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Elder Law Attorneys and Medi-Cal

Los Angeles Elder Law Attorney for Medi-Cal Planning

There is no actual major in school for elder law. Elder law is a recent discipline that was born because it is necessary. As the average life span increases, more people are living well into their golden years, and society has found that they have unique legal needs.

If you live in California, you have even more considerations on your plate, like Medi-Cal. Health insurance for elders is critical and requires a knowledgeable professional to ensure everything is set up correctly. That’s why it’s imperative that you work with an elder law attorney in Los Angeles.

Here is what you need to know about why you should use an elder law attorney to assist with Medi-Cal and long term care issues. 

What Do Elder Law Attorneys Do?

Elder law attorneys concentrate on protecting your rights as a senior citizen, making sure you have control over your end-of-life care, and ensuring that your assets transition smoothly to your chosen beneficiaries.

While there are some issues that any general lawyer can sort out for you, Los Angeles elder law attorneys have specific training and knowledge in areas that impact the elderly more severely. Navigating health insurance, specifically Medi-Cal, is one of them.

A Look at General Health Insurance

When we talk about health insurance, we often think of Medicare and Medicaid. These are two separate, government-funded health insurance programs. While they sound similar and are easily confused, the two are very different.


Medicare is a federal health insurance program for those who have reached 65 years of age. It is divided into four parts:

  • Part A covers stays in hospitals, nursing homes, or hospice care.
  • Part B is like regular insurance. It covers doctor’s visits, outpatient care, and preventative services.
  • Part C, called the Medicare Advantage Plus, is a plan you may purchase from a private company that pairs with Medicare. This program covers all of your Part A or Part B needs.
  • Finally, Medicare Part D is a plan for prescription medication.

Because of the vast coverage of Medicare and the volume of people vying for free healthcare, rejections of insurance claims are common. A Los Angeles elder law attorney can help settle disputes to ensure your coverage.


Medicaid is a federal program that provides healthcare to low-income adults and children. Your ability to use Medicaid is dependent upon your income. It helps with healthcare premiums, out-of-pocket expenses, and long-term care.

If you need to use this program to pay for a nursing home, there are complex applications and rules to follow. An elder law attorney can help create an appropriate plan to maximize your benefits while ensuring that your paperwork is completed correctly.

What is Medi-Cal?

Medi-Cal is a version of Medicaid specifically for residents of California. It provides financial help with healthcare costs for those with limited income. The difference between Medi-Cal and other health insurance programs is that Medi-Cal covers nursing home costs. Thus, in California, it is also one of the primary sources of assistance for seniors. Read more about medi-cal planning.

How do elder law attorneys help with Medi-Cal?

The issue with Medicaid - and thus, Medi-Cal - is that there are income and resource limits for this program that can exclude those who have worked for many years and have plenty of savings. Learn more about medi-cal planning in orange county.

Here’s how an elder law attorney in Los Angeles, CA can help you navigate the maze of Medi-Cal.

Qualify for Medi-Cal

Being disqualified for Medi-Cal can mean having to pay all of your medical expenses out of pocket. The biggest challenge is that insurance programs can look at your finances for the past five years when you apply for nursing home coverage, and decide that you’re financially well-off enough to not need Medi-Cal. If you don’t plan appropriately, you could be disqualified for benefits solely based on timing.

Because of the complexity of the Medi-Cal application and the various rules and requirements around qualifying, it’s crucial to have someone on your side who understands how to get around these barriers.

For instance, one way to qualify for Medi-Cal is to “spend down”, or reduce your assets in order to become eligible. Seniors may give away their assets to achieve this, but they are subject to risks; for example, a family member taking advantage of them, or being taxed when they give away substantial amounts of their estate.

An elder law attorney can help you create a trust which transfers some or all of your assets away from you so you can qualify for Medi-Cal while still protecting your ability to access those resources.

Plan For Long-Term Care

For many, long-term care planning is avoided due to its very nature. Instead of draining your savings or putting loved ones in a difficult position, you should have a proactive plan regarding long-term care. Hospitals, nursing homes, assisted living facilities, and rehab facilities come with a high price tag when it’s paid for out of pocket.

When it comes to Medi-Cal and long-term care, there are a variety of timelines, policies, and rules that dictate when and how money can be spent. Medicare, for example, will help pay for assisted living facilities, but only for a certain amount of time.

Many hope that Medi-Cal will kick in when Medicare disappears, but it can only do so when it’s set up correctly. Luckily, an experienced elder law attorney in Los Angeles will know the ins-and-outs of the system to ensure you can receive the right kind of Medi-Cal assistance when  you need it most.

Settle Claim Disputes

Qualifying for Medi-Cal is no easy task as it is, and yet qualifying is the easy part when compared to making actual claims. Some of the most common denial reasons involve not filling out the paperwork correctly and missing important deadlines. You may also run into issues if the medical codes used for you bills aren’t included in your plan, you use an out-of-network provider, or you’ve exceeded coverage for the year.

Paying for these much-needed services out-of-pocket is a surefire way to drain your savings. That means your estate will be worth much less and you won’t have as much to leave to your family and friends.

An elder law lawyer knows the proper way to submit a claim so that it’s accepted the first time. If Medi-Cal, Medicare, or your personal insurance provider denies the claim, your attorney can go to bat for you by filing the appropriate appeals. Even if hiring a lawyer seems like an extra expense, it will save you and your estate a great deal in the long run.

Meet With A Los Angeles Elder Law Attorney Today

Before you start the process of applying for Medi-Cal, it is crucial that you meet with an elder law attorney. If nothing else, you can take advantage of a consultation to make sure you understand the process. Your lawyer can ensure that you’re applying for Medi-Cal at the right time in the right way.

By having someone who knows the system help with you application, claims, and appeals, you are giving yourself the best chance to get approved. You worked hard to build up your estate and you pay into these programs; hiring a Los Angeles estate planning attorney is the best way to protect your assets while getting the most out of Medi-Cal and other government programs.

Thomas McKenzie Law
Estate Planning Attorney in California. Full-service law firm specializing in estate plans, wills and trusts, long-term care, and financial consulting. Thomas L. McKenzie received his Juris Doctor degree from Western State University College of Law, in Fullerton, California. While working full-time at night and attending full-time daily classes, Tom graduated law school with honors in 1993.

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