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How do you calculate shared cost for MediCal applicants?

I hired an advocate to help me navigate through the process of applying for MediCal coverage for my mother who needs 24-hour care in a nursing home. This advocate cost me $2500 :-( She told me our monthly shared cost would be $328.00 for my moms care. My mother has no property and we have exausted her savings. When we got the MediCal approval our shared cost is $1580.00 per month. No way can we afford this. This advocate will not answer my calls and I have no idea how she came up with this $328.00 figure. I know, I know, looks like I'll have to proceed with legal action but, in the meantime, does anyone know how shared cost are calculated?
Status: Open    Jan 26, 2015 - 10:31 AM

Finance, Medicare/Medicaid

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Expert Answers

Dec 15, 2015 - 09:28 AM

The way the share of cost works in a skilled nursing home is calculated two ways. One for a single Medi-CAL applicant and one for a married applicant.

Single: If you are in a skilled nursing home, Medi-Cal calculates all income, minus $35 a month (Personal maintenance allowance) and if the applicant pays for supplemental insurance this is deducted. So for you mother add total income (Social security, pension and IRA’s required minimum distribution), then subtract $35 and the amount you pay for supplemental insurance…. This is the Share of Costs.

Married: Both spouses income is counted in share of cost calculations.
**California law allows the community spouse to retain a maximum monthly maintenance needs allowance (MMMNA) of $2,981 for 2015. Under the “name on the instrument rule,” the community (well at home) spouse may keep any income received in his/ her name alone, even if this exceeds the MMMNA. For example, if the community spouse’s monthly income (in his or her name alone) is $5,000; the community spouse may keep it all.
**If the community spouse’s monthly income is less than the MMMNA of $2,981, he/she may receive an allocation from the institutionalized spouse’s income until he/she reaches the $2,981 MMMNA. If the community spouse can prove with a budget that they need more than the $2,981 per month to maintain their lifestyle, an elder law attorney can file a court order to reduce share of cost for spouse in nursing home.
**If combined both spouse’s income is under $2,081 (2015), there will be NO SHARE OF COSTS.

Good luck with your situation.

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