Attorney explains how stringent ‘asset test’ no longer required

By Mike Wood

Staff writer

Monday, March 31 (1:00 p.m.): There are situations where Medi-Cal can be viable for some Rossmoorians, elder law attorney Brian O’Toole told a group of residents on March 18 in the Fireside Room.

O’Toole spoke about Medi-Cal, this state’s version of Medicaid, at an Optimal Wellness Lecture presented by Rossmoor Counseling Services. O’Toole’s law practice, which is based in Walnut Creek, emphasizes estate planning, elder law, Medi-Cal eligibility, long-term care planning, trust administration, and probate administration.

One significant Medi-Cal change came at the start of 2024, when a Medi-Cal “asset test” requirement that an applicant have less than $2,000 in assets to qualify was eliminated. That old provision caused many Rossmoor residents to figure they were ruled out for Medi-Cal.

“In 2023, in the ‘old days,’ you had to have less than $2,000 in your bank account,” O’Toole said. “California got rid of that on Jan. 1, 2024. You live in a $5 million house; that’s no effect on your Medi-Cal. And even in the old days, Medi- Cal would let you keep your house as an exempt asset, so it did not count against you going into a program.”

The focus is on monthly income, which Medi-Cal uses to determine a “share of cost” that a person must pay monthly before Medi-Cal benefits kick in. It bears some similarity to how out-of-pocket deductibles function, with the threshold of income being under $1,801 a month.

“That’s a big distinction now in how the Medi-Cal program works,” he said. “It tends to be more favorable to people with assets and minimal income, and is not favorable to people with higher income and lower assets.”

Using Medi-Cal to supplement Medicare in certain situations can really help, particularly when someone needs long-term care in a skilled nursing facility.

“It’s one thing if you have a broken hip. Then you take the ride to the hospital, they patch it up, you do a little rehab, get back home. … That’s all covered by Medicare,” O’Toole said. “But what if you’ve broke your hip for the fifth time? And you have a little more trouble getting to the grocery store? Those are the situations where Medicare will cover the acute situation. But there are fewer benefits available for the longterm chronic situation.”

Responding to a resident’s question of whether a person on Medicare should also apply now to Medi-Cal if they currently don’t need it, he said, generally, “If you are not going to use it, don’t get it.”

While many may be uncertain when or if they’d need Medi- Cal, they probably also feel uncertainty about its future. As U.S. House Republicans work on a budget plan that envisions massive reductions to federal spending, a potential cut of $880 billion toward Medicaid funding could be on the table. About one in five Americans is on Medicaid, whose funding is split roughly 50/50 between the federal government and states.

With skilled nursing facilities, Medicare covers the first 100 days, with the latter 80 days requiring a co-pay. When a stay is going to be longer, Medi-Cal can prove helpful.

When asked how much Medi-Cal covers for a skilled nursing facility, O’Toole said, “The answer is whatever income you have coming in, you pay to the nursing home. If it’s about $5,000 of income, you have about $5,000 of contribution. You are capped at your monthly income.”

For those who already buy long-term care insurance, he said: “Most people, if they have it, will use their long-term care insurance first. The trouble is in the fine print. There’s often daily maximums, monthly maximums and lifetime maximums that you never really looked at in your long-term care (insurance).”

Answering a resident’s question about coverage of board and care homes, which have become increasingly prevalent, O’Toole said that generally speaking, “Medi-Cal does not cover room and board for anything other than skilled nursing. That includes assisted living; that includes memory care; that includes board and care.”

One Medi-Cal program that could help some individuals is an assisted living waiver (ALW), which has a long waitlist and requires that a person has no share of cost. Another program under the Medi-Cal umbrella is In Home Support Services, which can help pay for a caregiver in one’s home.

The presentation was recorded for Rossmoor TV. Check future TV listings in the News for air times.