Under the Affordable Care Act (“ACA”), low income persons under
age sixty-five (65) may enroll in the expanded Medi-Cal in order to meet the
federal requirement that everyone have health care insurance. At age 65,
Medi-care covers doctor visits, hospital visits, and some prescription
drugs. Medi-Cal, however, remains relevant for long term residential
custodial care in a skilled nursing home.
Expanded Medi-Cal targets a whole new population, including
young and middle aged persons without disability and/or with assets.
For example, someone who lost his or her job might become eligible for such
expanded Medi-Cal based on low income (i.e., at or below 130% of poverty
level).
A major concern among persons enrolling in the expanded
Medi-Cal program is whether their assets, including their home, might later
become answerable to Medi-Cal for reimbursement when they die. Unlike
traditional Medi-Cal, eligibility for the new expanded Medi-Cal is based
entirely on income. An applicant’s assets, age, disability and whether
the applicant is pregnant are irrelevant.
Federal ACA legislation provides that persons
participating in the expanded Medi-Cal program are subject to different
estate recovery rules than those persons participating in traditional Medi-Cal.
On February 21, 2014, the federal Centers for Medicare and Medicaid
Services (“CMS”) stated that while estate recovery also applies to
individuals in the expanded Medi-Cal that CMS intended, as much as legally
possible, “… to eliminate recovery of Medicaid benefits consisting of
items or services other than long term care and related services …
.”
That is, with respect to any services received by persons while under age 55,
CMS does not want to recover costs paid for physician visits, prescriptions
and hospital stays and only wants to recover costs paid for skilled nursing
home services (which involves custodial care).
However, because Medicaid/Medi-Cal is a combined federal and
state program much is left up to the individual states to decide.
Washington and Oregon have already enacted legislation that prevents estate
recovery for their residents who enroll in the Medicaid expanded program for
all services except for skilled nursing home care, as is required since 1993
under federal law.
Presently, California is also considering legislation that would
limit California’s estate recovery regarding expanded Medi-Cal to what is
required under federal law. The proposed limitations would prevent
recovery for any and all expanded Medi-Cal services received before age
55.
For those between ages 55 and 65, the proposed legislation would
allow recovery both for skilled nursing home care services and also for
community based services (i.e., hospital and prescription drug services) as
is required by federal law. Such persons might, in order to
avoid possible estate recovery, decide to enroll in Covered California.
However, anyone eligible for expanded Medi-Cal who participates in Covered
California would receive no government subsidies and so pay the full
premium.
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