Medi-Cal

Cuts to Medi-Cal Provider Payments Cause System Shake-Up

Cuts to Medi-Cal Provider Payments Cause System Shake-Up

State lawmakers are currently awaiting a decision by a federal appeals court which may have a drastic affect upon the Medi-Cal program in California. If the court rules in favor of the state’s proposed plan, provider reimbursement rates will be cut by 10 percent.  The court case concerns a law passed June 1, 2011, which outlines Medi-Cal budget cuts. The spending reductions never officially took effect, as the law has been challenged in court since that time. However, if the state does win the appeal and the cuts are applied, the changes are likely to hit providers fairly hard. Not only will reimbursement rates be lowered by 10 percent, but the changes will be retroactive dating back to June 2011. This means Medi-Cal providers will be required to repay the overpayment in fees they’ve received for the past two years.  However, rather than send providers a bill demanding an immediate refund of the overpaid fees, the state will bill providers by cutting fees an additional 5 percent until the overpayment is corrected. This means providers will essentially face a 15 percent fee reduction until their overpayment balances reach 0, and at that point will face only the 10 percent reduction as originally scheduled.  If the state wins the appeal, the fee reductions will take place at an inopportune time for Medi-Cal patients and providers. Due to the implementation of the Affordable Care Act and the subsequent expansion of Medi-Cal, the program is already facing a strain as it grows quickly to cover many more patients. This impending fee reduction poses an additional challenge to the state medical insurance program, as many providers and hospitals state they may no longer accept Medi-Cal patients.  Over the next few years, Medi-Cal patients may face doctor shortages, longer wait times, and difficulties finding hospitals which accept their insurance. Whether the program will make further changes to compensate for these problems remains to be seen. Those who rely upon Medi-Cal or anticipate needing the program in the future should watch carefully for more policy changes, as the system adjusts to the many problems it faces.  ...

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National Changes in Healthcare Law Affect Medi-Cal

National Changes in Healthcare Law Affect Medi-Cal

Sweeping changes imposed upon the healthcare and insurance industries on a national level are set to take effect in less than a year. The Affordable Care Act requires states to transition into compliance with the new laws by 2014, which has left Medi-Cal officials in California scrambling to make the necessary changes to the program. For those applying for Medi-Cal, getting approved for the program may at first glance seem much easier. The changes required by law will mean that more individuals will be able to qualify for Medi-Cal, as the income limits will be raised and childless couples will now be eligible. This could mean good news for seniors who are retiring, particularly those whose incomes were initially slightly too high for them to qualify. The new eligibility rules could create a significant strain on the government-funded healthcare program, however. Currently Medi-Cal covers approximately 7 million Californians, and that number is expected to increase by about 1 to 1.4 million between 2014 and 2019. Unfortunately, what this could mean is a severe shortage in the number of available physicians and a longer wait to see a specialist. The current wait to see a doctor is four to six weeks except in cases of emergency, and patients could see this time frame extended even longer due to a shortage of physicians who accept Medi-Cal payments. The new program rules will also include different tiers of eligibility, with some patients receiving free care while others will be required to pay premiums of varying amounts, depending upon income. Patients should also expect to see a shift toward more preventive care, as program planners hope this will ease the burden upon the system. As with any large government-run entity, pervasive changes in the program will translate into changes for the individuals who depend upon it. As changes to Medi-Cal occur over the coming months, those who apply for the program may face different requirements than in the past. The attorneys at Bethel Law are experienced in navigating the Medi-Cal system, and are dedicated to staying up to date on changes in the law which affect the...

