Elder Law Services of Ventura County

Craig R. Ploss - Attorney at Law

Medi-Cal Eligibility Planning & Qualification Assistance

California’s Medi-Cal Long Term Care (LTC) Program

What is Long Term Care?

Long Term Care (LTC) refers to a wide variety of services for people with prolonged physical illnesses, disability, or cognitive disorders, such as Alzheimer’s Disease. Long Term Care differs from traditional medical care as it is designed to assist a person maintain his/her level of functioning, as opposed to care and services designed to rehabilitate or correct certain medical problems.

The two levels of care generally exist in delivering the services needed, skilled care and custodial care...

Skilled care is that needed for medical conditions that require care by skilled medical personnel, such as registered nurses (for disbursing medications) or professional therapists, and is ordered by a physician and provided 24 hours/day.

Custodial care, aka personal care, helps a person perform the activities of daily living (ADLs), which include assistance with bathing, toileting, dressing, eating, continence, and transferring. It is less intensive or complicated than skilled care and can be provided in various settings, including adult day care centers, the home, Residential Care Facilities for the Elderly (RCFEs), assisted care facilities, or Skilled Nursing Facilities (SNFs).


What is LTC Medi-Cal?

Medi-Cal LTC is the California version of “Medicaid.” It is funded primarily by the federal government and is administered by the State. It is funded jointly by the state and federal governments. It is designed to help pay for medical care for low income persons and others with limited resources and high medical bills. Although Medi-Cal recipients often receive Medicare, the Medi-Cal program is not related to Medicare Insurance. Medi-Cal is a need-based program, that is, eligibility primarily depends on the amount of income and resources a person has. Principally it will pay the room and board for an individual residing in a skilled nursing facility, but not assisted living or a board and care home. Medicare may pay part for the SNF cost for up to 100 days if the patient was discharged into the SNF from an acute care hospital.


What Does LTC Medi-Cal Cover?

If you meet certain resource requirements and if there is authorization from a doctor or health care provider, your nursing home care will be covered. You must be admitted on a doctor's order and the stay must be "medically necessary.”

If you have income, you must pay a "share of cost" of the nursing home charge and Medi-Cal will pay the rest of the costs. The share of cost is calculated by the Medi-Cal office. If you qualify for Medi-Cal, you may not need private "medigap" or nursing home insurance to pay for costs, though if such insurance is carried, the premiums are deducted from income when computing the share of cost.

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