FAQ

Are you a Skilled Nursing Facility, and are you Medicare and Medi-Cal Certified?

We are a Skilled Nursing Facility with 24-hour skilled nursing and rehabilitation. We accept Medicare, Medi-Cal and private insurance.

What is Medi-Cal?

Medi-Cal (called Medicaid in other states) provides health care coverage for California residents who have limited resources and income. Medi-Cal is administered by the California Department of Health Services, and locally by the different counties.

Who is Eligible?

An individual or family must meet asset, income, institutional status, residence, and citizenship/alien requirements. These requirements vary based on the Medi-Cal category under which a person is eligible.

A person is automatically eligible to Medi-Cal if cash benefits are received under any of the following:

Supplemental Security Income / State Supplementary Program (SSI/SSP).
California Work Opportunity and Responsibility to Kids Program (CalWORKs).
Refugee Cash Assistance (RCA).
Foster Care or Adoption Assistance.
In-Home Supportive Services (IHSS). Other Eligible Categories:
Children under 21 years of age.
Persons 65 years of age or older.
Blind or disabled, including working disabled, persons.
Persons receiving care in a skilled or intermediate care facility.
Pregnant women.
Certain adults between 21 and 65 years of age if they have minor children living with them.
Persons with certain chronic conditions such as tuberculosis or kidney dialysis.
Certain refugees, asylees, Cuban/Haitian entrants.
Families transitioning from CalWORKs to employment (Transitional Medi-Cal). Qualified low-income Medicare recipients (Medicare Savings Programs).

Other eligibility factors include:

Assets (bank accounts, vehicles, etc.) must fall within the Medi-Cal limits listed below. The limitation is based on family size. Assets are waived for pregnant women and children if their income falls within certain Federal Poverty Level (FPL) limits. A married person with a spouse in long-term care is allowed to retain a higher amount of assets ($95,100 for the year 2005).
Income is used to determine whether the person/family receives free Medi-Cal or has to pay part of their monthly medical expenses, called a Share of Cost (SOC), before Medi-Cal will begin to pay. The SOC is determined by subtracting an amount set by the State, called a Maintenance Need, from the net non-exempt income.
Federal Poverty Level limits are used to determine income eligibility for other categories. These figures change in April of every year.
All assets and income must be reported. However, some items may be exempt and will not be counted in determining eligibility or Share of Cost.
To be eligible for the full scope of Medi-Cal benefits, a person must be a United States citizen or a legal permanent resident. Undocumented immigrants are limited to restricted benefits that cover emergency and pregnancy related services only.

How Does a Person Apply For Medi-Cal?

An application for Medi-Cal can be obtained either in person at a Social Services Agency district office or by calling 1-800-281-9799. District offices serving the applicant's city are located in the white pages phone book under County Government. Eligibility staff at the toll-free phone number can also answer questions about the Medi-Cal program. An assigned Eligibility Technician will assist the applicant by making sure all forms have been completed and identifying the required verifications that must be provided. In some situations, Medi-Cal can be requested for the three months preceding the application month. The same application process is followed.

What if a Person Does Not Quality For Medi-Cal?

Adults aged 21 through 64 with limited resources but who do not qualify for Medi-Cal can apply for medical care. The applicant must be a U.S. citizen or have legal permanent resident status. There is an income limit, based on family size, of 200% of the Federal Poverty Level ($1595 for one person as of 4/05).

What is Medicare?

Medicare is a federal health insurance program for people 65 years of age and older. While it is the primary source of publicly funded health care for the elderly, people with permanent kidney failure, as well as certain younger disabled people, are also eligible to receive Medicare benefits. Medicare has two parts: (1) Part A covers inpatient care in hospitals and skilled nursing facilities, as well as hospice care and some home health care (but not custodial or long-term care); and (2) Part B, covers doctors' services, outpatient hospital care, and some other services such as physical and occupational therapy and some home health care. Most individuals become eligible for Medicare at age 65. There is no monthly premium for enrollment in Part A, but there is a monthly premium for enrollment in Part B ($66.60 as of 2004). You may enroll in Part A without enrolling in Part B.

How many days does Medicare cover in a nursing home?

Medicare pays for skilled nursing care and not long term custodial care. Skilled care is different from basic personal or custodial care, such as assistance in walking, getting in and out of bed, eating, and dressing, bathing, and taking medicine. Medicare Part A will not pay for custodial care if that is the only kind of care you require. After a related three-day inpatient stay, Medicare Part A will pay all of the cost for the first 20 days in a skilled nursing facility and part of the cost for days 21-100. It pays none of the cost after 100 days.

How many days per week do residents receive therapy?

All therapies require a physician's order. The amount of therapy received by a patient is dependent on how much progress the patient makes. All therapists need to document significant progress to keep a patient on a caseload. Further information is available from our facility rehabilitation director.

What are the visiting hours for the facility?

Visiting hours established by the facility are 10 a.m. to 8 p.m. If a resident is in hospice care, we allow more flexible visiting hours for family and friends.

Who does the patients' laundry?

Our facility offers laundry services at a nominal cost, or a family may elect to do a patient's laundry at home.

Who will make transportation arrangements for patients who have appointments outside?

Social Services makes all transportation arrangements.

Do you allow pets to visit the facility?

We do welcome pets, so long that they are vaccinated and a record can be shown on entry to the receptionist/or nursing stations.

May I take a patient out of the facility?

Yes, but only if there is a written physician's order. Residents need to be signed out by the responsible party at the nurse's station.