Artificial intelligence, the internet, and well-meaning friends often offer advice on how to pay for care, but unfortunately, much of it is inaccurate or incomplete. Recently, I’ve had to educate several people, including attorney friends, about how Medi-Cal truly works. Misunderstanding the rules can be costly for seniors.
One common myth is that you should apply for Medi-Cal to become “Medi-Medi” (having both Medicare and Medi-Cal) so that care will automatically be covered when you need it. However, this is not how the program works. “Medi-Medi” only benefits individuals with incomes low enough to qualify for full-scope Medi-Cal with no share of cost. For those with higher incomes, the share of cost can often exceed what Medicare co-pays would have been, making early Medi-Cal application counterproductive.
Another myth is that once you qualify for Medi-Cal or run out of money, your care will automatically be covered. The reality is more complex:
Home and community-based services, like In-Home Supportive Services (IHSS), require proof of need through an evaluation. Even then, there is a maximum of 9 hours per day covered, and any privately paid care hours reduce this allocation.
Assisted living programs funded by Medi-Cal have long waitlists and are only available to individuals with full-scope Medi-Cal.
For 24/7 care, Medi-Cal pays for skilled nursing facilities, but gaining admission can be challenging. These facilities often prioritize private-pay residents or those with Medicare coverage from a hospital discharge over those solely on Medi-Cal.
If you’re trying to figure out how to pay for care, avoid relying on friends, AI, or online sources for advice. It’s critical to consult an expert who understands the intricacies of Medi-Cal and related programs. As a Certified Elder Law Attorney, I specialize in Medi-Cal, Medicare, and other resources to help families navigate care costs. If you need guidance, give me a call.
