Medi-Caid Recovery is E$TATE RECOVERY!! is YOUR KIDS LOSING THE HOUSE! It's a war, the STATE VERSUS the ESTATE!
A RUSE BY ANY OTHER NAME WOULD SMELL AS SOUR!
                

THE GOV WILL GO THRU YOUR POCKETS WHEN YOU'RE DEAD! AND TAKE IT ALL!
YOUR HEIRS WILL BE TOSSED ON THE STREET! LEARN WHAT YOU CAN DO to prevent this horrid occurence, there are easy, secret tricks!

Did you know that your state will take back all the money their MEDICAID program spent  on you? Rather, money you and your family spent in your old age or BILLED to them, or spent on your health care? And the state will TAKE it back, take it right out of your estate. Do a Google on some search terms right now, ""estate recovery" + maryland + medical costs expenses then your state's name

California’s Medi-Cal applicants and beneficiaries are often confused about
their rights regarding Medi-Cal and are particularly concerned that the
state will “take” their homes after they die if they received Medi-Cal
benefits. The following “Frequently Asked Questions” attempts to answer
some of these concerns and to provide consumers with the information
necessary to make informed choices about their estates when they are
applying for Medi-Cal.

I. Can The State Take my Home If I Go On Medi-Cal?

The State of California does not take away anyone’s home per se. Your home
can, however, be subject to an estate claim after your death. For example,
your home may be an exempt asset while you are alive and is not counted for
Medi-Cal eligibility purposes. (SO SELL IT WHEN YOU GET OLD, INVEST
THE MONEY IN YOUR CHILDREN's BUSINESS IDEAS, in buying them
a NICE LITTLE FARM. ) However, if the home is still in your name
when you die, the state can make a claim against your estate for the amount
of the Medi-Cal benefits paid or the value of the estate, whichever is
less. So that heart operation and convalescence? Adios casita! So carefully
read the HOLISTIC prevention of all disease website.

II. Can the State Put a Lien on My Home?

Consumers often confuse liens and estate claims. Both have been used by the
state in attempts to reimburse the Medi-Cal program for payments made to
beneficiaries. Liens are placed on living Medi-Cal beneficiaries’ estates
to “hold” the property until the person dies. Estate claims are claims made
against the estate of the Medi-Cal beneficiary after he or she dies. As of
January 1, 1996, California is not permitted to impose liens against the
homes of nursing home residents or their surviving spouses, except in cases
where the home is not exempt (i.e., the nursing home Medi-Cal applicant did
not indicate an intention to return home) and the home is being sold. Under
current law, these are the only liens that can be placed on the homes of
living beneficiaries.

WHEN YOU PUT PARENT AWAY, THEY MUST SAY "I'm GOING HOME
as SOON as I'm well" That intention must be on every family member's LIPS.

Most Medi-Cal applicants’ homes are exempt because a spouse, child or
sibling lives there or they do indicate an intention to return home on the
Medi-Cal application, so even these liens are rare. After the beneficiary
has died, the heirs or survivors may sign a “voluntary” lien for Medi-Cal
recovery purposes, if they can’t otherwise have an estate claim against the
property waived.

III. What Happens After I Die If I Received Medi-Cal?

After the Medi-Cal beneficiary’s death, the state can make a claim against
the estate of an individual who was 55 years of age or older at the time he
or she received Medi-Cal benefits or who (at any age) received benefits in
a nursing home, unless there is a surviving spouse or a minor, blind or
disabled child. Thus, if there are any assets left in the estate of the
deceased beneficiary, Medi-Cal will seek to be reimbursed for benefits
paid. It is important to note that, even if you received Medi-Cal at home,
any benefits paid while you were 55 years of age or older will be subject
to Medi-Cal recovery.

IV. How Much Can the State Recover?

California’s definition of “estate” includes such previously immune assets
as living trusts, joint tenancies, tenancies in common and life estates.
Many consumers place their property into living trusts, thinking that this
will protect it from an estate claim. It does not. The state can still make
a claim against property held in a living trust, joint tenancy or tenancies
in common, as long as the beneficiary’s name is still on the property at
the time of death.

