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Form Dhcs 7077 - California Notice Regarding Standards For Medical Eligibility - Health And Human Services Agency

State of California—Health and Human Services Agency

Department of Health Care Services

NOTICE REGARDING STANDARDS FOR MEDI-CAL ELIGIBILITY

If you or your spouse is in or is entering a nursing facility, read this important message!

You or your spouse do not have to use all your resources, such as savings, before

Medi-Cal might help pay for all or some of the costs of a nursing facility.

You should be aware of the following to take advantage of these provisions of the law:

Unmarried Resident

An unmarried resident is financially eligible for Medi-Cal benefits if he or she has less

than $2,000 in available resources. A home is an exempt resource and is not

considered against the resource limit, as long as the resident states on the Medi-Cal

application that he or she intends to return home. Clothes, household furnishings,

irrevocable burial plans, burial plots, and an automobile are examples of other exempt

resources.

If an unmarried resident is financially eligible for Medi-Cal reimbursement, he or she is

allowed to keep from his or her monthly income a personal allowance of $35 plus the

amount of health insurance premiums paid monthly. The remainder of the monthly

income is paid to the nursing facility as a monthly deductible called the “Medi-Cal

share-of-cost.”

Married Resident

If one spouse lives in a nursing facility, and the other spouse does not live in a nursing

facility, the Medi-Cal program will pay some or all of the nursing facility costs as long as

the couple together does not have more than $123,600 in available assets. The

couple’s the spouse in the nursing facility is allowed to keep a personal allowance of

$35 plus the amount of health insurance premiums paid monthly. The remaining money,

if any, generally must be paid to the nursing facility as the “Medi-Cal share-of-cost.” The

Medi-Cal program will pay remaining nursing facility costs.

Under certain circumstances, an at-home spouse can obtain an order from an

administrative law judge that will allow the at-home spouse to retain additional

resources or income. Such an order can allow the couple to retain more than $123,600

in available resources if the income that could be generated by the retained resources

would not cause the total monthly income available to the at-home spouse to exceed

$3,090. Such an order also can allow the at- home spouse to retain more than $3,090 in

monthly income, if the extra income is necessary “due to exceptional circumstances

resulting in significant financial duress.”

An at-home spouse also may obtain a court order to increase the amount of income and

resources that he or she is allowed to retain, or to transfer property from the spouse in

the nursing facility to the at-home spouse. You should contact a knowledgeable attorney

for further information regarding court orders.

DHCS 7077 (01/18) ENG

Form Dhcs 7077 - California Notice Regarding Standards For Medical Eligibility - Health And Human Services Agency