reminder, while you folks type in your questions for Lisa here is that we will send you a link to that video that we just saw a few minutes ago of Lisa. I think it's a great overview. And to be able to share that with others in such an easy format is, I think very helpful. So I'm glad we use that Lisa. So let's see a few questions that have come in. One is our long term care insurance disbursements considered income as part of the share of cost calculation? So long term care insurance. Is a great product and it can be very helpful in keeping someone in their home. Unfortunately, some products don't pay out enough in order to cover the total cost of their care. And a number of people still need to be institutionalized in a long term care facility while they're still receiving the benefits from their long term care plan. So if you have long term care insurance, you want to kind of check out the policy and how much does it pay. Is it $100? A day? $300 a day? How long does it last? Do they give you a cost of living? Raise every year there's a lot of the questions you want to ask your the individual who sold you the policy. So, but if you are receiving benefits from your long term care insurance policy, there's a couple ways in which you can receive those disbursements. The so it depends on your policy. They may pay them directly to the consumer, or they may require that they're paid to the provider. So depending on how their paid is really will. Determine how Medi-Cal will assess it. If it's paid directly to the provide to the provider. The Med account only does not count that as income, but if it's paid directly to the consumer, sometimes Medi-Cal counts that as income. Hey, thank you. We have a question what? About, uh custodial care level facility. Will Medi-Cal pays? For custodial level of care in a skilled nursing facility through their long term care program, and that's a lot of what we were talking about today. Also, Medi-Cal will pay for custodial level of care in an assisted living community through the assisted Living Waiver Program. So that applies Lisa for assisted living in like a board and. Care as well. Yes, as long as the board and care or the assisted living community is signed up for the assisted Living Waiver program, then you can research receive services through that community. OK, all right and we have a couple of people saying they have specific questions about. You know their clients that they'll be reaching you out, reaching to you for to discuss. OK as. If you go to the next slide lamp. We could do. Yes. Thank you. Yeah, there there's my email address that you can actually email me. If you have specific questions, what I do recommend though, if you want somebody situation assess so we can tell you precisely what you can do for that individual, we're going to need you to complete our assessment on our website. Mehdihelper.com it's in the top right hand corner of our homepage of Big orange button. It says free Medi-Cal Assessment if you complete that, you'll get on our calendar and we'll call you for one hour free consultation with no obligation, and you'll get all your questions answered specifically for that particular individual. That's great Lisa. We actually have someone coming up in just a few days with you, so we're going to go through this process ourselves with a client who's developmentally delayed. So this will be a good exercise for us. We had do have a question from a fiduciary she says or she asked as a fiduciary is extremely difficult to find a Medi-Cal bed and, uh, sniff in the San Francisco Bay area. I was just about to move my conservative to Sacramento, then last minute of fiduciary pulled strings to get me into a. Sniff is this. A common experience. Unfortunately it is a lot of times and I think in life as it is. It's all in who you? Know unfortunately so. Sometimes I can help my clients because I have a lot of connections in the nursing home industry as I used to be a corporate consultant so I can help them kind of facilitate that process at times. But you have to keep in mind. In that long term care nursing home, it is to business and it's a business of caring. But it's still a business, so sometimes things aren't always explained in detail, or sometimes they're explained to purposely mislead someone. So we can really help you understand the process. If you're struggling with that. So give us a call and it's trying to help you figure it out. Right? He mentioned that the counties are struggling to implement the county-based waiver program. Can you speak more to this situation? Absolutely, even though the waiver program came out in November of 2017, there there's 58 counties in the state of California. All the states are all the counties receive new regulations from Sacramento from the state analysts. They come down and then they're sent to each county. And then there's staff. To the county workers, and in this process sometimes the ball gets dropped. Misinterpretation occurs, so we're finding even though this program came out in November of 2017, there's still many counties that are really struggling to figure. Out how to hand. And not only this program, but it's a lot of regulations. We're constantly educating the workers throughout different counties on how to handle certain regulations and processes that they really should know. But being a former Medi-Cal worker and having my team of former Medi-Cal workers here really helps us with the. Knowledge that we. Need to help them understand how to process and approve these regulations properly. And if they do process an application and they do it, do it properly, then we file an appeal. We go in front of an administrative law judge to get them to make sure they follow and adhere to these state regulations. OK, thank you. Could you please give an example of a situation in? Which it would. Be allowable to increase