However, the amount of recovery is limited to the amount of benefits paid
or the value of the beneficiary’s estate, whichever is less. For example,
if the appraised value of your home is $200,000 and you left it in joint
tenancy with your three children, the state can only collect up to $50,000,
which is your part of the estate - even if the Medi-Cal benefits paid to
you is more than $50,000. The value of the estate is also reduced by any
outstanding mortgages or debts on the home. For example, if the home had an
outstanding mortgage of $100,000, this reduces the value of the estate to
$100,000 (the appraised value of $200,000, minus the mortgage). This, in
turn, reduces the amount of the estate claim to $25,000. (The value of the
home ($100,000) divided by the four joint tenants.) Deducting the amount of
burial costs or estate settlement costs can also reduce the claim.

When the state files an estate claim, they are also required to send an
itemized billing of benefits paid over your lifetime. It is important to
review the billing to see if there are any errors. As of September 1, 2000,
the state ceased collecting for the amount of In Home Supportive Services
(IHSS) paid. Thus, if IHSS services are included in the itemized billing,
the collection representative should delete this from the billing.
V. Are There Any Exceptions to An Estate Claim?

A. Surviving Spouse: The state is prohibited from recovery while a
surviving spouse of a deceased Medi-Cal beneficiary is alive. However,
after the surviving spouse dies, recovery may be made against any property
received by the spouse through distribution or survival, e.g., property
left under a will or community property. However, if the home is
transferred out of the nursing home resident’s name while he or she is
alive, no claim can be placed on the home. Spouses should be careful to
“transmute” the property, i.e., through a court order or by having the
nursing home spouse sign a declaration relinquishing his/her interest in
the property.

B. Minor, Blind or Disabled Child: If a minor child or a blind or disabled
child of any age survives the beneficiary, a claim is prohibited by federal
law. The surviving child or his/her representative only needs to send
proof, such as a birth certificate, that they are the child of the decedent
and, in the case of disability, documentation of disability or blindness,
such as a Social Security or SSI award letter. If the surviving child does
not have documentation of disability from the Social Security
Administration, he/she can still file for a disability determination with
the Department of Health Services. It is important to note that the
surviving child does not have to live in the home (or even in the state,
for that matter) in order for recovery to be barred.

C. When There is Nothing Left in the Estate: Since most deceased Medi-Cal
beneficiaries leave nothing but their homes, it is most important to look
at the deed to the property. Whose name was on the property at the date of
death? If the beneficiary transferred the property outright prior to death,
then send a copy of the deed, along with a letter explaining that the
beneficiary left nothing in his/her estate and ask that the case be closed.
If the beneficiary left any funds in an account, these funds must be paid
to the state, after documented expenses are deducted, unless there is an
exempt survivor or unless you file for a hardship waiver.
VI. What Else Besides My Home Can the State Claim Against?

Under current law, “estate” is defined as any real or personal property and
other assets in which the individual had any legal title or interest at the
time of death (to the extent of such interest), including assets conveyed
through joint tenancy, tenancy in common, survivorship, life estate, living
trust or other arrangement. Because the state has not published clear
regulations, the current policies and procedures are important. Anything
left in the decedent’s bank accounts, for example, can be subject to
recovery, after estate and burial expenses are paid. The state cannot
recover from IRAs, work-related pension funds or life insurance policies.
As of August 2004, the state can recovery from annuities purchased on or
after September 1, 2004, regardless of whether the remainder interest in
the annuity is a lump sum or a stream of income. Because the recovery
regulations are fluid, call the CANHR office if you have specific questions
regarding recovery.

