Medi-Cal Reimbursement

When Congress enacted the Social Security Act of 1965, it created two public benefit programs, Medicaid, known as Medi-Cal in California, and Medicare. Medi-Cal is the government-sponsored medical program for largely the poor and disabled. Medicare is the government-sponsored medical program for those 65 and over, or those with disabilities. 

A key distinguishing feature of Medi-Cal is the mandatory reimbursement of funds, subject to certain conditions, expended for the benefit of the patient once the patient passes away. Welf & I C §14009.5. Medicare has no such reimbursement feature. In other words, the state of California is entitled to be repaid what it spent on the patient once the patient has died, subject to certain qualifications. If the patient had assets when they passed away, the state of California will seek recovery whether such is a short or lengthy endeavor. The following case illustrates how long the process can take.

Bunnie R. Gregoire was the owner of a home in Brisbane, CA. In 1997 she transferred this home into her restated revocable trust. She named her granddaughters, Selena H. Firth and Jennifer C. Martin, the beneficiaries. In 2001, Firth applied for Medi-Cal benefits on behalf of Gregoire given her advanced age of 90. On the application form, Firth acknowledged that "the State has the right to seek reimbursement from my estate for all Medi-Cal benefits I received after age 55."

In 2002, the San Mateo County Public Guardian was appointed conservator of the person and estate of Gregoire. In 2005, Gregoire died and the Public Guardian tendered notice to the State Department of Health Care Services (DHCS) that Gregoire had died (this is required by law). On the schedule of assets, the Public Guardian erroneously listed the value of Gregoire's estate as "0.00." An official from the DCHS then did a public records search which revealed that Gregoire owned a home in Brisbane. Over the next couple of years, the DCHS sent notices to the Public Guardian to explain the discrepancy, albeit to no avail. In 2007, the successor trustee sold the Brisbane home and distributed the funds in accordance with Gregoire's trust. 

Eventually the DCHS filed suit in 2008 against the beneficiaries for Medi-Cal reimbursement given that it believed that Gregoire's estate was solvent when she died. The beneficiaries objected to the claim by the DCHS because they believed that the DCHS should have filed suit sooner. Ultimately in 2011, the beneficiaries lost on appeal because they used the wrong law to support their statute of limitations argument. I will spare you the boring legal arguments. Just know that the beneficiaries lost. End of story.

My takeaway from this case is that it is demonstrative of the phrase "the long arm of the law." Gregoire died in 2005 but the validity of her Medi-Cal reimbursement liability was not settled until 2011, six years later.  

Medi-Cal

One of the largest federal programs is Medicaid, which is known as Medi-Cal in California. The following are some frequently asked questions associated with Medi-Cal.

1. What is Medi-Cal?

Medi-Cal is a needs-based public benefit program that provides payment for various medical services to qualified individuals here in California.

2. What is Medicare?

Medicare is the federally subsidized health care system for individuals over the age of 65.

Yes, the fact that there is Medicaid, Medi-Cal and Medicare can be quite confusing.

3. What is a needs-based public benefit?

A needs-based public benefit is a benefit that is granted to individuals who demonstrate need. For example, those with low-incomes or are disabled are eligible for Medi-Cal because they have a need for medical services but are unable to afford it. Conversely, an entitlement public benefit is where the recipient qualifies just for the sheer fact that they are a member of a certain class of individuals, regardless of their background. For instance, Medicare is an example of an entitlement benefit because anybody 65 or older will qualify.

4. What does Medi-Cal provide?

Medi-Cal provides eligible recipients with payment for hospitalization, doctors' services, prescription drugs, lab tests, home health care, nursing home care and other related medical services. Welf & I C §14132.

5. What makes Medi-Cal unique?

Medi-Cal is the only government program that pays for long-term nursing home care.   

