California medicaid

Home State: CALIFORNIA

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Minimum Wage in California: $10.00 per hour2 (my friend is a waitress)

Part-time basis:  34 hours per week4  – part time is 1-34 hours per week.  ($16,320 annual household salary)

Eligibility requirements for Medicaid/Medi-Cal:

Since my friend’s spouse is currently in a rehab hospital.  My friend can apply for Hospital Presumptive Eligibility (HPE) Program.  This program will provide “immediate access to temporary, no-cost Medi-Cal while applying for permanent Medi-Cal coverage.”1 The qualifications include:

·        Have income below the monthly limit for household size.1

·        Be a California resident.1

·        Not already have Medi-Cal.1

·        If not pregnant, have not received PE Enrollment benefits from any Medi-Cal PE Program up to the maximum limitation allowed within the past 12 months of applying. If pregnant, have not had a PE Enrollment during the current pregnancy of applying.1

And, be eligible in one of the following HPE groups below:

·        Children under 19 years old1

·        Parents and Caretaker Relatives1 (my friend will be the primary caretaker of her husband)

·        Pregnant Women (benefits are limited to ambulatory prenatal services.)1

·        Former Foster Youth between ages 18 to 26 years old, who were in foster care in any state on their 18th birthday or older. (No income limit)1

·        Adults between ages 19-64 (my friend is only 62 years old), not pregnant, not in Medicare, and not eligible for any group stated above.1

This is a Medi-Cal benefit for up to 2 months.

They can also qualify based on income since their annual yearly earnings is less than $22,108 for a family size of 2.

To see if you qualify based on income, look at the chart below. Income numbers are based on your annual – or yearly – earnings.5

Family Size138% Poverty Level
116,395
222,108
2 Adults22,108

 

Medi-Cal qualifications may also include the following5:

·        65 or older

·        Blind

·        Disabled

·        Under 21

·        Pregnant

·        In a skilled nursing or intermediate care home

·        On refugee status for a limited time, depending how long you have been in the United States

·        A parent or caretaker relative or a child under 21 if:

o   The child’s parent is deceased or doesn’t live with the child, or

o   The child’s parent is incapacitated, or

o   The child’s parent is under employed or unemployed

·        Have been screened for breast and/or cervical cancer

The Medi-Cal program governs eligibility for benefits on a “means” tested basis. “The 2002 community spouse resource allowances are $89,280 in assets and $2,232 in monthly income.  For a married couple with one spouse in a nursing home and the other spouse at home, the spouse at home may keep up to $89,280 in resources (property and other assets) while the spouse in a nursing home may keep $2,000.  The spouse at home may keep all of the income received in his or her name, regardless of the amount.  If the amount is below $2,232 per month, the spouse in the nursing home may allocate income to bring the at-home spouse’s income up to the $2,232 per month limit.  The spouse in the nursing home is permitted to keep $35 a month for personal needs.”8

Home care services – yes, they are eligible for In-Home Operations6

Adult day health program – yes, they are eligible for Community-Based Adult Services (CBAS) – formerly Adult Day Health Care (ADHC)7

Nursing home care – yes, they are eligible care in a skilled nursing facility6

 

The sites are not user friendly.  There is quite a number of FAQs that are not really related to my inquiries.  The search box is not helpful as I one would think.  It took me several attempts to look for the information that I needed to get.  If I had an age- related limitation such as poor vision and hypertension, then I would definitely get a headache and my blood pressure would increase out of frustration.  I did take a long nap during the course of this assignment because it was a bit frustrating not to find the information that I wanted to get immediately and I was getting tired.  Patience is definitely necessary to go over these CA.gov sites.

 

References:

1.      Hospital Presumptive Eligibility (HPE) Program (2016). In California Department of Health Care Services. Retrieved fromhttp://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/HospitalPE.aspx

2.      Minimum Wage (2016). In State of California Department of Industrial Relations. Retrieved fromhttp://www.dir.ca.gov/dlse/FAQ_MinimumWage.htm

3.      Fair Labor Standards Act Advisor. In United States Department of Labor.  Retrieved fromhttp://webapps.dol.gov/elaws/faq/esa/flsa/014.htm

4.      Labor force characteristics. In Bureau of Labor Statistics.  Retrieved from http://www.bls.gov/cps/lfcharacteristics.htm#fullpart

5.      Do you qualify for Medi-Cal benefits? In California Department of Health Care Services.  Retrieved fromhttp://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx

6.      In-Home Operations. In California Department of Health Care Services.  Retrieved fromhttp://www.dhcs.ca.gov/services/ltc/Pages/In-HomeOperations.aspx

7.      Community-Based Adult Services (CBAS) – formerly Adult Day Health Care (ADHC). In California Department of Health Care Services.  Retrieved from http://www.dhcs.ca.gov/services/Pages/Community-BasedAdultServices(CBAS)AdultDayHealthCare(ADHC)Transition.aspx

8.      Medi-Cal Questions and Answers. Retrieved from http://www.dhcs.ca.gov/services/ltc/Documents/Medi_CalQandA.pdf

 

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