The Medi-Cal Share of Cost Is Breaking Me!

The Medi-Cal Share of Cost Is Breaking Me!

Introduction
Share of Cost
Increasing the MMMNA
Return on Expense
Factors to Consider
Use an Experienced Attorney

Dear Mr. Miller:

Introduction: Some might call me fortunate as my wife and I have $7000 of monthly income (mostly hers) what with our social security and retirement checks. But that’s definitely not the case. She is in a skilled nursing facility, has no understanding of what is going on, and communicates at only the most basic of levels. Worse, the facility charge is over $10,000 per month. Given her physical health, she will be with us for several years more.

We applied for Medi-Cal a number of months ago and it was granted. We pay $4069 per month and Medi-Cal picks up the difference. That’s good but it only leaves me with $2931 to live on. We don’t have a whole lot in savings and I’m drawing on that to keep the ship afloat. It won’t last much longer.

What can I do?

Panicked Husband

Dear Panicked:

Share of Cost: The $4,069 is what is called your “share of cost” for the facility. Basically, the rules say that your wife must pay all of her income (except for $35) to the share of cost. Your income stays as your income.

MMMNA: In addition, the well spouse is entitled to the minimum monthly maintenance needs allowance (MMMNA) which is currently $2935. In other words, if your income does not come up to the MMMNA then you can move whatever amount is necessary to bring you up to that level from your wife’s ledger to yours. Assuming your income is $2000 of the family total of $7000, then Medi-Cal increases your side by $935 and reduces your wife’s (and her share of cost) by the same amount. That apparently is what happened in your wife’s case ($7000-4069=2935).

Increasing the MMMNA: What many people don’t realize is that the MMMNA is a guaranteed baseline, not the maximum. One can go to court to have the MMMNA increased to what is necessary. The court request is based on a number of factors, one major one being your reasonable monthly expenses and how much you need to make ends meet.

Let’s assume your monthly needs are $5000. That is what you need to live on, not extravagantly, just reasonably. That means you need an additional $2069 ($5000-2931=5000). Your attorney would file a petition (request) with the court setting forth all of the reasons why you need this money. The court would typically appoint a guardian ad litem (guardian solely for this court case) for your husband. The guardian ad litem would investigate the situation and the law, probably speak with your attorney, and file his findings with the court. The court would make a ruling and the ruling would be filed with the Medi-Cal authorities so that they would decrease your wife’s share of cost in the appropriate amount.

Return on Expense: If successful, and if done right you probably would be, that’s a difference of almost $25,000 per year. Assuming three years that’s $75,000! More than enough to make this strategy worthwhile.

Factors to Consider: In order to maximize your MMMNA you would want to take all of your expenses into account along with projected expenses. For example, do you own your house and are there repair and maintenance projects that need to be completed? That requires money that needs to be plugged into the projected expenses. Or when your wife dies, does some of her income cease, such as one of her retirement payments? Are you aware that if you are currently receiving social security on her work record then you are being paid 50% of her full retirement benefit and she is receiving 100%? But after she dies you will probably receive 100% of her full retirement benefit but your 50% that you were receiving will terminate. That decreases the monthly income that you have coming in to support you. All of this needs to be taken into account along with a myriad of other details.

Use an Experienced Attorney: Medi-Cal is an extremely complex area of the law. You want things to go as smoothly and rapidly as possible. Your best bet is to contact an experienced elder law attorney who has handled these types of cases before.

8/10/14