Fillable State of CaliforniaHealth and Human Services Agency NOTICE (Department of Health Care Services)

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State of CaliforniaHealth and Human Services Agency NOTICE (Department of Health Care Services)

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State of California—Health and
Human Services Agency
Department of Health Care Services
NOTICE REGARDING STANDARDS FOR MEDI-CAL ELIGIBILITY AND RECOVERY
For Distribution by Insurers, Agents, and Brokers
IF YOU OR YOUR SPOUSE ARE CONSIDERING PURCHASING A FINANCIAL
PRODUCT BASED ON ITS TREATMENT UNDER THE MEDI-CAL PROGRAM, READ
THIS IMPORTANT MESSAGE!
You or your spouse do not have to use up all of your savings before applying for Medi-
Cal.
Recovery
An annuity purchased on or after September 1, 2004, shall be subject to recovery by the
state upon the annuitant’s death under the regulations of the Medi-Cal Recovery
Program. Income derived from the annuity must be used to meet the annuitant’s share
of costs and, if the annuitant is married, the income derived from the annuity may
impact the minimum monthly maintenance needs of the annuitant’s community spouse.
An annuity purchased by a community spouse on or after September 1, 2004, also may
be subject to recovery if that spouse is the recipient of past or future Medi-Calbenefits.
Unmarried Resident
An unmarried resident may be eligible for Medi-Cal benefits if he/she has less than
$2,000 in countable resources.
The Medi-Cal recipient is allowed to keep from his/her monthly income a personal
allowance of $35 plus the amount of any health insurance premiums paid. The
remainder of the monthly income is paid to the nursing facility as a monthly share-of-
cost.
Married Resident
Community Spouse Resource Allowance: If one spouse lives in a nursing facility and
the other spouse does not live in a 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
$126,420 in countable resources.
Minimum Monthly Maintenance Needs Allowance: If a spouse is eligible for Medi-Cal
payment of nursing facility costs, the spouse living at home is allowed to keep a monthly
income of at least his/her individual monthly income, or $3,161 in monthly income,
whichever is greater.
Fair Hearings and Court Orders
Under certain circumstances, an at-home spouse can obtain an order from an
administrative law judge or court that will allow the at-home spouse to retain additional
resources or income. The order may allow the couple to retain more than $126,420 in
countable resources. The order also may allow the at-home spouse to retain more than
$3,161 in monthly income.
DHCS 7102 (12/18) ENG
State of California—Health and
Department of Health Care Services
Human Services Agency
Real and Personal Property Exemptions
Many of your assets may already be exempt. Exempt means that the assets are not
counted when determining eligibility for Medi-Cal.
Real Property Exemptions
• One principal residence. One property used as a home is exempt. The home will
remain exempt in determining eligibility if the applicant intends to return home
someday.
• The home also continues to be exempt if the applicant’s spouse or dependent
relative continues to live in it.
• Money received from the sale of a home can be exempt for up to six months if
the money is going to be used for the purchase of another home.
• Real property used in a business or trade. Real estate used in a trade or
business is exempt regardless of its equity value and whether it produces
income.
Personal Property and Other Exempt Assets
• IRAs, KEOGHs, and other work-related pension plans. These funds are exempt if
the family member whose name it is in does not want Medi-Cal. If held in the
name of a person who wants Medi-Cal, and payments of principal and interest
are being received, the balance is considered unavailable and is not counted. It
is not necessary to annuitize, convert to an annuity, or otherwise change the form
of the assets in order for them to be unavailable.
• Personal property used in a trade or business.
• One motor vehicle.
• Irrevocable burial trusts or irrevocable prepaid burialcontracts.
There may be other assets that may be exempt.
This is only a brief description of the Medi-Cal eligibility rules. For more detailed
information, you should call your county welfare department. Also, you are advised to
contact a legal services program for seniors or an attorney that is not connected with
the sale of this product.
Please note: If you seek Medi-Cal payment for nursing facility services, you may be
ineligible for those services if payments from your annuity extend beyond your life
expectancy based upon life expectancy tables adopted by the Department of Health
Care Services for this purpose. To find out about these tables, you may contact your
local county welfare department.
Finally, the Department of Health Care Services is currently refining its policy regarding
the treatment of annuities when determining eligibility for nursing facility services. Any
regulatory changes will only impact annuities that are purchased after the effective date
of any regulatory amendments.
Different rules apply to annuities that are qualified retirement arrangements established
pursuant to Title 26, Internal Revenue Code, Subtitle A, Chapter 1, Subchapter D, Part
DHCS 7102 (12/18) ENG
State of California—Health and
Department of Health Care Services
Human Services Agency
1. In some circumstances, Medi-Cal does not count funds held in an IRA, Keogh, or
other work-related retirement arrangement.
To find out if Medi-Cal would count your IRA, Keogh, or work-related retirement
arrangements, you may contact your local county welfare department.
I have read the above notice and have received a copy.
Purchaser signature Date
Spouse’s signature Date
Legal representative signature Date
DHCS 7102 (12/18) ENG
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State of CaliforniaHealth and Human Services Agency NOTICE (Department of Health Care Services)

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Completed 23 November 2020

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