 LTC Bullet: Medi-Cal’s Asset Test Elimination Friday, February 7, 2025 Seattle— LTC Comment: We explore the topic of California’s Medicaid program (Medi-Cal) eliminating the asset test for long-term care benefit eligibility after the ***news.*** *** ILTCI ’25 Conference announced a special screening of excerpts from Caregiving, a compelling, two-hour documentary executive produced by Bradley Cooper and produced by Lea Pictures, Ark Media, and WETA, scheduled to air in primetime on more than 330 PBS stations nationwide in June 2025. This groundbreaking public media documentary delves into the personal stories of caregivers, shedding light on the challenges they face in providing short and long-term care, as well as palliative and end-of-life care for individuals of all ages. Join us March 10, 2025, from 9:00 - 10:15 am ET for the Caregiving Keynote Presentation, Sponsored by CareScout. *** *** DOGE (the ad hoc, but influential “Department of Government Efficiency”) claims to have already cut over $64 billion according to the National Debt Clock. GAO says more is needed to address “our unsustainable fiscal path” as we reported in this LTC Clipping. Center for LTC Reform premium members receive LTC Clippings by email in real time. Regular members receive the same content compiled in weekly LTC E-Alerts. Join the Center, receive these publications, and help us change LTC financing policy for the better. 2/5/2025, “The Nation's Fiscal Health: Strategy Needed as Debt Levels Accelerate,” by GAO, GAO-25-107714 Quote: “The federal government is on an unsustainable fiscal path that poses serious economic, security, and social challenges. We reported that:
We continue to recommend that Congress develop a strategy to inform the difficult policy choices in addressing our unsustainable fiscal path. For more information on federal debt, see our resource: How Could Federal Debt Affect You?” LTC Comment: Another dire warning from the Government Accountability Office (GAO). Likely to have the same impact as all the previous ones. Namely, none. Can the unofficial Department of Government Efficiency (DOGE) do better? According to the National Debt Clock, DOGE has already cut over $60 billion. As Reagan said, “Trust, but verify.” We’ll see what’s real, if anything, in time.***
LTC BULLET: MEDI-CAL’S ASSET TEST ELIMINATION LTC Comment: I’m researching Medi-Cal’s elimination of the asset test for LTC benefit eligibility. Before I put all the pieces together into an organized analysis, I thought readers might like to see some of the information I’m turning up. Following is a sampling with sources linked. Click through for eye-opening insights into the mind-boggling, budget-busting ideology behind this momentous policy change.
“As of January 1, 2024, Medi-Cal will no longer count assets to determine eligibility. This means that anyone, regardless of how much they own, may receive Medi-Cal benefits, including:
“SSI and other
categorically-related recipients are also automatically eligible for Medi-Cal.” “Asset
Elimination Overview “Q: For which
Medi-Cal programs will the asset limit be eliminated? “As Medi-Cal coverage is an essential lifeline in providing for the health care needs for millions of beneficiaries (including dental, vision, hearing, transportation, and long-term care), this win [elimination of the asset test] greatly increased the quality of life, health and economic wellbeing of tens of thousands of people.” (California Health Advocates, emphasis added) “Starting January 2024, there will no longer be an asset limit for Medi-Cal eligibility. This change has significant implications, as it means that more individuals can now qualify for Medi-Cal and access home care services through the In-Home Supportive Services Program.” (Bet Tzedek, emphasis in the original) “Some 36% of Californians are covered by Medicaid, compared with 19% of Floridians and 15% of Texans. The federal share of the Golden State’s Medicaid spending—nearly $120 billion—is more than Florida’s entire budget.” (WSJ column) “Consider California, where 37% of residents are covered by Medicaid. The state has extended Medicaid to undocumented immigrants and waived asset limits for beneficiaries. Mr. Newsom’s budget forecasts some $190 billion in Medicaid and other health spending this year, $119 billion of which will be picked up by the feds. The latter amount is greater than Florida’s annual budget.” (Wall Street Journal editorial, 1/24/25) “A [transfer of assets] lookback period will no longer apply to transfers made on or after January 1, 2024.” (Overview of Medi-Cal for Long Term Care by California Advocates for Nursing Home Reform) “Medi-Cal
applicants, beneficiaries and their spouses should always be aware of the
Medi-Cal Recovery rules and plan ahead if they want to avoid recovery on
their home or other assets. For detailed information on the Medi-Cal
Recovery program, see CANHR’s consumer booklet on Medi-Cal Recovery, https://canhr.org/wp-content/uploads/Medi-Cal_Recovery.pdf” “A new
report from the Kaiser Family Foundation finds that nursing home
staffing has decreased from 2015-2024 and the number of federal
deficiencies assessed per facility has increased. The KFF data show that
staffing in California nursing homes has decreased from 4.54 hours of
nurse staff per resident per day to 4.39 while the number of deficiencies
per facility has risen from 10.5 to a whopping 16.7. Also from 2015 to
2024, the percentage of California nursing homes receiving a deficiency
for actual harm or jeopardy nearly doubled, from 14% to 27%.” “Recent Surge in Senior Caseload Driving Increase in Costs. From January 2024 through July 2024, we have observed a sharp increase in Medi-Cal enrollment among the senior population. Specifically, monthly growth averaged about 14,500 people, notably higher than the previous six months (averaging 1,600) or even during the continuous coverage period (averaging 6,200), when the state temporarily paused redeterminations of enrollee eligibility. We assume that the key driver of this caseload surge is the recent (January 1, 2024) full elimination of the asset limit test. (In addition to specific income limits, prior to July 2022, seniors and persons with disabilities faced strict asset limits for eligibility. Specifically, nonexempt assets could not exceed $2,000 for individuals and $3,000 for couples. The 2021 budget package raised the asset limit to $130,000 for individuals and $195,000 for couples effective July 2022, and fully eliminated the asset test as of January 1, 2024.)” (From November 20, 2024, The 2025‑26 Budget: Medi-Cal Fiscal Outlook) “As a result of the terms of the ACA’s expansion of Medicaid, the federal government currently discriminates against traditional Medicaid enrollees. With expansion, Medicaid resources have been diverted from children and individuals with disabilities to able-bodied, working-age adults. And existing Medicaid enrollees have a harder time obtaining health care appointments after expansion, with a large increase in emergency department use for non-emergency services.” (Source) “Skilled nursing facility residents must agree to pay the facility a portion of their income each month. This is called the monthly resident cost and is treated much like rent. The resident is responsible for paying their monthly resident cost to the facility, and Medi-Cal will then cover the remaining costs for the month. … “For example, under a legal settlement, Hunt v. Kizer, recipients may use old, unpaid medical bills that they have to reduce the monthly Medi-Cal resident cost. Original documentation showing the billing statement is an outstanding balance should be provided to the County eligibility worker. … The monthly resident cost will be adjusted to reflect the cost of the outstanding balance, which could, for example, mean no monthly resident cost until the old, unpaid bills are paid off. This is not automatic and should be discussed with the Medi-Cal county eligibility worker. “Under the Johnson
v. Rank settlement, recipients may use their monthly resident cost to
pay for medically necessary supplies, equipment or services not covered
under the Medi-Cal program. This deduction is only applicable to long term
care residents.” |