VII. How Does the State Know When a Medi-Cal Beneficiary Dies?

A. Notice of Death: When a Medi-Cal beneficiary dies, the County Medi-Cal
office notifies the Department of Health Services in Sacramento and
benefits are terminated. However, for recovery purposes, the burden of
notifying the State of the death is still on the beneficiary’s estate.
California law, under Probate Code §215, requires that, when a deceased
person has received or may have received health care benefits or was the
surviving spouse of a person who received such benefits, the estate
attorney, the beneficiary of the estate, the personal representative or the
person in possession of the property is required to notify the Director of
the Department (at the Sacramento office of DHS) no later than 90 days
after the person’s death. A copy of the death certificate is required to be
sent. Because neither the law nor the regulations indicate the Director’s
address, and since most consumers simply notify the county office, it is
important that you send the notice and death certificate to the correct
address, if you want the matter to be addressed in a timely manner. It is
recommended that the notice of death and the death certificate be sent by
registered or certified mail to: Director, DHS, MS-4720, P.O. BOX 997425,
Sacramento, CA 95899-7425.

The director has four (4) months after receipt of the notice in which to
file a claim. If a claim is not filed within that period, the state is
forever barred. But if you don't tell them you're dead, you're also
debarred forever.

B. Beware of False Forms: The Recovery Unit has sent out a number of
questionnaires to consumers implying that they are under a legal obligation
to complete and return them. One such form, a “Medi-Cal Estate
Questionnaire,” is neither necessary nor legal, and consumers are advised
not to complete it, unless the case is clear, i.e., the decedent has
already transferred the property during life or left no estate at all.
Another form letter is often sent to spouses of deceased residents asking
for the surviving spouse’s social security number and date of birth. It is
not necessary to respond to this letter, either. Remember, the only legal
obligation under law is to send a notice of death and a copy of the death
certificate when a deceased Medi-Cal beneficiary or the spouse of a
deceased beneficiary dies.

VIII. How Does a Survivor Appeal an Estate Claim?

When a claim seems unavoidable, an applicant still has a number of options
to use in contesting the claim. However, the Recovery Unit has been
particularly lax in meeting regulatory timelines and in applying the
appropriate regulatory standards. Thus, it is next to impossible for an
applicant to really receive a “fair hearing” on the hardship issue. Claim
amounts are often miscalculated, hardship waiver decisions are delayed for
months and are arbitrary and capricious, and collection representatives are
misinformed as to the applicable regulations. Consumers are advised to
complete the hardship application as completely as possible and to submit
substantial documentation to support any hardship.

A. Hardship Waivers and Estate Hearings: State regulations provide that the
applicant (i.e., the dependent, heir or survivor of the decedent) may file
for a hardship waiver within 60 days of notice of the claim. The hardship
application is provided with the notice of the claim and the itemized
billing, along with a copy of the regulations. A written decision regarding
the hardship application must be sent to the applicant within 90 days of
submission of the application. The applicant may challenge the Department’s
hardship waiver decision by requesting an estate hearing within 60 days of
the date of the Department’s hardship waiver decision. The estate hearing
is an administrative law hearing and is required to be set within 60 days
of the date of the request and must be conducted in the court of appeals
district in which the applicant resides.

B. Caregiver Exemption: There is currently no legal exemption from recovery
for children of deceased Medi-Cal beneficiaries who lived in the home
continuously for at least two years and provided care that enabled the
beneficiary to remain at home or delayed entry into a nursing home.
However, the Recovery Unit has adopted an unwritten “policy” to consider
such factors in determining hardship.

The applicant must still complete the hardship waiver form and is also
advised to submit adequate documentation that shows that the applicant
provided a level of care for at least two years that delayed the deceased
beneficiary’s entry into a nursing home. This includes a statement from the
doctor or other medical provider attesting to the deceased’s condition
prior to entering the nursing home and what specific level and frequency of
care the deceased received from the child. Declarations from medical
providers, friends of the deceased, copies of pertinent medical records,
etc. can be useful in documenting the extent of the caregiving provided.

C. Judicial Review: Estate hearing decisions can be appealed judicially by
filing a writ of mandate with the appropriate court. The state may also
refer the claim to the Office of the Attorney General if the claim is not
paid and their collection efforts are unsuccessful.

