Gilroy Elder Law Attorney: What is Medi-Cal Spend Down for Long Term Care?

First off, don’t be confused about the programs. We have Medicare, Medicaid, and Medi-Cal. Medicare is a federal program that serves individuals who are citizens and age 65 or older. Medicaid is a federal program administered through the states, so each state can make some of their own rules. In California, Medicaid goes by the name Medi-Cal, and that leads to some confusion.

Medi-Cal serves people of all ages if they qualify, but the focus of this article is on using Medi-Cal to pay for the long term care needs of seniors.

Two types of care are available through Medi-Cal. One type is In Home Supportive Services, also known as IHSS. This is available for qualified people over 65 years of age, or people who are disabled or blind. IHSS is provided to qualified people to assist in paying for services to enable them to stay at home. This is an alternative to out-of-home care such as nursing homes or board and care homes. If a person is approved for Medi-Cal, the county then evaluates the person to see how much care is needed to keep them at home. This is usually a certain number of hours of assistance that will be provided by Medi-Cal each day.

The other Medi-Cal program that is frequently used by seniors is the program that pays for long term care in a skilled nursing facility. Nursing home costs in our area run about $11,500 per month, so having this cost covered by Medi-Cal can provide a tremendous benefit to seniors and their families.

If a person enters a nursing home as a resident, the average length of stay, nationally, is 30 months. Many people think that Medicare will cover the nursing home expense, but that’s not true. Medicare will cover a stay of up to 100 days, but in most cases the Medicare coverage ends well before the 100 days are up. When Medicare coverage ends, the family must use their private funds or rely on Medi-Cal to pay for the senior’s care.

If the senior stays at the nursing facility for an extended period, the senior typically is on Medi-Cal, but only after they have depleted their assets. People refer to this depletion of assets as “spend down” or “spending down the senior’s assets.” Although this method is frequently used in other states, or the family uses this method through lack of knowledge about alternatives, this method is NOT used in California by knowledgeable elder law attorneys who are trying to preserve the senior’s assets. California law permits us to use other methods which result in preserving the assets of the senior.

I have had people say to me, “we spent over $500,000 of my mother’s assets before someone told us to go see a good elder law attorney.” Or, they say something like, “we’ve been paying for Dad’s nursing home costs for five years now, and he’s almost out of money.”

Don’t let this happen to your family. California Medi-Cal laws allow for advance planning to preserve the assets for the benefit of the senior, a spouse, and other heirs. Even if you don’t need Medi-Cal planning for yourself or a loved one now, make sure that you have the proper legal documents in place so that the right decisions can be made in the future. Don’t let the terms of a poorly drafted power of attorney or trust document prohibit your agent or trustee from taking the actions that you would have wanted them to take to preserve your assets for your family or your preferred charity.