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Impact of Medi-Cal Asset Limit Elimination Follow Up

Summary
With the implementation of the elimination of the asset limit for Medi-Cal Non-MAGI (Non-Modified Adjusted Gross Income) programs effective 1/1/24, the California Department of Health Care Services has released additional information. While we had presumed the 30-month “look-back” into a Medi-Cal Long Term Care applicant’s financial transactions would simply go away, and with it, periods of ineligibility for violations, this is incorrect. With this, and many other moving pieces, the need for Professional Medi-Cal Planners remain vital.

Changes

Look-Back Rule & Penalty Period

Asset Transfers Made On or After 1/1/24
Medi-Cal’s Look-Back Period and Penalty Period will be obsolete for asset transfers made on or after Jan. 1, 2024. Bank statements and / or verification of transfers will no longer be requested.

Asset Transfers Made Prior to 1/1/24
The Look-Back Period and Penalty Period will not be obsolete for asset transfers made prior to Jan. 1, 2024. On 1/1/24, the Look-Back Period will be the 30-month period immediately prior to this date. The length of the “look back”, however, will decrease each subsequent month until the Look-Back Period is completely eliminated in July of 2027. Therefore, starting in February of 2024, the Look-Back Period will no longer be from the date of one’s Medi-Cal Long-Term Care application and will no longer be 30-months.

2024 Medi-Cal Look-Back Periods (Post Asset Elimination)
Application Date Months of “Look Back” Look Back Period
Jan. 2024 30 July 2021 – Dec. 2023
Feb. 2024 29 Aug. 2021 – Dec. 2023
March 2024 28 Sept. 2021 – Dec. 2023
April 2024 27 Oct. 2021 – Dec. 2023
May 2024 26 Nov. 2021 – Dec. 2023
June 2024 25 Dec. 2021 – Dec. 2023
July 2024 24 Jan. 2022 – Dec. 2023
Aug. 2024 23 Feb. 2022 – Dec. 2023
Sept. 2024 22 March 2022 – Dec. 2023
Oct. 2024 21 April 2022 – Dec. 2023
Nov. 2024 20 May 2022 – Dec. 2023
Dec. 2024 19 June 2022 – Dec. 2023
Jan. 2025 18 July 2022 – Dec. 2023
Feb. 2025 17 Aug. 2022 – Dec. 2023
March 2025 16 Sept. 2022 – Dec. 2023
April 2025 15 Oct. 2022 – Dec. 2023
May 2025 14 Nov. 2022 – Dec. 2023
June 2025 13 Dec. 2022 – Dec. 2023
July 2025 12 Jan. 2023 – Dec. 2023
Aug. 2025 11 Feb. 2023 – Dec. 2023
Sept. 2025 10 March 2023 – Dec. 2023
Oct. 2025 9 April 2023 – Dec. 2023
Nov. 2025 8 May 2023 – Dec. 2023
Dec. 2025 7 June 2023 – Dec. 2023
Jan. 2026 6 July 2023 – Dec. 2023
Feb. 2026 5 Aug. 2023 – Dec. 2023
March 2026 4 Sept. 2023 – Dec. 2023
April 2026 3 Oct. 2023 – Dec. 2023
May 2026 2 Nov. 2023 – Dec. 2023
June 2026 1 Dec. 2023
July 2026 0 No Look-Back Period

The maximum Penalty Period that one can receive is 30 months from the date of the disqualifying asset transfer. The last month / year in which one can be penalized for violating the Look-Back Rule is June 2026.

Spousal Impoverishment Provisions

Community Spouse Resource Allowance
Effective Jan. 1, 2024, the Community Spouse Resource Allowance (CSRA) is no longer applicable for persons whose first month of eligibility is on or after this date. If one applied prior to 1/1/24, say Dec. 1, 2023, the CSRA, as well as the applicant asset limit for 2023, would still be applicable for December. The 2023 applicant asset limit is $130,000 and the CSRA is $148,620.

