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Horizon Elder Law & Estate Planning Blog

Thursday, December 12, 2019

What Are the Criteria for Admission to a Nursing Home?

When a person can no longer care for him or herself, the person may need long-term skilled nursing care. Nursing homes provide skilled round-the-clock care for individuals of all ages. Paying for nursing home care can be expensive. A California long-term care planning attorney can help you with long-term care planning to prepare for this potential expense and protect assets for your spouse and other family members.

Who Pays for Nursing Home Care in California?

Some individuals have personal assets that can be used to pay for nursing home care or long-term care insurance that pays for nursing home expenses. However, most individuals need assistance with nursing home costs.

Medi-Cal, the state’s Medicaid system, is funded by state and federal funds. Before Medi-Cal pays for nursing home care, an individual must qualify for nursing home care and meet the eligibility requirements for Medicaid.

Eligibility Requirements for Nursing Home Care Paid by Medi-Cal

First, Medi-Cal only pays for nursing home care if the person is determined to have a medical need for nursing home care. Medical necessity is usually defined as the need for care to protect life, alleviate severe pain, or prevent significant disability or illness. Typically, a doctor prescribes nursing home care because the patient requires skilled nursing care or intermediate care.

Medi-Cal assesses the person’s abilities to perform activities of daily living (ADLs), such as bathing, toileting, eating, dressing, mobility, and continence.

It also accesses the person’s physician and cognitive function and whether a person needs assistance with medications and/or medical treatments. If a person only needs assistance with one or two daily functions, Medi-Cal may find that the person does not need skilled nursing care or intermediate care.

If a person qualifies for nursing home care based on medical necessity, the person must still meet the income and asset eligibility requirements for Medicaid. Medicaid has strict income limits and asset limits. The program is designed as a needs-based assistance program. However, individuals 65 years or older, blind, or disabled can qualify for Medi-Cal. If a person has too much income or assets to qualify for Medi-Cal, the person might still qualify for assistance by sharing the cost of nursing home care with Medi-Cal.

Medicaid Planning and Long-Term Care Planning

Because the cost of nursing home care and long-term care is expensive, working with an experienced attorney to plan for long-term care can protect your assets and ensure you qualify for Medi-Cal when you need it. There are legal ways to protect assets from Medicaid liens. However, it is important to begin planning now. Transferring assets within a certain period before applying for Medicaid benefits can result in a penalty period in which you cannot receive benefits. Working with an attorney to develop a long-term care plan is the best way to avoid these problems.

Contact a California Elder Law Attorney Now for More Information

Long-term care planning and Medicaid planning are important aspects of estate planning. Applying for Medi-Cal can be overwhelming. Schedule a consult with our California elder law attorneys to learn more. Our California elder law attorneys can help you address any issues that may arise and resolve matters to help prepare for long-term care or help you file for a loved one who needs nursing home care now.


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