In this continuing series of posts we will focus on Medi-Cal for our over-65 clients who need assistance with long-term care. Here, we continue our discussion of the issues we discuss in our first appointment with our clients.
- What About Veteran’s Benefits?
One preliminary question we ask our clients has to do with their prior military service. In some cases, veterans and the surviving spouses of veterans can be eligible for benefits from the Department of Veterans Affairs (VA) to help pay for long-term care. This benefit does not require that the recipient need nursing-home level care and in fact is most often used by recipients who live in their home or in an assisted living facility. This is a cash benefit paid to wartime veterans and their surviving spouses to assist with medical and care expenses. Clients might be eligible if the veteran served on active duty, at least 90 days, at least one of which occurred during a period that has been designated as wartime. This includes specific dates during World War II, The Korean Conflict, The Vietnam War, and The Gulf War, which is ongoing. If a client may be eligible for this benefit, we will have to assess which benefit, Medi-Cal or VA benefits or both, will best meet the client’s needs, and plan accordingly. In this series, our focus is Medi-Cal, and we will not cover VA benefits in detail.
- What Needs to Happen for Medi-Cal Eligibility?
In order to be eligible for long-term care assistance from Medi-Cal, our client must meet three requirements: they must be medically eligible; their income must be below a specified threshold; and their countable assets must be below a specified threshold. Medical eligibility is not usually something for which our clients need our advice. It is a doctor who determines that the client is in need of nursing-home level care. In our office, we are more focused on the income and assets, so during this initial appointment we will be gathering information about the client’s income and assets.
We will need to know exactly what our client’s monthly income is and where it comes from: Social Security, pension, interest, dividends, IRAs, annuities, rent. We need the same detail about assets. We ask how much they are worth and exactly what they are: home, cars, bank accounts, investment accounts, retirement accounts (IRAs and 401k), real estate, insurance policies.
- Who Can Help?
In order to do Medi-Cal planning, we must have trustees, agents under powers of attorney, and various other roles filled by people our client trusts. We need to talk about the family members and their relationships, with our client and with each other. We need to identify potential problems and conflicts so that we can come up with the best possible plan for our client. If the children don’t get along, we don’t want to create a plan that requires them to cooperate with each other, for example. If one child is estranged from the family, we will need to discuss the risks of doing planning without that child’s participation or consent.
In our next post we discuss the work we do after we’ve gathered information at the first appointment with our client.