It had been a long time since I first helped my client when his wife needed Medi-Cal. Now, it was his turn. After a week in the hospital, he had been moved to a “Rehab Center,” also known as a Skilled Nursing Facility. They wanted to send him home, claiming he had “plateaued.” But he wasn’t ready—he needed 24/7 care, and there was no one at home to provide it. He knew that going home would only mean a few hours of care from outside providers, which wasn’t enough.
I advised him to appeal the discharge with Medicare. While appeals can extend care temporarily, eventually, Medicare stops paying. Medicare typically covers up to 100 days in a facility, but often it’s only about 20 days. Once Medicare stops paying, the next step is Medi-Cal. Starting January 1, 2024, there is no asset test, meaning my client wouldn’t need to “spend down” his savings to qualify.
Medi-Cal will cover custodial care, and though he will have a share of cost, it will only be based on his income, making it the most affordable option. Without Medi-Cal, he would face almost $12,000 per month in private pay. Assisted living isn’t an option for him, as his needs are too great, and Medi-Cal rarely covers assisted living care.
If your loved one is in a similar situation and the hospital is talking about discharge, give me a call. We can discuss how to navigate Medicare, Medi-Cal, and long-term care options.
