U.S. Dept of Health & Human Services Calculator

It calculates the projected cost of long-term care (using your selected state’s average costs) and compares this to your projected savings. This gives you a ballpark number of the critical gap between the cost of long term care and what you are able to fund yourself.

This is of course, a preliminary first step in planning for your long term care needs. If you have a “sizeable” financial gap, you need to explore other options available to you, BEFORE you enter into what is called a “crisis planning” mode. You need to talk to an Elder Law Attorney who specializes in Long-term Care Planning, and who also has expertise in utilizing public programs such as Medi-Cal (Medicaid) benefits, and the Veteran’s administration Aid and Attendance Program.

Here at the California Elder Law Center, we specialize in helping seniors finding money to pay for their long-term care needs. So if you live in the Palm Springs area (Coachella Valley) or in the greater Los Angeles area, don’t hesitate to call us and make an appointment to discuss you own situation. Our toll free number is (888) 500-6700.

• SSI/SSP
• CalWorks (AFDC)
• Refugee Assistance
• Foster Care or Adoption Assistance Program
• In-Home Supportive Services (IHSS)

You can also get Medi-Cal if you are:

• 65 or older
• Blind
• Disabled
• Under 21
• Pregnant
• In a skilled nursing or intermediate care home
• On refugee status for a limited time, depending how long you have been in the United States
• A parent or caretaker relative or a child under 21 if:

The child’s parent is deceased or doesn’t live with the child, or
The child’s parent is incapacitated, or
The child’s parent is under employed or unemployed

• Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

Costs for a nursing home averages to more than $6,000 a month, which means that it can cost seniors upwards of $70,000 a year out-of-pocket. People who receive long-term care services at home spend can be spending more than $1,600 per month.

Some seniors can cover the long-term care they need in the future with long-term care insurance, savings plan annuities, certain life insurance policies, and reverse mortgages. The optimum solution really depends on one’s personal finances and family situation. Planning for disability or incapacity is something that we can’t afford not to do.

There are basic steps every one can take to start thinking about how to provide for health care as we all age:

1. Estimate how much of the cost of long-term care you could afford on your own.

2. Talk with you independent financial planner for more information about your financial situation.

3. Ask your current or former employer if you are eligible for group long-term insurance, savings plan annuities, or similar long-term care benefits.

4. Do some research and learn about long-term care insurance, trusts, annuities, reverse mortgage or other options for financing long-term care needs.

5. Call your local Area Agency on Aging to finds out about other programs that might help pay for long-term care. Look under “aging” or “Human Services” in the local government blue pages of the phone book for the number. You can also call 1-800-677-1116, which is the toll-free information line for the Eldercare Locator. (This is a public service of the U.S. Administration on Aging connecting you to services for older adults and their families.)

6.  If you have low income, you may qualify for Medicaid (or Med-Cal in California). If you live in California, you can go to the Department of Health Care Services Medi-Cal page to get more information about the program.

7. Last but not the least, if you happen to live in Southern California, you can call the Cal Elder Law office to make an appointment for a consultation: (562) 920-6100. As elder law attorneys, our expertise is in helping seniors plan for their their long-term care needs, at the same time protecting their hard-earned savings and assets.

Medi-Cal is different from Medicare Insurance. It is a needs-based program, and eligibility is based on the amount of income and resource a person has.

You should be aware that Medicare does not pay for all medical expenses, and usually must be supplemented with private insurance. Furthermore, there is no Medicare coverage for nursing home care beyond 100 days in any single benefit period. It also only pays for “skilled nursing care,” and therefore does not cover any “custodial care” expenses.

Also, it should be noted that there are a number of other Medi-Cal programs for special categories of consumers. This post focuses on Medi-Cal for long-term care.

Eligibility

To be eligible for Medi-Cal’s long-term care services, you must meet the requirements for: (a) income, (b) assets (real or personal property), (c) residence, and (d) citizenship.

Most of the eligibility requirements relevant to long-term care can be grouped into two general categories:

(1) those classified as categorically needy and therefore qualify for Medi-Cal;

(2) those who are medically needy and may become eligible by incurring medical expenses each month.

These categories include some low-income Medicare beneficiaries who are also eligible for Medi-Cal.

Low income individuals who receive cash assistance from programs like CalWORKS or Supplemental Security Income (SSI) qualify for Medi-Cal automatically. Other eligible groups are those who meet financial criteria but are not receiving cash assistance, including those with specific health needs like dialysis; individuals who are in a long-term care institution; or individuals who would require the level of care provided in a nursing home.

Individuals who are medically needy are those with high medical expenses who may have too much income or property to qualify as categorically needy. However, they must meet the cash assistance requirements (e.g., age, blindness, disability) to be eligible. These individuals may be eligible with or without a “share of cost.” This refers to the amount of medical expenses an individual must incur before Medi-Cal kicks in. Share of cost is determined by income.

