Tips On Finding Nursing Home Bed When On Medi-Cal

October 5, 2017 by · Leave a Comment 

Most everyone agrees it can be very difficult — next to impossible, really — for Medi-Cal enrollees to snag a spot in a nursing home, especially if they’re transferring from their homes or assisted living facilities rather than going straight from the hospital.Senior man taking cough syrup while reclining on hospital bed

Not everyone agrees on the reasons, however.

“There’s massive, systemic Medi-Cal discrimination,” says Pat McGinnis, executive director of California Advocates for Nursing Home Reform. She believes some nursing homes illegally turn away enrollees because they don’t want to accept Medi-Cal’s lower reimbursement rates.

“If they can get more money with private pay or Medicare, they would rather accept one of them,” she says.

Deborah Pacyna, director of public affairs for the California Association of Health Facilities, which represents most of the state’s standalone nursing homes, says it’s illegal for nursing homes to discriminate based on payment type. She blames access problems on the state’s rapidly aging population.

“Projections are that we will run out of nursing home beds by 2020,” Pacyna says. “That is putting even more pressure on the Medi-Cal population.”

No matter what you believe, the situation amounts to a crisis for Californians who desperately need a nursing home and are covered by Medi-Cal, the state’s version of the federal Medicaid program for low-income residents, says Susan Geffen of Hermosa Beach, an elder law attorney, gerontologist and author of the book “Take That Nursing Home and Shove It!”

If you think low-income doesn’t mean you, think again. Many middle-class Californians need Medi-Cal to help pay for their long-term care because they run out of money paying the bills on their own, she says.

Despite the access challenges many Medi-Cal enrollees face, about two-thirds of California’s nursing home residents rely on the program to cover all or part of their costs.

The state Department of Health Care Services (DHCS), which oversees Medi-Cal, says that nearly 90 percent of California’s 1,400 nursing homes accept its enrollees. The department is the only entity I interviewed that “is not aware of Medi-Cal members who are having difficulty finding a nursing home that will accept them.”

Today, I’m offering some advice if you or a loved one needs a nursing home for a long-term stay. It will be easier if you’re already in the hospital, which I realize is cold comfort.

Finding a bed if you’re not in the hospital — especially a bed in your community — might mean you’ll have to pay out of your own pocket initially. Or it might require some creative maneuvering, like working with your doctor to get you admitted to a hospital. Even then, “a hope and a prayer” might be necessary, says Derrell Kelch, executive director of the California Association of Area Agencies on Aging.


If You’re Coming From the Hospital

More than 90 percent of nursing home admissions last year came directly from hospitals, according to data from the Office of Statewide Health Planning and Development.

If you or a loved one is in the hospital and may not be able to return home afterward, “start working with the hospital discharge planner immediately” and ask for a list of nearby nursing homes, Kelch advises.

If you have fee-for-service Medi-Cal, you will require prior authorization, and the request must be made by the hospital or the nursing home, says DHCS spokeswoman Carol Sloan. If you’re in a Medi-Cal managed care plan, it will help determine where you go, she says.

You may want to visit the facility first before committing your loved one to it, Pacyna suggests. Also check out Nursing Home Compare on the Medicare website for quality ratings.

Medicare, the publicly funded health insurance program for older Americans, is often the first payer when you move into a nursing home. Under certain conditions, it will cover you for a limited time — up to 100 days.

The traditional form of Medicare will pay 100 percent for the first 20 days, after which you will owe $164.50 a day for up to 80 additional days. But you can qualify for this coverage only if you enter a Medicare-approved nursing facility within 30 days of an inpatient hospital stay that lasted at least three days. Beware: “Observation” care in the hospital won’t count as an inpatient stay.

Medicare does not cover long-term nursing home stays.

So, once you are in the nursing home, don’t wait to apply for Medi-Cal if you’re not already enrolled in it, Geffen says. Medi-Cal can help cover your Medicare copays, if you’re eligible, and then take over when your Medicare coverage ends, she says.

“They can’t just discharge somebody [from a nursing home] because they’re going on Medi-Cal,” McGinnis says.