6. Who is eligible?

There are two main types of Medi-Cal beneficiaries: (1) the "categorically needy" and (2)beneficiaries whose incomes are above the supplemental security income (SSI) limit but whose medical costs would leave them impoverished.

Examples from category (1) would be persons age 65 or older and blind or disabled persons of any age who receive SSI payments. Examples from category (2) would be individuals enrolled in the following programs: Aged and Disabled Federal Poverty Level program; Aged, Blind, and Disabled Medically Needy program; 250 Percent California Working Disabled program; Institutional Deeming Waiver program; Nursing Facility/Acute Hospital Waiver program; and Transition programs.

7. Does the beneficiary of the Medi-Cal have to repay the benefits?

The precise answer is that no, the recipient of Medi-Cal benefits does not have to re-pay the benefits received. However, the beneficiary’s estate is, generally speaking, liable for the reimbursing the State of California for the amount of Medi-Cal benefits received. 42 USC §1396p(b)(1); Welf & I C §14009.5.

For example, Donna Decedent was of modest means and disabled. She received Medi-Cal during her lifetime. When Donna passed away, her estate was worth $50,000. The State of California, via Medi-Cal, paid $100,000 for Donna’s medical care during her lifetime. Donna’a estate, namely $50,000, would be subject to recovery by the California Department of Health Care Services (DHCS) for the benefits paid.  

8. Are there instances when recovery is delayed or barred?

Yes, DHCS may not make a claim when there is a surviving spouse during his or her lifetime. Welf & I C §14009.5(b)(2)(A); 22 Cal Code Regs §50961(d)(2). Furthermore, DHCS may not make a claim if there is a surviving child of the deceased beneficiary who is under 21 or who is blind or permanently and totally disabled. Welf & I C §14009.5(b)(2)(B)-(C); 22 Cal Code Regs §50961(d)(3)-(4).

9. Is there a citizenship requirement for Medi-Cal?

No, there is no citizenship requirement for receiving Medi-Cal. Medi-Cal beneficiaries may be aliens lawfully admitted for permanent residence, as well as to persons Permanently Residing in the United States Under Color of Law. Welf & I C §14007.5.

Probate Deadlines in California

There are deadlines in life for everything. Administering an estate is no different. The following are some deadlines that apply to various estates. Failure to observe these deadline may result in penalties or liabilities for the offending party.This is not an exhaustive list of all responsibilities for reference.

• The custodian of the decedent's original will must (1) lodge the original will with the clerk of the county where the decedent resided at the time of death and (2) mail a copy of the will to the named executor within 30 days of learning of the death. Prob C §8200.
• If the decedent had a probate estate worth $100,000 or less, a minimum of 40 days must elapse before an affidavit can be executed and presented to a holder of the decedent's assets for recovery. Prob C §13100.
• When a trust becomes irrevocable or a change in trustee of an irrevocable trust occurs, the trustee must serve notice to various parties no later than 60 days after the occurrence of the event requiring service of the notification, or 60 days after the trustee becomes aware of the existence of a person entitled to receive notification if that person was not known to the trustee at the time of the occurrence of the triggering event. Prob C §16061.7
• A person receiving a 16061.7 notice has 120 days to contest the trust from the date the notice is served on him or her, or 60 days from the date when a copy of the terms of the trust is mailed or personally delivered to the person during that 120-day period, whichever is later. Prob C §16061.8.
• If the decedent received Medi-Cal or was the surviving spouse of a person who received benefits, a Medi-Cal notice must be sent to the California Department of Health Services within 90 days from the date of death and must include a copy of the decedent's death certificate. Prob C §215
• Once a will has been admitted to probate, a petition for revocation of probate must be filed within 120 days. Prob C §8270(a)
• If the decedent owned real property, a Preliminary Change of Ownership Report (PCOR) must be filed within 150 days of the date of death even if the transfer was through the medium of a trust. Rev & T C §480(b).
• The estate tax return is due within 9 months after the date of decedent's death. IRC §6075(a).