Jul11Written by:NHS Editor
7/11/2010 10:11 PM 
“MEDI-CAL” THE WELFARE MYTH
Unfortunately families, with loved ones suffering from a Catastrophic Illness such as Dementia, Parkinson’s, Stroke, or Alzheimer’s and in need of Long Term Nursing Home Care, labor under the mistaken notion that Federal funds from Medi-Cal are only for low-income patients. In fact, many Nursing Home operators are equally suffering from the same mistaken beliefs. Nothing could be further from the truth.
The Private Pay Myth
Many nursing home operators prefer to simply bill the family, a process which is both familiar and relatively easy for their business office. Yet, if a patient needs extensive medical care, costs can quickly climb from a minimum of $5,000 per month to over $20,000 or more per month. Most families would find themselves hard pressed to privately pay these kind of costs for more than a few months. Often, Nursing Home operators stand by as families fall behind on their payments and as accounts payable stretch to 180 days or more.
The result is a vicious cycle for both the patient as well as the family. The family takes the loved out of the facility due to the high cost of the Nursing Home stay, the family attempts to care for the loved one at home until both the sick family member and the caregiver are exhausted and at physical risk. The last step in this vicious cycle is the inevitable ride back in an ambulance to a local Emergency Room for what is now a more serious medical problem. The result is a loose – loose scenario. Everyone loses, from the sick family member to the Nursing Home operator. The fact is that all of this could have been avoided.
Medi-Cal, A Very Different Solution:
Once a patient is approved by Medi-Cal for Long Term Nursing Home Care, Medi-Cal pays 100 cents on the dollar for patient care while in the Nursing Home. That includes either skilled or custodial care, medications, speech and physical therapy, personal items such as diapers and equipment such as specialized beds. Reimbursement continues for as long as the patient needs the care and remains in the Nursing Home. In California, the Medi-Cal daily rate (for 2010) is close to the top of the scale charged for private pay by many if not most Nursing Homes.
The Myth of Medi-Cal as a Poverty Program
Confusion over Medi-Cal also arises because it administers two major components: One for the poor and another for Long-Term Care. Admittedly, Medi-Cal for the Country’s low-income population does have its problems. But the Medi-Cal Program for Long-Term Care is well run and efficient. Oversight is much stricter, payment occurs promptly, usually within 30 days of invoices, and reimbursements are ongoing once a client is enrolled via an annual Treatment Authorization Request (TAR).
In truth, Medi-Cal is an entitlement program, just as is Medicare. Like Medicare, Medi-Cal has various rules and regulations that must be met in order to receive benefits. Still, an estimated 90% of all Skilled Nursing Homes are currently Medi-Cal approved in California.
PAYMENT OPTIONS
Indeed, when all available payment options are examined – Medicare, private-pay, Long-Term Care Insurance, etc., – Medi-Cal offers the most complete payment for patients and provides the highest consistent reimbursement rate for Nursing Home operators. Proper structuring of assets and income can enable most individuals to meet the Medi-Cal rules, qualify for benefits and preserve personal assets, even if the family has a loved one already in a Nursing Home, this can still be accomplished.
For more information on Long Term Nursing Home Care paid by Medi-Cal, you can reach Nursing Home Solutions at 800 773 6467.