Monthly Maintenance Needs Allowance
Since income will still count towards Medi-Cal eligibility in 2024, the Monthly Maintenance Needs Allowance is still applicable. The rules surrounding this Spousal Income Allowance will remain the same. While we had previously projected the 2024 Monthly Maintenance Needs Allowance to be $3,853, it will be $3,854.

Retroactive Coverage

Retroactive coverage allows one to receive Medi-Cal benefits for up to 3 months prior to the date of their application. If one submits an application in January, their assets will not be considered for this month. However, for the 3 months prior to January (October, November, and December) their assets will be considered. This is because the asset limit was in place at that time. The 2023 asset limit is $130,000 for an individual and $195,000 for a couple. If only one spouse applies for Long-Term Care, the individual asset limit of $130,000 applies, as does the Community Spouse Resource Allowance of $148,620.

2024 Medi-Cal Eligibility Criteria

• Income Limits – For Medicaid Waiver programs – $1,677 / month for an individual and $2,269 / month for a couple with both spouses as applicants. These limits are effective 4/1/23 – 3/31/24 and are 138% of the Federal Poverty Level (FPL) for 2023. In April of 2024, the income limits will increase based on 2024 FPLs. There is no income limit for Medi-Cal Nursing Home coverage. However, nearly all of one’s income must go to the nursing home as a share of cost.
• Asset Limits – There is no asset limit for 2024.
• Monthly Maintenance Needs Allowance – $3,854 / month.
• Community Spouse Resource Allowance (CSRA) – There is no CSRA for 2024.
• Home Equity Limit – California has no home equity limit.

Other Information to Note

• SSI Recipient Pathway – The elimination of assets does not apply to individuals who qualify for Medi-Cal via SSI. SSI is a federal program with its own asset limits.
• Estate Recovery Program – No changes are being made to Medi-Cal’s Estate Recovery Program. Asset information cannot be requested for purposes of estate recovery.
• IRA Withdrawals – A lump sum withdrawal from an IRA will count as income in the month that it was received. It will only impact eligibility for the month of receipt.
• Income-Producing Assets – While income-producing assets themselves will be exempt with the elimination of the asset limit, any payments will continue to count as unearned income. This includes income from annuities, IRAs, work-related pension plans, rental properties, and interest & dividends.
• Trusts – Income rules regarding trusts have not changed.

Implications

For Assisted Living Providers

Expect a greater number of residents to seek Medi-Cal eligibility earlier given that CA AL residents have no asset limits. Californians who were denied Medi-Cal due to excess assets in the 6 months prior to the elimination of the asset limit will be contacted and told they can reapply. Furthermore, with the elimination of the asset limit, it is anticipated many Californians who otherwise may not have applied, will seek assistance. Combine this with the greater availability of Medi-Cal assisted living benefits through the Enhanced Care Management Benefit and California assisted living providers can expect a reduction in private pay residents.

For Nursing Homes

Since all nursing home residents should meet Medi-Cal’s Nursing Home Level of Care criteria, expect a much higher percentage of your residents to seek Medi-Cal Nursing Home care. Applicants who were recently denied, may now be eligible. Those who were denied eligibility within the last 6 months because of too many assets will be contacted and encouraged to reapply. It is anticipated that the number of private pay residents in nursing home facilities will decrease.

Need for Medi-Cal Planning

Medi-Cal Planners continue to be in demand. For applicants who know they have violated the Look-Back Period, or may have unknowing violated it, there is a timing component to one’s Medi-Cal application. A Professional Medi-Cal Planner can examine one’s past financial transactions to see if this rule has been violated, and if so, advise one the best time to apply given one’s financial situation. Furthermore, a layer of complexity is added with the changes, and ensuring that county eligibility workers are aware of them and apply them accurately. A knowledgeable Medi-Cal Planner can catch and correct mistakes. This includes ensuring a non-applicant spouse receives the highest Monthly Maintenance Needs Allowance as possible and an applicant’s Share of Cost is as low as possible.

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