In preparation for the elimination of property and asset consideration from eligibility requirements for Medi-Cal, the California Department of Health Care Services issues periodic guidance and updates to county Welfare Directors. Below are excerpts of the guidance from August 2023 with the All County Welfare Directors letters attached.
California Eliminating Asset Test for Medi-Cal in 2024
In January 2024, the asset test for Non-MAGI Medi-Cal will be eliminated for many programs. This means that many individuals can receive Medi-Cal benefits from the Medicare Savings Program and Long-Term Care programs without having to necessarily spend down their assets to qualify. The extra help programs are complicated and complex in terms of eligibility especially when the individual has a spouse.
If you believe you or family member may qualify, also apply for the extra help from Medi-Cal. While you may not qualify in 2023, with the elimination of the asset test, you may qualify in 2024. Each California county manages the eligibility and enrollment for their residents into the various Medi-Cal programs. The case workers are usually very good at assisting residents with applications and guidance.
ASSET ELIMINATION AND OVERPAYMENTS DUE TO EXCESS PROPERTY
ACWDL 23-17, August 18, 2023
The purpose of this All-County Welfare Directors Letter (ACWDL) is to provide counties with guidance regarding the elimination of assets for Non-Modified Adjusted Gross Income (Non-MAGI) Medi-Cal programs and the elimination of the requirement to compute and report potential overpayments based on excess property1.
As enacted by Assembly Bill (AB) 133 (Chapter 143, Statutes of 2021), the elimination of asset limits for all Non-MAGI Medi-Cal programs, including Medicare Savings Programs (MSPs) and Long-Term Care (LTC) becomes effective on January 1, 2024.
The Medi-Cal Eligibility Procedures Manual (MEPM) provides information and procedures regarding computing, referring, and investigating potential Medi-Cal overpayments and recovering funds due to such overpayments. Potential overpayments are defined in the California Code of Regulations (CCR), Title 22, Sections 50781 and 50781.5 and Article 16A of the MEPM.
Overpayments Due to Excess Property Beginning January 1, 2024
Beginning January 1, 2024, counties are no longer required to compute and report potential overpayments based on excess property, as outlined in MEPM Article 16C Section II, because resources, including property or other assets, will no longer be used to determine eligibility for Non-MAGI Medi-Cal programs. Activities related to overpayments that occur prior to January 1, 2024, including computations, reporting/referring, investigations, prosecutions, and collections, may continue after January 1, 2024, or until DHCS considers the matter resolved/closed.
There will be no change to the requirement to compute and report potential overpayments related to increased and/or unreported income, and failure to report other health coverage. Counties shall continue to follow the process for computing these overpayments as outlined in MEPM Article 16C, Sections I, III, and IV. Counties shall continue to follow the process for reporting any potential non-property overpayments to the DHCS Audits and Investigations Division, as outlined in Medi-Cal Eligibility Division Information Letter (MEDIL) I 19-02.
- The term “excess property” means resources, including property and other assets.
SPOUSAL IMPOVERISHMENT UNDER ELIMINATION OF ASSET LIMITS BEGINNING JANUARY 1, 2024
ACWDL 26-16, August 1, 2023
The purpose of this All County Welfare Directors Letter (ACWDL) is to provide counties with instructions regarding how to apply spousal impoverishment (SI) provisions beginning on January 1, 2024, when the asset limit will be eliminated and all property will be exempt. The changes described in this letter apply to both the long-term care (LTC) and home and community-based services (HCBS) Medi-Cal populations.
What this means:
The initial month refers to:
•The first month for which an institutionalized spouse has applied for Medi-Cal coverage for LTC services or has been admitted to a LTC facility and is expected to remain for 30 consecutive days, whether or not they actually remain that long(see ACWDL 91-84, sections 50033.5 and 50377). This could be a retroactive month, the month of application, or the month of admission into an LTC facility.
•The first month in which an HCBS spouse has both:
- requested in-home care or HCBS Waiver and Program services (see the Screening Tool in MEDIL I 22-35 for a description of requests), and
- met the nursing facility level of care criteria through a needs assessment or the MC 604 MDV.
Applications by institutionalized spouses, or requests for in-home care or HCBS waiver and program services, submitted prior to January 1, 2024, and any requests for retroactive coverage for months prior to January 1, 2024, will still be subject to all of the property eligibility determinations and verification requirements for the initial month when the CSRA is being determined. In addition, beneficiaries who are institutionalized spouses and HCBS spouses will still be subject to property limits for any months of eligibility prior to January 1, 2024, with the exception of months covered by the asset waiver in accordance with MEDIL I 23-19. Fair hearings regarding eligibility for months prior to January 1, 2024, may still be requested and heard on or after January 1, 2024, according to ACWDL 90-01, Section 50491.
Which spousal impoverishment provisions will no longer apply beginning January 1, 2024?
The following is a list of the primary ACWDLs relating to SI property and other issues. Counties were instructed to follow the SI property provisions for HCBS spouses in ACWDLs 17-25 and 18-19.
The sections of the SI property ACWDLs listed below, as they relate to property will no longer apply, beginning January 1, 2024:
ACWDL 90-01 –
50031.5 Community Spouse Resource Allowance (CSRA)
50142 Screening
50142.5 Assessment of Resources for Institutionalized and Community Spouses
50154 County Department Responsibilities for Informing All Medi-Cal Applicants or Potential Applicants at Screening
50157 Face-to-Face Interview
50377 Medi-Cal Family Budget Unit (MFBU) Determination, Family Member in a Long-Term Care Facility or in Board and Care (last revised in ACWDL 91-84)
50402 Availability of Property
50403 Treatment of Property
50416 Utilization Requirements
50417 Utilization – Good Cause
50455.5 Cash Payments for Medical and Social Services
50458 Pension Funds
50483 Loans
50490 Property Treatment for Institutionalized and Community Spouses
50490.1 Exempt Property – Community Spouse Resource Allowance (CSRA) and the Property Reserve of the Institutionalized Spouse
50490.3 Property Considered Available to the Institutionalized Spouse
50490.5 Calculation of the Community Spouse Resource Allowance (CSRA)
50490.7 Transfer of the Community Spouse Resource Allowance to the Community Spouse
ACWDL 91-28–
50377 Medi-Cal Family Budget Unit (MFBU) Determination, Family Member in a Long-Term Care Facility or in Board and Care (last revised in ACWDL 91-84)
50416 Utilization Requirements
50417 Utilization – Good Cause
50427 Other Real Property
50441 Mortgages, Deeds of Trust and Other Promissory Notes,
50453 Checking and Savings Accounts
50473 Livestock, Poultry or Crops
50485 Business Property
Which spousal impoverishment provisions will continue to apply beginning January 1, 2024?
All Sections of ACWDLs 90-01 and 91-28 not listed above will remain applicable, and ACWDL 91-84 will continue to apply in its entirety except that the definition of Community Spouse is changed to:
50031.5. Community Spouse. A person who is not an inpatient in a medical or nursing facility, or a participant in a Home and Community-Based Waiver or Program.
The entirety of ACWDLs 90-03 and 90-89 remain applicable.
The definitions and income provisions for HCBS spouses differ from those of institutionalized spouses and therefore, counties must continue to follow the instructions in ACWDLs 17-25 and 18-19 and MEDIL 21-07 with regard to definitions and the SI income provisions only for HCBS spouses.
DHCS will release a forthcoming ACWDL consolidating the listed LTC SI definitions and provisions that will remain effective beginning January 1, 2024, into one easy to reference letter.