D. Legal Representation: The hardship waiver and appeal processes can be
complicated and many surviving beneficiaries of the estate cannot afford
legal representation.
 

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http://www.sen.ca.gov/aging/FACT_SHEETS/3medcal.htm

MEDI-CAL URLS
Senior Fact Sheet #3
What is Medi-Cal?
Who is Eligible for Medi-Cal?
How to Apply for Medi-Cal
What is Covered by Medi-Cal?
How to Apply for Medi-Cal When Not on SSI
Providers and Reimbursement
What If You Have Medi-Cal and Medicare?

WHAT IS MEDI-CAL?

Medi-Cal, California's version of Medicaid, is a combined federal and
state program that pays for health and long-term care for eligible low
income citizens and legal residents of the United States. The State of
California's Department of Health Services administers Medi-Cal. It is
important to remember that not all physicians, clinics, or hospitals
accept Medi-Cal.

Some people receive benefits both from Medi-Cal and Medicare. Medicare,
the federal health insurance program administered by the Social Security
Administration, is available regardless of income for persons at least
62 years of age or who have been disabled for at least 24 months.

WHO IS ELIGIBLE FOR MEDI-CAL?

SSI RECIPIENTS: If you are 65 or older, or blind or disabled, and on
SSI, you are automatically covered by Medi-Cal without a share-of-cost
(SOC). If you receive SSI and have not received your Medi-Cal card,
contact your county welfare department. AFDC recipients also get
automatic Medi-Cal coverage. Contact your county welfare department to
make sure you qualify under new federal welfare reform provisions.

Disabled widows and widowers who received SSI prior to age 60 remain
eligible for Medi-Cal even if they become ineligible for SSI cash grants
because they receive Title II retired spouse's benefits.

OTHERS: If you are between 21 and 65 and in a nursing home, or you are
pregnant or a refugee, and your income and resources meet the Medi-Cal
limits, you may also be eligible for Medi-Cal. However, you should
contact your county welfare department to be sure your particular
immigration status has not been affected by recent federal welfare
reform laws. See How to Apply For Medi-Cal When Not on SSI.

Individuals may have private insurance through their union, group,
employer, other organizations, or family coverage, and these sources
will be considered in evaluating your eligibility for Medi-Cal. Under
the California Partnership for Long-Term Care, Medi-Cal will consider an
amount of resources unavailable if an insurance policy certified by the
Medi-Cal program has paid certain amounts to the Medi-Cal claimant's
skilled nursing facility costs. Additionally, the entire contents of
joint accounts are considered as available to Medi-Cal applicants,
unless funds can be clearly traced to income or transfers of an exempt
account holder.

MEDICALLY NEEDY ONLY (MNO): If you are not receiving SSI because you
have excess income, but you: (a) meet the SSI resource limits; and (b)
are either 65 plus, or blind or disabled, (as described below ), you may
still qualify for Medi-Cal under the medically Needy Only (MNO) program.
Under MNO you may have received a free Medi-Cal card or you may have a
SOC each month before Medi-Cal will pay the remainder of your medical
bills. To determine your SOC the county Welfare Department will take
your total monthly income and subtract all applicable deductions, for
example, $20 is deducted if you have unearned income.

You may also subtract any health insurance premiums that you pay
including Medicare Part B premiums. The figure that results after
deductions from your gross income are applied is called your net
non-exempt income. This figure is rounded. Then your "maintenance need"
is subtracted. The maintenance need for a single individual is $600 or
$934 for a couple. The remaining amount is your SOC - the amount that
you will have to spend or obligate yourself to pay each month toward
your own medical care expenses, if you have any, before Medi-Cal will
pay the remainder of your medical expenses that month. If you are in a
board and care home and your monthly payment to the home is greater than
your maintenance need, the extra amount you pay is deducted from your
net income before your SOC is determined.

