As 97-year-old Rosaline George pays for hourly care out of her own pocket, the savings she earned while working as a journalist and local government employee are dwindling by the month.
“If I didn’t have a caregiver, I would have died within two days,” she said.
Joining Medi-Cal, California’s Medicaid program, could be her entry point into a program that pays home caregivers. But George learned that doing so would require spending most of his Social Security check on medical expenses, leaving him with just $600 a month to live in his Hollywood apartment.
In California, elderly and disabled people who earn too much to qualify for Medi-Cal can still access the program by paying a “portion” of their medical bills. But advocacy groups are renewing calls for changes to the rules, arguing they are too restrictive and lock out many Californians who need such assistance.
California calculates how much seniors like George have to hand over by subtracting from their monthly income a set amount they need to survive, called the “maintenance income level.” There is.
“Without my caregiver, I would have died within two days,” says Rosaline George, 97.
(William Liang/For the Times)
This maintenance fee has been set at $600 per adult per month since 1989. This amount equates to more than $1,500 in today’s dollars.
This means that even people who barely exceed the Medi-Cal income limit (currently $20,783 per adult per year) only have $600 left over because they must spend so much money each month to get coverage. There will be no. Other expenses such as rent, utilities, and food.
Among people not living in nursing homes, only a small portion (8%) of seniors and people with disabilities who are eligible for a “share of the cost” of Medi-Cal will be eligible for treatment in January 2023, according to health care providers. It is said that the patient had spent enough medical expenses to meet the requirements. Latest data available from the state.
“This is really punitive for people,” said Tiffany Fuen, California director of Medicare and Medicaid Advocates for Elder Justice, one of the groups pushing for the change in requirements. Cho said. “Today’s $600 is not enough to live on.”
Seniors typically have insurance through Medicare, but unlike Medi-Cal, it doesn’t broadly cover the kind of home care many Californians need as they age. But even for those above the Medi-Cal income limits, paying for home health care out-of-pocket can be prohibitively expensive.
As a result, many families end up taking on work duties themselves, losing paid employment, and stinging older adults with the help they need. Advocates say living without such support can compromise health and ultimately require more expensive institutional care.
Out-of-pocket payments for home health care may count toward the monthly “costs” required to receive Medi-Cal, but the treatment must be prescribed by a clinician under certain circumstances. Huyen Cho said. Advocates said the logistics of trying to submit such expenses could be so complicated that it would be unfeasible.
In Hollywood, George said he receives less than $2,900 a month through Social Security. This is a modest income, but significantly above Medi-Cal standards. Advocates told her that based on her income, she would have to pay more than $2,200 a month in medical bills to qualify for Medi-Cal.
There are ways to reduce or eliminate cost-sharing requirements, but they require spending. When George sought help from legal advocacy group Bet Tzedek, the group suggested she could purchase additional health insurance to reduce her “countable income.”
“I said, ‘Wait a minute, are you saying we should eliminate some Social Security benefits?'” George said. “And they said, ‘That’s what Medi-Cal says.'”
Purchasing additional health, vision, or dental insurance reduces the amount of income that counts toward the Medi-Cal program, allowing people to avoid paying a portion of the cost. In the San Francisco area, one family spent more than $2,100 a month on these supplemental insurance plans to help a 93-year-old woman access Medi-Cal and its home care program.
“Frankly, I think this is crazy,” Jaime said. His mother, Maria, suffered a stroke and requires 24-hour care. Her family asked that her last name not be used to protect her privacy. Maria was a retired diner owner for many years, and her Social Security checks and her husband’s pension put her over the Medi-Cal income limit.
Supplemental insurance costs more than half of her monthly income of less than $4,200, but Maria would otherwise need to spend about $3,600 each month on medical expenses to qualify for Medi-Cal.
“The way I see it, its function is to eliminate cost sharing,” Jaime said of the money spent on supplemental insurance. “Otherwise, my mother won’t get any benefit from purchasing that insurance.”
Two years ago, California officials agreed to change the $600 monthly allocation for other needs to match 138% of the federal poverty level. (This number changes every year and is the same number that California generally sets as the income limit for Medi-Cal.) This year, it will amount to more than $1,700 a month.
The new levels were due to come into effect in January 2025, but the plan was abandoned amid the national budget deficit. Advocates for the elderly and disabled are now asking the state to make that happen in 2026.
Justice on Aging and other advocacy groups asked Gov. Gavin Newsom in an October letter to allocate $33 million from the general fund in the next budget year and $80 million each year thereafter. State analysts have previously estimated the proposed changes would cost between $53 million and $151 million a year, half of which would be covered by federal funds.
A spokesperson for Newsom said the governor’s office “cannot speculate” on what the governor will include in the upcoming 2025-26 budget. Health policy experts predict that federal funding for the Medicaid program could be cut after President-elect Donald Trump’s second inauguration, in which case California would The burden of using state funds to maintain existing programs could become even greater.
Dozens of states, like California, have “medically in need” options in their Medicaid programs. “The key to these programs is that they are targeted to low-income people based on their spending on health care,” said KFF’s director of Medicaid and Uninsured Programs, which conducts independent health policy research, public opinion polls, and research. said Alice Burns, Associate Director. Press.
“A person must document all of their medical expenses and prove that those expenses lowered their income below the medical hardship threshold,” Burns said. He says this can be a complicated process.
Before retiring, George worked part-time for the Los Angeles County Supervisor on aging issues, but at 97 years old he didn’t have to give up his Social Security income or benefits to meet his basic needs. He said no. Roosevelt gave us that. ”
“They’re telling me, ‘Too bad,’ you’re too rich,” George said. But what should you do if you run out of savings? she asked.
“If I can’t pay my salary, my caregiver can’t do his job.”
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