Changes in Assets and Medi-Cal Coverage Eligibility

Focused on workers’ compensation law, Slade Neighbors provides knowledgable defense in a wide range of California cases. Conversant on the latest legal developments, Slade Neighbors has an in-depth understanding of Medicare and injury and workers’ compensation law.

In July 2022, California budget wording significantly expanded the amount of assets that can be retained by a disabled person while maintaining Medi-Cal coverage eligibility. Before the law’s enactment California, like other states, placed a $2,000 cap on a disabled individual’s assets (exempting vehicle or home) for Medi-Cal coverage qualification.

The new law increases the cap to $130,000, with each family member in the household generating another $65,000. In addition, assets within Medicare Set-Asides (MSAs) are not considered income to determine expanded or traditional Medi-Cal eligibility.

This means injured parties can now keep $130,000 or more in assets and MSA account funds while maintaining Medi-Cal benefits extending to long-term care. One major consideration is that the beneficiary needs to reside in California. Otherwise, the asset limit returns to $2,000. In such cases, the injured party must take complex steps such as creating a Special Needs Trust (SNT) in the state where they now reside, transferring MSA assets to a trust, and liquidating assets to below $2,000.

Medical Treatment Entitlements for Injured Workers in California

Attorney Slade Neighbors’ career has spanned more than three decades. Since 1995, Slade Neighbors has led an Encino, California, firm focusing on workers’ compensation law defense cases.

Workers’ compensation systems in the US vary by state. Governments have outlined benefit entitlements for workers injured on the job. In addition to other benefits, California mandates coverage of medical treatment for such injuries, paid for through a plan funded by employers.

The medical benefits cover all costs related to medical evaluation and treatment. The compensation also includes the cost of transportation to medical appointments, set at a per-mile rate by the Internal Revenue Service. As of July 1, 2022, the rate is 62.5 cents per mile. Coverage also extends to prescription drugs.

If an employee has pre-selected their personal physician before they have a work-related injury, the claims administrator may sanction treatment by that physician. If the employer has a Medical Provider Networks (MPN) or has partnered with a health care organization (HCO), care may be provided by these entities. MPNs are a group of physicians accredited by the Division of Worker’s Compensation (DWC) to treat diverse work-related injuries; HCOs are authorized by DWC to coordinate all aspects of medical care for work-related injuries.

If a worker does not have a pre-selected physician and their employer hasn’t partnered with an HCO or MPN, the claims administrator will select an appropriate health practitioner within the first 30 days after the employer is apprised of the injury. If the claims administrator fails to assign a practitioner for treatment within that timeframe, the injured worker may choose a physician for their treatment, as long as that professional practices within a reasonable geographic area.