If the nursing home balks and says it can’t keep you after you’ve switched to Medi-Cal, you can seek help from McGinnis’ organization ( or 800-474-1116) or another advocacy group, including legal services organizations or your local Long-Term Care Ombudsman, she says.

Be sure to let the facility know that you know it can’t discriminate against Medi-Cal enrollees, McGinnis adds.

If You’re Coming From the Community

Just because a small percentage of patients admitted to nursing homes last year came from their homes or assisted living facilities doesn’t mean people aren’t trying, says Mike Connors, an advocate for McGinnis’ group.

“It’s just extraordinarily difficult,” he says. “People end up waiting for months. … They get sick and get hospitalized.”

To find a facility that is certified for Medi-Cal, go to the state Department of Public Health’s database at You might need to target larger nursing homes that have higher turnover, McGinnis says.

If it’s financially possible, consider starting out as a private-pay client.

Instead of getting rid of all of your money ahead of time to become eligible for Medi-Cal long-term care coverage, Geffen suggests keeping some in reserve so you can gain entry as a cash customer.

Then, once you’re a resident and run out of money, “they’re not allowed to kick you out,” Kelch says.

Geffen also knows of people who have gone to the hospital in the hope of getting admitted, so they can be discharged directly into a nursing home. “Some people have had to go to extraordinary feats in order to get into a nursing home on Medi-Cal,” she says.

You can also consult with your doctor to devise a plan. If she agrees that you need to be in a facility, request documentation that you can take to the nursing home as proof, Pacyna says. Or, “if you’re ill, it may be appropriate to be admitted to the hospital,” Connors says.

I wish there were more support for individuals and families struggling through this.

Placement services, such as A Place for Mom, can help you find a nursing home with openings. You can also talk to an elder law attorney.

You can even ask your county social services department for help, says Benson Nadell, director of the San Francisco Long-Term Care Ombudsman program. “People cannot navigate this complex system on their own,” he says.


Cuidado con Estafadores Ofreciendo Cobertura Médica Barata

April 20, 2017 by · Leave a Comment 

Mientras el futuro de la cobertura médica continúa siendo un tema de conversación nacional, estafadores están aprovechándose de las preocupaciones sobre los posibles cambios a las leyes de seguro médico.

Una estafa común es cuando el estafador llama a personas al azar y les dice que necesitan nueva cobertura médica debido a cambios recientes en la ley federal. El que llama le pedirá información tal como el número de seguro social, de cuenta bancaria o de seguro médico.

Al conseguir esta información el ladrón entonces puede robarle la identidad a la víctima.

Las siguientes recomendaciones son pasos que puede seguir si llegase a encontrarse en esta situación.


  • No provea su información personal en llamadas no solicitadas
  • Llame a su compañía de seguro médico o a Medicare para verificar si en realidad han habido cambios a su póliza por los cambios en la ley.
  • Reporte estafas de este tipo a la Comisión Federal de Comercio en 877-FTC-HELP

Dreamers In Search of Affordable Health Care

June 2, 2016 by · Leave a Comment 

June 15, 2012 was a historic day for thousands of young immigrants who under President Obama’s executive action became eligible for temporary relief from deportation.

“These are young people who study in our schools … they pledge allegiance to our flag. They are Americans in their heart, in their minds, in every single way but one: on paper,” said Obama when he introduced Deferred Action for Childhood Arrivals (DACA), a program making nearly 1.5 million youth brought to the country illegally as children eligible for a reprieve from deportation and a work permit, both renewable every two years.

Lea este artículo en Español: Soñadores en Busca de Cuidado de Salud Asequible

Over 853,000 immigrants between the ages of 16 and 31, often referred to as “dreamers,” have applied for DACA status since the president’s announcement. For many, with the ability to work legally came the hope of higher wages and perhaps benefits.

Getting health insurance, however, has not been easy for some. For others, it’s not a priority.

The Affordable Care Act (ACA) enacted in 2014—commonly known as Obamacare— excluded DACA recipients from coverage because they are not permanent legal U.S. residents or citizens.