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Medi-Cal Basics

Medi-Cal Basics

Growing older often means some very complicated decisions must be made about health care and long-term living arrangements. Most people are already aware of Medicare by the time they hit retirement age, and may be expecting it to pay for all future medical expenses. Unfortunately, Medicare often does not cover all of the costs of necessary care. In many cases Medi-Cal will be needed to cover these additional expenses. Those who find themselves in a situation which requires long-term nursing care often receive an unpleasant surprise from Medicare. While Medicare does pay for a nursing home stay in certain circumstances, there are many cases in which there is no coverage for this type of care. In this situation the individual or his or her caretaker will need to apply for Medi-Cal, which will cover the high costs of a nursing home or In Home Supportive Services (IHSS). If the patient is transferred to a nursing home directly from a hospital, and is expected to stay at least three days, Medicare may pay the bill. The patient must be in the home because he or she needs daily rehabilitation services, or specialized physician or nursing care. An example of this type of situation would be the level of care needed to recover from a stroke. However, Medicare will not pay for a nursing home stay unless the referral was made for the aforementioned reasons. There are many other situations in which someone may need this level of care. For instance, those who need assistance with personal care like bathing, remembering medications, and preparing meals often decide a nursing home is the best environment for meeting those needs. Another option in this situation is In Home Supportive Services. The individual or his or her caretaker will need to apply for Medi-Cal, which is another form of health insurance. Medi-Cal does not replace Medicare, but is used as supplementary insurance to help pay for these costs not covered by Medicare. Navigating the Medi-Cal application process can be quite difficult in many circumstances. The experienced attorneys at the Bethel Law Corporation can help guide applicants through this process, advise them on legally rearranging assets, and aide them in avoiding future recovery claims by the state of...

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Treatment of After-Acquired Assets

Treatment of After-Acquired Assets

What about the treatment of After-Acquired Assets is an often asked question by all our Community (well) Spouse Medi-Cal clients. In other words, can the well spouse keep or receive assets independently of the Medi-Cal after the Medi-Cal eligibility has been established? All County Welfare Directors Letter (ACWDL) No. 99-29 states that the community spouse’s resources are considered at the time of initial eligibility. Afterwards, any newly acquired property of the community spouse may not be considered available to the institutionalized spouse. For example, eligibility may be established in January for Mr. Jones. In February, Mrs. Jones may inherit $500,000. Even though her assets substantially exceed the allowable CSRA (Community Spouse Resource Allowance), the elgibility of Mr. Jones may not be re-examined. Her assets are safe. However, if Mr. Jones were to inherit this money, the result would be very different. His assets would then exceed $2,000 and Mrs. Jones would face the loss of eligibility with regard to her...

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Preserving the Residence from Recovery by Medi-Cal

Preserving the Residence from Recovery by Medi-Cal

Protecting the family residence from recovery by Medi-Cal is a necessary ingredient of proper planning for the Medi-Cal patient’s family. We are referring to the procedure of preserving the principal residence of your ill spouse or parent following their death. Normally, recovery will take place at death against assets of an unmarried Medi-Cal recipient, or after the death of the last to die of a married couple, at least one of whom has received Medi-Cal benefits. However, such recovery against the family residence can be avoided in California since it is the one state in the country that prevents transfers of the residence from penalizing, or disqualifying, transferors who are Medi-Cal qualified. The logic is as follows: since a principal residence is exempt under Medicaid laws, its transfer by a Medi-Cal recipient could not be for the purpose of qualifying for Medi-Cal, and therefore carries no penalty. The intention of transferor to live in the residence (or to return to live there) is the only prerequisite to establishing the necessary ingredient of the home being a principal residence as defined under Medi-Cal rules. There are a number of ways to prove this intent. At the Bethel Law Corporation we take pride in proving such by the use of specially drafted Financial Power of Attorneys or Living Trust documents. These documents have special Medi-Cal powers to preserve the privacy of the family in arranging the ill parent or spouse’s assets is such a way as to avoid any unnecessary spend-down on long term care. It is important these powers be apart of your estate planning package so that if the Medi-Cal issue arrives, you and or your family are protected and your principal residence is protected. Please give us a call for further information on how to protect the residence from Medi-Cal spend-down and...

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