New Federal Regulations on Medi-Cal and Nursing Homes by Kevin Staker

Revised Federal Regulations on Medi-Cal and Nursing Homes

The Centers for Medicare & Medicaid Services ("CMS"), part of the United States Department of Health and Human Services has issued a final rule on long term care facilities.

This rule revises the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. These changes reflect the substantial advances that have been made over the past several years in the theory and practice of service delivery and safety. These revisions are also an integral part of their our efforts to broadly improve both the quality of health care furnished through federal
programs, and patient safety.  However, they also attempt to reduce the  procedural burdens on long term care providers.

One important rule is a prohibition of arbitration clauses in pre-admission agreements.

These regulations are effective on November 28, 2016.  They revise 42 Code of Federal Regulations Parts 405, 431, 447, 482, 483, 485, 488, and 489.

By Kevin Staker

2016 Medi-Cal Amounts by Kevin Staker

2016 Medi-Cal Amounts for Long Term Care by Kevin Staker

The Community Spouse Resource Allowance ("CSRA") for 2016, the amount at home spouse can have in countable assets is $119,220 in assets. 

The maximum amount of income the at home spouse is guaranteed to receive is $2,981.  This amount is called the Minimum Monthly Maintenance Needs Allowance ("MMMNA"). The MMMNA can be increased by going to Court and requesting additional support for the at home spouse from the income of the ill spouse. 

For 2016 the Average Private Pay Rate ("APPR") for nursing homes for 2016 is $8,189.  The APPR is used in calculating the term of ineligibility if an individual gives non-exempt assets to other individuals.

By Kevin Staker

Medi-Cal Recovery Only Against Probate Estate for Long Term Care Costs by Kevin Staker

Medi-Cal Recovery Only Against Probate Estate for Long Term Care Costs by Kevin Staker

We have had some time now to digest the 2016 California State Budget Act and its limitations on recovery by the California Department of Health Care Services ("DHCS") arising out of services from Medi-Cal. 

The key point that surfaces is that DHCS can only recover against a probate estate.  Futher, tt can only recover for nursing home facility and long term care services provided after age 55 or any age if the person was “permanently institutionalized”. 

Hence, a living trust of a decedent avoids recovery.  This is another clear advantage of living trusts for estate planning. 

Joint tenancies will also escape recovery; but they can be very crude in their disposal on assets. Especially because a co-tenants creditors can go after their share of the asset.  A living trust avoids that.

Please note these changes are effective for individuals who die on or after January 1, 2017..

For an explanation further in depth, go to the site of the California Advocates for Nursing Home Reform at http://www.canhr.org/factsheets/medi-cal_fs/html/fs_medcal_recovery_FAQ.htm.

By Kevin Staker