qualifying income amount. I think what this question is Speaking of and Jody, correct me if I'm wrong, but I think you're Speaking of increasing the what they call the emna. We talked about the 3260 minimum monthly maintenance needs allowance that that's allowed initially. If with the income. The husband and wife are this. The couple have. If their income is at an amount to where they end up with a rather large share cost, and it's difficult to pay that share cost with all of the bills that they have in the Community in order to maintain the lifestyle that they're accustomed to, you can file some court proceedings and request that they increase that amount so you can remain in the community. And have the income that you need to survive. We have another one here that says can you just confirm the threshold for a single person to incept into Medi-Cal? Can you say that one more time? I'm sorry. Laser threshold for a single person to the word is incept into Medi-Cal. Now when you say threshold, I'm not sure if you're talking about income or assets now just to speak of assets. That when you're single, you're allowed $2000 of countable resources, and countable is the keyword there, so it's really important to understand what's countable and what's not cause, like I mentioned in the video, there's three ways in which Medi-Cal assesses. Sets so if you're wondering if someone is eligible to Medi-Cal, again, go to my website and complete that free assessment and we can look at that situation in particularly and address your questions there. OK, oh, I thought you were. Gone Shannon, she says income. OK, so when it comes to income so. When you're a single individual now, let me step back a minute 'cause when I mentioned just a moment ago that when there's a single individual, it's $2000 of countable resources. That's for someone who's being assessed under traditional Medi-Cal. Now, as I spoke about in the video, there's two different types of Medi-Cal now and they're very different. But once you qualify, it's the same program. So if someone is under the age of 65 and they're not on Medicare, they'll be assessed under the. Affordable Care Act Medi Cal, which is called Magi. Modified adjusted gross income. Now that program for those individuals. All that Medi-Cal looks at is your income. OK, if you're 65 or older, or if you're under than 65 and you're on Medicare, you're going to be assessed under traditional Medi-Cal where all they qualify you under is what your assets are. And under that. Program you have $2000 of countable resources. Now additionally, under that program there is no income limit in order to qualify, they just, they will just verify your income to determine what your share of cost is in the shared cost calculation is completely different depending on which programming fall under. For example, the long term care. Program if you're single and in a nursing home, you're allowed to keep $35 of your income. That's it. The rest of your income needs to be paid to the nursing home as your share of cost, but they cover all the. Costs of your. Care and everything you need, your medic, your not only your room and board medications, ancillaries, even pay for your haircuts and shampoos. The only things that they don't. Cover is if you wanted. Cable, if they didn't already. Have it up a phone. And I think if you smoke cigarettes, but that's about it, everything else is covered. That's good, thank you Lisa, I'm sure. Glad you're out there to. Give people all this information at. Such a great resource we have with. You I think we have one last question here and. We're approaching on 9:00 o'clock. We got one minute to go. If anybody needs to pop off, I just want to remind you that we will be sending you a copy again of the PowerPoint in case you missed that that was sent out last night. We're going to send you a link to Lisa’s wonderful video as well as a copy of this recording. That we've done. Here for today's on CE class. You will get your certificate as well within seven days, so just wanted to let you know that in case anybody popping off for 9:00 o'clock, which is right now. The last question I see here for you, Lisa, is, is there a limit to the number of waivers that can be issued, or is it primarily an issue of the county processing capabilities? So for my understanding, there is no limit, but you're only going to be eligible for whatever your circumstances are, so you have to be your circumstances kind of drive. What you'll be eligible for? So for example, like the HCBS waiver that we were talking about in the. Video that's only set aside for married couples. Who are both in the community and one of them has the level of care that meets custodial level of care. So if you don't meet that criteria, you won't be eligible to the waiver, so there has there's criteria for each waiver program. So if you meet that waiver, you'll be eligible. Thank you so. OK well I Think that we've come to the end. Look at that. We're right on time perfect. So thank you Lisa. You are, as I say, such a great resource for us. I just cannot say that enough. And thank you for being willing to do this class. This web and are with us today. Please feel free to reach out to Lisa and ask your questions. Get connected with her staff as well. Thank you all again for being present. Here today and we will get your content over the next few days out to you. If you have. Any feedback or any more questions please? Either send them directly to Lisa or if it's easier to send them to me replying to one of my emails. Please do that and I'll make sure I get that over to Lisa, so thank you again, Lisa, and also to Ronnie. In the background. There we really appreciate all you've done. To be here today. Take care, everybody stays safe and we'll hopefully see you in the new year. With another class, another web and R, thanks. Take care everybody.