Once you pay your monthly share of cost towards your medical expenses, you will receive a Medi-Cal card, which you can then use to pay for Medi-Cal covered services. Share of cost works like an insurance deductible. It is determined by the Medi-Cal Office and is generally defined as the difference between your gross monthly income, minus deductions and the need standard.

Over 40% of people getting close to 65 will need to spend time in a nursing home at some point. And the average monthly cost is steadily rising and is around $6k/month now.

So what are your options when faced with the potential of a long term care crisis?

One. Pay the costs out of private funds. This option is great if you’re independently wealthy or have wealthy family to help you out, if not, this is just not going to work.

Two. Purchase long term health care insurance. Purchasing long term care health insurance is becoming more popular as people realize the debilitating costs of full-service long-term care. So if you can afford it, make sure you use a reputable company and buy at least 5 years of in-home, assisted living and nursing home coverage at a minimum of $150 per day with the cost of living rider.

Three. Apply for and qualify for public benefits including Veterans and Medi-Cal benefits. Medi-Cal will pay for minimal in-home care and assisted living and can also be very complicated and stressful to apply for. Here’s why. There are certain assets that are counted against you when applying for Medi-Cal so having an attorney review your assets and decide how to treat them will help your chances of keeping your hard-earned possessions as well as qualify for the benefits you need now. These items may include your home, car, whole life insurance, household furnishings, cash at hand, bonds, savings, stocks, retirement accounts, etc. Some of these items may need to be transferred to someone else or used up in order to qualify for your benefits.

But the rules have changed! Congress passed legislation that majorly affects Medi-Cal Nursing Home benefits. This new law imposes new restrictions on the ability of the elderly to transfer their assets before qualifying for coverage.

Some of the Provisions Include:

• The look back period is extended from 3 to 5 years.
• The value of a house that can be exempt is $500,000.
• Annuities and many other planning tools will be eliminated.
• Monthly gifts are severely curtailed.

We strongly encourage adult child caretakers and seniors to readjust your long-term care planning or start planning now. Pre-planning is more critical than ever to maximize the possibility of saving your family’s assets and getting the senior the quality long-term care coverage they will likely need. Contact us today for a free consultation with one of our skilled Elder Law attorneys. Call 562-627-9600

Rule #1 for nursing home hunting is to do it before you actually need one. Do it now when your loved one can give their input; when you are all feeling cool, calm and collected. When you wait until your loved one is under duress, seriously ill or otherwise it’s not the best time to remember to ask all your questions and get the valuable answers you need to feel secure in your decision.

The cost of nursing home care is another source of stress for most families. Learn ahead of time what Medicare or private insurance covers and what the gaps might be so you can have your loved-ones estate plan setup to handle the costs. You should also realize that Medicare does not pay for what’s called “custodial care”, that includes: help with walking, eating, bathing and other daily activities. The average cost of nursing home care is $200-$300/day. And that doesn’t include whatever additional fees you may face in situations of Alzheimer’s of dementia when additional specialty staff and care is required.

Do your research! The Centers for Medicare and Medicaid Services collect valuable data on over 15,000 nursing homes cross-country. The data includes health inspection, staffing and a measure of the quality of care all combined to score each facility with an overall ranking from one to five stars. Additionally, the site offers a nursing home compare tool as well as a brochure titled “Medicare’s Guide to choosing a Nursing Home” for each facility.

Visit the home often, and at different times. Similar to when you are house hunting and want to check out the neighborhood different days of the week and times of the day- choosing a nursing home is the same way. Pop in to see if the experience feels different. Pay attention to patients looking for help, bad smells, or anything else that feels neglectful or just not right.

And take the checklist from the nursing home compare website with you so after you’ve toured each facility you can sit down as a family and discuss your findings together; carefully weighing the pros and cons of each facility. Also, bring your own list of questions along. Some questions to ask include: Do you engage in “person-centered care” as well as “consistent assignment” care? Ask what the daily schedule is, visiting hours, security of the building, activities or classes offered, and eat the food while you’re there. All of these things should weigh into your final decision.

If you are looking for help in California, try the California Elder Law Center. For access to a free clinic to learn more, we offer them every Wed at 2pm or for additional information please call (888-500-6700).

2)      Take the pressure off of your loved ones by having your wills, trusts and power of attorney handled by a professional elder law attorney. By working with an elder law attorney to plan your estate you can avoid costly mistakes so you can leave behind an inheritance to your loved ones, and LEGALLY keep your house & life savings in the process.

3)      Take full advantage of the Medi-Cal benefits you qualify for. By doing this you can legally secure your house, life savings and ensure you or your loved one gets the quality care they deserve.

These are complicated and trying issues to navigate alone. You have rights. To learn how to take full advantage of those rights the California Elder Law Center provides a free clinic every Wednesday at 2pm in our offices.

Visit us online at www.calelderlaw.com or call (562) 627-9600! This is life saving information you can’t afford to miss.