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Medi-Cal Application Pending

Dear Advocate,

My wife’s Medi-Cal application is pending right now, but her nursing home is asking us to pay the full private pay rate until the application goes through.

Can they do this?

Irked in Irvine

Dear Irked,

There is a conflict between recent federal policy and current state law on this issue. Federal policy permits a nursing facility to charge an applicant or resident privately while the Medi-Cal application is pending. However, California law prohibits the facility from evicting or transferring a resident for non-payment while the Medi-Cal application is pending. In addition, the facility may not evict the resident or transfer within the facility (except from a private room to a semiprivate room) as a result of conversion from private pay to Medi-Cal.

See if the facility will accept the estimated share of cost (the resident’s monthly income minus $35 for personal expenses). Since Medi-Cal eligibility is established as of the date of application, the facility must reimburse the difference between the share of cost and the private pay rate once the Medi-Cal application is approved. Thus, acceptance of the estimated share of cost saves the facility the trouble of reimbursement.

For further questions, call CANHR toll-free at (800) 474-1116.