Case study -The Health For California Insurance Center
Read the Below and Respond with References. The response doesn’t have to be long, look at the attached to see some of the sample responses. I reside in the state of California and our Medicaid program is Medi-Cal. The Medi-Cal on-line website is:
http://www.medi-cal.ca.gov/
The Health For California Insurance Center Blog is:
https://www.healthforcalifornia.com
What are the eligibility requirements for Medicaid in your state? Are they both eligible for Medicaid in your state?
Recent eligibility requirements for Medi-Cal expansion are that for Californians under age 65 and without children is their annual income must be lower than 138% of the Federal Poverty Level (PLA). All individuals above 65 are eligible. All individuals with disabilities are eligible. Both the female at age 62 and the male at 72 are eligible for Medi-Cal because given she is under 65, it’s likely her part-time waitress income qualifies her at less than 138% PLA since he is not working. He is both over 65 and is in rehab recovering from a stroke which would qualify him as disabled. (Medi-Cal Expansion, 2016)
How much income (Social Security, wages, pension, interest, etc.) is allowed each month (as a Medicaid beneficiary)?
The amount of income allowed each month under Medi-Cal eligibility is for 2 Adults is $22,107. See grid below for program Eligibility by FPL (Fed Poverty Level, 2016)
How much assets are they allowed?
The allowable assets to qualify for Medi-Cal for a household of two without children is $3,000 that is net of specified Real Property and Personal Property (www.dhcs.ca.gov pdf, 2016)
Which possessions count as assets?
REAL PROPERTY
Principal residence. Property used as a home is exempt
Other real property. Up to $6,000 of the equity value in non- business real estate (excluding the home), mortgages, deeds of trust, or other promissory notes may be exempt.
Real property used in a business or trade. Real estate used in a trade or business is exempt regardless of its equity and whether it produces income.
PERSONAL PROPERTY
One motor vehicle.
Personal property used in a trade or business.
Personal affects. This includes clothing, heirlooms, weddings and engagement rings, and other jewelry with a net value of under $100.
Household items.
IRAs, KEOGHs, and other work-related pension plans.
Irrevocable burial trusts or irrevocable prepaid burial contracts.
One revocable burial fund or revocable prepaid burial contract with a value of up to $1,500 plus accrued interest per person.
Burial space items.
Musical instruments.
Recreation items including TVs, VCRs, computers, guns, collection, etc.
Livestock, poultry, or crops.
Countable property equal to the amount of benefits paid under a state-certified, long-term care insurance policy.
Life insurance policies. Each person may have life insurance policies with a combined face value of $1,500 or less accrued interest and dividends.
Assuming eligibility, what benefits are available? Provide an overview of the assistance programs specific to their needs. She is considering home care services, an adult day health program, or the possibility of nursing home care.
Below are the listed benefits provided to Medi-Cal qualified households. In the case of this couple I have highlighted programs specific to their current needs for what care she is considering and for his stroke recovery.
Medi-Cal covers a core set of services, including doctor visits, hospital care, and pregnancy-related services, as well as nursing home care for individuals age 21 or older through either a fee-for-service or managed care delivery system. For a majority of enrollees, Medi-Cal provides covered services through managed health plans in all 58 counties. The ACA ensures all Medi-Cal health plans offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include:
Outpatient (Ambulatory) services
Emergency services
Hospitalization
Maternity and newborn care
Mental Health and Substance Use Disorder Services including Behavioral Health Treatment
Prescription Drugs
Rehabilitative and Habilitative Services and devices
Laboratory services
Preventive and wellness services & chronic disease management
Pediatric services (including oral and vision care)
The array of mental health and substance use disorder services has expanded to better meet the needs of individuals eligible for Medi-Cal. The following mental health benefits are available through Medi-Cal managed care plans or the fee-for-service delivery system:
Individual and group mental health evaluation and treatment (psychotherapy)
Psychological testing when clinically indicated to evaluate a mental health condition
Outpatient services for the purposes of monitoring drug therapy
Outpatient laboratory, drugs, supplies and supplements
Psychiatric consultation
Specialty mental health services currently provided by County Mental Health Plans will continue to be available.
The following substance use disorder services benefits will also be made available to eligible Medi-Cal beneficiaries:
Voluntary Inpatient Detoxification
Intensive Outpatient Treatment Services
Residential Treatment Services
Outpatient Drug Free Services
Narcotic Treatment Services
Dental care, vision services and speech therapy are generally available only to children and youths under age 21, but certain adults and pregnant women are also eligible for these services. Dental services are available to all adults.
Share your thoughts: Are the sites user-friendly? Consider health care literacy standards. Also contemplate getting the information if you had an age-related limitation such as poor vision, limited hand function due to arthritis, or short term memory loss.
California is a very liberal state and I have found that Medi-Cal is very comprehensive from this research. I suspect that incrementally there will be benefit rollbacks in the future given that Healthcare California government expenditure accounts for 29% of the Cal Budget. California has run a consistent $10 Billion deficit for the last few years, that is California tends to spend 108% to total revenue collected on government programs where Medi-Cal and other Healthcare budgeted services are a third of the total budget. Not Good. It took some time to put this information together. The Medi-Cal website is difficult, likely deliberately to cause and information hurdle to recipients due to budgetary concerns. It took several websites and digging into Medi-Cal to find the Eligibility and Property reqs. I doubt low income seniors with limited internet savvy could do any better with potential limiting physical abilities.