In this three-part series, EGP looks at some of the challenges this group of dreamers face in their search for affordable health care and the options they have to access services.


DACA and Obamacare: Who Qualifies?
Los Angeles resident Nidia Torres was brought illegally to the U.S. when she was six years old. She lived in the shadows for over two decades, hoping not to be discovered or deported back to Mexico, a country she does not call home.

In 2013, everything changed. Torres was granted DACA status and excitedly started planning for the future. The opportunities a work permit, driver’s license and social security number would bring to her life were endless, including providing a better future for her U.S. born daughter, Torres told EGP.

“No more shame for being undocumented,” she recalls thinking when her work permit arrived in the mail.

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she consider home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she considers home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Torres soon landed a job waitressing at a national restaurant chain where she was paid minimum wage plus tips, but did not offer health insurance.

“I can work legally, my daughter has Medi-Cal, so I think I’m OK,” she told EGP, explaining that after years of low-paying jobs and long hours that left her little time for her daughter, the new job was a big step forward.

“I just wanted a job,” she told EGP. “Plus I don’t really get sick,” so health insurance was not a big deal, she said, adding she had no idea where to get coverage on her own.

Torres, who speaks both English and Spanish and has some college education has since been promoted to manager and is earning more money, but still has no health benefits.

The goal of the Affordable Care Act was to increase “the quality, availability, and affordability” of private and public health insurance to the then over 44 million uninsured Americans, providing they are legal permanent residents or U.S. citizens. To keep costs down, large numbers of young, healthy individuals — the same group targeted by DACA — would have to be enrolled, yet undocumented immigrants and DACA recipients are ineligible to buy health coverage through government sponsored health exchanges or receive premium tax credits or other savings on marketplace plans, even though they pay into the tax system.

Gabrielle Lessard, a health policy attorney with the National Immigration Law Center, calls the policy unjust. DACA recipients are working and paying taxes for a service that they can’t apply for, she told EGP.

“The exclusion of DACA recipients probably increases the price of insurance for all other people,” Lessard said.

In California, however, some low-income undocumented immigrants and DACA recipients may qualify for Medi-Cal, a state funded health insurance program for low-income families, people with disabilities, pregnant women, children in foster care and low-income adults who meet certain requirements.



Torres is not one of them. According to the California Department of Health Care Services and federal eligibility requirements, Torres’ $23,000 a year income puts her just slightly above the $22,108 maximum Federal Poverty Level (FLP) for a family of two, making her ineligible for Medi-Cal.

Like many other DACA recipients with incomes “too high” for health insurance subsidies, Torres’ options for health coverage are limited, and the process for finding affordable coverage can be complex, according to the UC Berkley study, “Realizing the Dream for Californians Eligible for Deferred Action for Childhood Arrivals: Health Needs and Access to Health Care.”

Many DACA recipients don’t even know they have options, the study found. The lack of information reflects “the complexity” of the network of programs available and the process to access them, researchers stated.

Getting health care doesn’t have to be a problem, says Irene Holguin, director of community relations with Arroyo Vista Family Center, a network of five clinics serving the east and northeast side of Los Angeles.

During a free family health fair Friday at Arroyo Vista’s clinic in Lincoln Heights, Holguin told EGP there are options for everyone, regardless of immigration status or income.

When people arrive at one of our clinics for the first time they undergo a financial screening to determine what types of programs they are eligible for, she said. “We don’t turn anyone away,” she added. She explained that the clinic offers discount programs and fees to those who not qualify for state or federal funded program.

For example, if a patient can only pay $10, Arroyo Vista will help them set up an affordable payment plan for the balance, Holguin said.
The Arroyo Vista clinics provide primary health care in communities where approximately 98% of families are Latino and many of them low-income, explained Holguin.

“There’s a lot [more] that needs to be done in regard to informing the community and encouraging people to be proactive and seek preventive health services,” she said, “because a lot of people have illnesses that they don’t even know they have.”