Example: Fred is single and 70 years old. He is below the SSI resource level. However, Fred's $700 monthly income is over the SSI eligibility amount. He would like to get on the MNO program. Here is how to calculate his SOC:

Monthly Income.........................................$700.00
Subtract....................................................-$20.00
Subtract Health Insurance Premium
(Medicare Part B).......................................-$43.80
Total Net Non-exempt Income.................... $636.00
Subtract Maintenance Need.......................-$600.00
Share-of-Cost (rounded) ...............................$36.00

This means Fred must pay (or obligate himself to pay) the first $36.00
each month in medical bills before Medi-Cal will pay the remainder of
his medical expenses. Note: Under the legal ruling Hunt v. Kizer,
medical expenses incurred in a previous month may sometimes be used to
offset your SOC liability. The rules on this are complicated. Check with
your Medi-Cal eligibility worker or legal services office for more
details.

PICKLE AMENDMENT: If you received both SSI benefits and Social Security
benefits in any month after April 1977, but have since lost your SSI
benefits, you may still be eligible for Medi-Cal without a SOC even if
you no longer receive SSI (Pickle Amendment). Contact your county
welfare department or Medi-Cal eligibility worker for more details.

HOW TO APPLY FOR MEDI-CAL

In order to be eligible for Medi-Cal, you must apply through your local
county human services or welfare office, and they will determine
eligibility. Even though you may be automatically eligible for Medi-Cal
based on your Social Security benefit status, Medi-Cal is administered
through your local county welfare department. Your local human
services/welfare office will be listed in the telephone directory under
the name of the county in which you reside.

You must be a resident of California in order to qualify for Medi-Cal;
your eligibility worker will ask you to provide proof of residence.
Acceptable evidence of California residency includes:

- A recent California rent or mortgage receipt or utility bill in your
name.

- A current and valid California drivers license or identification card.

- A current and valid California motor vehicle registration in your name.

- A document showing your are registered with a public or private employment service in California.

- Evidence that you or your children are enrolled in school in California.

- Evidence that you are registered to vote in California.

- Other acceptable evidence of California residence; or a declaration, under penalty of perjury, that you do not have any of the documents or evidence listed above.

You do not have to furnish separate proof of California residence if you are applying for minor consent services, are the child of a parent who already has furnished Medi-Cal with proof of California residency, or your spouse has furnished proof of California residency, provided you both reside at the same address. (Recent federal welfare reform policies may establish other residency requirements. You should contact your county welfare office for details.)

WHAT IS COVERED BY MEDI-CAL?

Medi-Cal pays for health care services which meet its definition of
medically necessary. Services covered include physicians visits,
prescription drugs, hospitalization, x-ray and laboratory, nursing home
care, adult day health services, some dental care, some ambulance
services, prosthetic and orthopedic devices, eyeglasses, hearing aids
and some medical equipment and hospice care.

If you are sick or have a chronic illness or if your children need to
see a doctor, you should make an appointment with a doctor who takes
Medi-Cal. Your doctor will be paid for the office visit to diagnose the
problems and will let you know if your treatment can be paid by
Medi-Cal. Some services must be approved in advance. These include
nursing home care, home health care, non-emergency surgery and some
prescriptions. This advance approval is often referred to as prior
authorization. Your health care provider, not you, makes the prior
authorization request, or "TAR" (treatment authorization request).
Emergency care, most doctor's office visits and many drugs do not need
prior authorization. Your pharmacist can tell you if your prescription
requires prior authorization for Medi-Cal payment. Denials or delays may
be appealed. See appeals section below.

COPAYMENTS: Sometimes there is a $5 charge for non-emergency services in
an emergency room. In some cases, doctors are allowed to charge $1 per
office visit but this is not common practice. In more limited cases, a
$1 charge may be made for prescriptions.

NURSING HOMES: In order for Medi-Cal to pay for a nursing home stay, the
patient must be admitted on a doctor's order and the stay must be
medically necessary. Nursing home residents with incomes from any source
are allowed to keep only $35 per month for personal needs. Residents
with no income receive an SSI grant of $40 per month for their Personal
Needs Allowance (PNA).

