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Medi-Cal Reimbursement

Dear Advocate,

My wife is in a nursing facility, and I am living at home. She became eligible for Medi-Cal to pay for her nursing home stay in August of last year. Until that point, I had been privately paying for her, including the month of August. The facility told me they would reimburse me for the difference. It’s March now, and they still haven’t paid me back. What do I do?

Miffed in Marin

Dear Miffed,

According to California Welfare & Institutions Code § 14019.3(e), upon reimbursement by Medi-Cal, a facility must return any money paid on behalf of a beneficiary other than what the beneficiary owes for share of cost.

Your wife became eligible for Medi-Cal in August, so she would only be liable for her share of cost that month, not the full private-pay rate. It’s March now. Medi-Cal most likely has reimbursed the facility for August, so it must return to you the difference between what you paid and the share of cost.

You should write a firm but polite letter demanding your money back. Should the facility fail to comply, you should file a written complaint with the Department of Health Services.