As for Torres, she told EGP she would be open to going to a clinic like Arroyo Vista to look into her what her options are. “Better safe than sorry,” she said.


The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.


To read Part 2: The Health Challenge In Mixed-Status Homes

To read Part 3: SB10 is it worth it? What is an exemption?


Twitter @jackiereporter

La Constante Duda, ¿Qué Cubre Medicare?

August 28, 2014 by · Leave a Comment 

Medicare ayuda a cubrir el costo de una gran variedad de productos y servicios médicos en hospitales, consultorios y otros establecimientos de salud. Sin embargo, es importante saber lo que está y no está incluido.

Los servicios están cubiertos, ya sea por la Parte A o Parte B de Medicare.

La Parte A es seguro hospitalario que ayuda a pagar por:

  • Los servicios de hospitalización en hospitales o en centros de enfermería especializados (no de custodia o cuidado a largo plazo) o una institución religiosa de atención de salud no médica;
  • Cuidado de hospicio;
  • Los servicios de atención médica en el hogar:

La Parte B (seguro médico) ayuda a cubrir los servicios médicamente necesarios de los médicos, atención ambulatoria, servicios de salud en el hogar, equipo médico duradero, como sillas de ruedas y andadores y otros servicios médicos.

La Parte B también cubre muchos servicios de atención preventiva.

Usted puede averiguar si tiene las Partes A y B al ver su tarjeta de Medicare. Si usted tiene Medicare Original, podrá usar esta tarjeta para obtener los servicios cubiertos por Medicare. Si se inscribe en un plan de salud de Medicare, en la mayoría de los casos debe utilizar la tarjeta del plan para obtener sus servicios cubiertos por Medicare.

Bajo Medicare Original, si se aplica el deducible anual de la Parte B ($147 en 2014), usted deberá pagar todos los costos (hasta la cantidad aprobada por Medicare) hasta que cumpla con el deducible de la Parte B antes de que Medicare empiece a pagar la parte que le toca.

Después de cumplir con el deducible, usted normalmente paga el 20% del costo del servicio aprobado por Medicare si el médico u otro profesional de la salud acepta la asignación. “La aceptación de asignación” quiere decir que un médico u otro proveedor se compromete a ser reembolsado directamente por Medicare, y debe aceptar la cantidad de pago que Medicare aprueba por el servicio, y no facturarle más que el deducible y el coaseguro de Medicare a usted.

Usted tendrá que pagar más si usted ve médicos o proveedores que no aceptan la asignación. Y no hay límite anual en lo que usted paga de su propio bolsillo.

Si usted está en un plan de Medicare Advantage (como un HMO o PPO) o tiene otro seguro, sus costos pueden ser diferentes. Póngase en contacto directo con el administrador de beneficios o del plan para averiguar acerca de los costos.

En la Parte B, Medicare paga por muchos servicios preventivos (como las pruebas de detección de cáncer y enfermedades del corazón) que pueden detectar problemas de salud a tiempo, cuando son más fáciles de tratar.

Usted no paga por la mayoría de los servicios preventivos cubiertos si obtiene los servicios de un médico u otro proveedor calificado que acepta la asignación. Sin embargo, para algunos servicios preventivos, es posible que tenga que pagar un deducible, coaseguro, o ambos.

Medicare no cubre todo. Si necesita ciertos servicios que no están cubiertos por la Parte A o Parte B, usted tendrá que pagar por ellos a menos que:

  • Usted tenga otro seguro (o Medicaid) para cubrir los costos;
  • Está en un plan de salud de Medicare que cubre estos servicios.

Es importante saber que Medicare no cubre algunos de los servicios y productos tales como:

  • El cuidado a largo plazo (también llamado la atención de custodia);
  • La atención rutinaria dental o de la vista;
  • Dentaduras;
  • La cirugía estética;
  • La acupuntura;
  • Audífonos y exámenes para probarlos

Si tiene dudas sobre su Medicare puede obtener ayuda llamando al 1-800-633-4227.

Copyright © 2017 Eastern Group Publications/EGPNews, Inc. ·