In this three-part series, you’ll learn more about how California’s Medicaid program, Medi-Cal, is managed and what that means for applicants. It’s a common concern for a family member of someone who needs nursing home support to wonder about how to these benefits. Not every person who needs nursing home care will necessarily qualify for Medicaid benefits in California, so it’s important to know the general requirements when you or a loved one intends to apply.
Medi-Cal will only pay for nursing home benefits when it is medically necessary for the patient. Medically necessary refers to those treatments that are necessary and reasonable to protect life, to prevent significant disability or illness, or to alleviate severe pain.
A treating physician must prescribe a nursing home for a patient because of the need for either intermediate care or around the clock skilled nursing care. Intermediate care refers to a protective and supportive environment that allows for observation on an ongoing basis to minimize health deterioration.
Skilled nursing care, on the other hand, includes things like replacing or inserting catheters, changing wound dressings, giving injections, handling bed sores or managing feeding through a gastric tube. Medi-Cal completes what is known as a level of care assessment that reviews the limitations in the activities of daily living for the affected patient, in addition to their physical function and cognitive function to determine whether or not they are eligible to receive intermediate care benefits. Medi-Cal does have the ability to determine that a nursing home stay, however, is not medically necessary.
No matter what you’re concerned about with elder law, it’s beneficial to have the support of a trusted estate planning and elder law team. You will have plenty of questions about the process and can trust our dedicated Pasadena law office to help you answer them.
Our Pasadena estate planning law office is here to help you. Need support with California Medicaid qualification or want to know how to plan in advance? Schedule a meeting with us today.