Medi-Cal recipients in nursing homes who own their own homes (which may
be multiple dwelling units) remain eligible for Medi-Cal as long as: 1)
they intend to return home; or 2) the residence is used by a spouse
and/or dependent relatives; or 3) the residence is used by a sibling or
adult child who lived there at least one year before the owner entered
the nursing home; or 4) they make a good faith effort to sell the home.

Persons not capable of making a good faith effort to sell (for instance,
those who need conservatorships) remain eligible for Medi-Cal. In that
case, bona fide steps have to be taken so that someone else can sell the
home.

LIENS & ESTATE CLAIMS: Federal law expands California's ability to seek
recovery from a deceased Medicaid beneficiary's estate for expenses paid
under the Medi-Cal program. This will affect individuals aged 55 years
or older who received services provided by Medi-Cal or anyone who
received Medi-Cal benefits in a nursing facility.

Federal law also allows the State of California to define "estate" to
include any real and personal property that the Medi-Cal beneficiary had
any legal title to or interest in at the time of death. The definition
may include assets held in joint tenancy, tenancy in common,
survivorship, life estate, living trusts, etc. If an asset is held in
joint tenancy at the time of the Medi-Cal beneficiary's death, the State
can seek recovery from the deceased beneficiary's portion of the asset
to recover benefits paid under the Medi-Cal program. No recovery can be
made until after the death of the surviving spouse and only if there is
no minor, blind or disabled child.

If an estate claim is filed you have a right to a hearing and waivers
are available in cases where recovery would cause undue hardship. Estate
claims can be complicated. If you receive notice of an estate claim
contact your attorney, local legal services office or California
Advocates for Nursing Home Reform at 1-800-474-1116.

The best way to avoid an estate claim is not to have anything in your
estate when you die. As noted earlier, by declaring an intent to return
home, a nursing home resident will retain his or her home as an exempt
asset, and exempt assets may be transferred without affecting Medi-Cal
eligibility. Any transfers considered should take place before or as
soon as possible after an individual enters a nursing home. Transfers
should be reviewed with a qualified Medi-Cal knowledgeable estate
planning attorney.

Effective January 1, 1996, California is no longer permitted to impose
liens against the homes of nursing home residents or their surviving
spouses except in cases where the home is not exempt and is being sold.
Note: As federal and state laws on Medicaid/Medi-Cal are revised, this
may change.

IN HOME SUPPORTIVE SERVICES: IHSS is a non-medical long term care
program which provides assistance with housework as well as personal
care. Persons who are aged 65 or over, disabled, and on SSI or who are
eligible for Medi-Cal, are also eligible for IHSS if, without these
services, they cannot remain safely at home. Some eligible persons may
have a SOC to pay towards IHSS. These people will pay their SOC directly
to their IHSS provider and will receive a Medi-Cal card that can be used
without paying any additional SOC.

HOW TO APPLY FOR MEDI-CAL WHEN NOT ON SSI

If you are single and have no children under 21 living with you, you are
allowed a maintenance need of $600 plus any other applicable deductions.
Any amount over and above your maintenance need and applicable
deductions will result in a SOC. If there are two spouses living
together in the home the maintenance need level is $934 per month. There
are a number of deductions allowed from both earned and unearned income
and for other health coverage premiums. Contact your Medi-Cal
eligibility worker at the county welfare department or your legal
services office for more details.

Resources: A single person may have resources up to $2,000, and a couple
may have resources up to $3,000 and still qualify for Medi-Cal. Certain
assets are exempt from this limit such as: the value of a car; the value
of prepaid burial expenses and burial plots and the face value of life
insurance totaling no more than $1,500 per person; the value of the home
(including multiple dwelling units), is exempt as long as 1) they intend
to return home; or 2) the residence is used by a spouse and/or dependent
relatives; or 3) the residence is used by a sibling or adult child who
lived there at least one year before the owner entered the nursing home.
Other exceptions may also apply to you. Contact your legal services
office for more information.

If you are hospitalized, ask to speak to the hospital employee who
assists with Medi-Cal applications. Apply as soon as you realize you
cannot afford medical or hospital expenses or nursing facility
placement, since verification is required before Medi-Cal is granted.
When the paperwork is done, you will receive your Medi-Cal card. You
will get help with your medical costs after you incur your SOC, if you
have one. You will be eligible for the month in which you apply and for
three months retroactively (if you request retroactive coverage within
one year from your date of application and if you meet the resource
limits for each of those retroactive months). Your SOC, if you have one,
will be determined each month. It will change if your income changes.
(Remember: Under the legal ruling Hunt v. Kizer, unpaid medical expenses
incurred in a previous month may be applied to offset your SOC
liability.)

If your resources are too high, you can become eligible for Medi-Cal by
transferring or spending down your resources. WARNING: Giving your
resources away or selling them below a fair price may make you
ineligible for nursing facility level of care. Very strict rules apply
to transferring or spending down your resources in order to qualify for
Medi-Cal coverage of nursing home care.

Couples do not have to spend all their resources in order for one spouse
to be eligible for Medi-Cal coverage in a nursing facility. The person
going into the nursing facility can transfer his or her interest in the
home to the spouse remaining at home without affecting Medi-Cal
eligibility. A couple also may divide its non-exempt property so that
the spouse at home may keep up to $1,976 a month of the couple's income
and up to $79,020 of the other assets for his/her needs. The spouse at
home may also keep any independent income. A couple may divide their
property however they wish. In determining eligibility under the spousal
impoverishment provisions, Medi-Cal counts the property held in the name
of either or both spouses. As soon as the countable non-exempt property
is below $81,020 ($79,020 + $2,000 which can be retained by the
institutionalized spouse), the county can establish initial eligibility.
The couple then has at least 90 days to transfer everything but $2,000
into the name of the non-institutionalized spouse. The
non-institutionalized spouse may retain all of the income that he or she
receives in his or her own name. Consult legal services or a private
attorney familiar with Medi-Cal law if either you or your spouse may
need nursing facility care. (See Senior Fact Sheet #9: What Every Couple
Should Know When One Spouse May Have to Enter a Nursing Facility). Under
some circumstances, the allowable income and resources may be higher
than are shown above.

PROVIDERS AND REIMBURSEMENT

If you don't have a doctor who accepts Medi-Cal, you should find one
before you need medical care or else use medical clinics which serve
Medi-Cal patients. Always tell a provider you are on, or plan to apply
for, Medi-Cal. Providers bill Medi-Cal and are forbidden from billing
you, except for copayments. Medi-Cal pays providers directly. In most
areas, to get Medi-Cal to pay for hospital care, you have to be in a
hospital which has a contract with Medi-Cal, unless it is an emergency.
Your doctor will know which hospitals take Medi-Cal. Also, some prepaid
health plans have contracts to serve Medi-Cal patients.

WHAT IF YOU HAVE MEDI-CAL AND MEDICARE?

For persons who have both Medicare and Medi-Cal, Medi-Cal pays Medicare
deductibles, premiums and copayments. Medi-Cal also covers many services
not covered by Medicare. Therefore, if you are eligible for Medi-Cal,
you should not buy supplemental insurance, as it will not provide any
additional benefits to you.

COUNTY MEDICAL SERVICES: Counties are required to provide emergency
medical care and other services to persons who are not eligible for
Medi-Cal and who cannot afford to pay. The range of services available
varies by county. Contact your county welfare department, or, if you are
hospitalized, ask to speak to the hospital employee who assists with
County Medical Services applications.

APPEALS: Applicants for Medi-Cal or County Medical Services have the
right to appeal any decision made by the welfare department regarding
Medi-Cal or County Medical Services eligibility. Medi-Cal and County
Medical Services recipients have the right to a hearing regarding any
denial of services or of prior authorization for services, or any
unreasonable delay of prior authorization. Contact your legal services
office or your Area Agency on Aging for a referral to your legal
services office (1-800-510-2020) for assistance with problems regarding
Medi-Cal or County Medical Services.