Need your help please!

Hello everyone,

I am working on a complex San Francisco senior case and wanted to see if any of you know of California-specific elder support avenues I may be missing.

Client is a mentally intact gay senior living alone who wants to remain at home, but currently requires 24-hour private duty care after a recent medical decline costing him $650 per day. He does not qualify for Medi-Cal or IHSS at this time due to approximately $130K in assets. He already has Kaiser Medicare and Federal LTC insurance that will be activated, but LTC home reimbursement is limited, and there is a 90-day elimination period.

Beyond the standard Medi-Cal/IHSS routes, are there any California county programs, Kaiser community supports, waiver programs, LGBTQ senior resources, nonprofit grants, or other home-preservation funding/support options that could help offset custodial care or provide supplemental in-home assistance?

Any California insight would be greatly appreciated.

Thank you,

Mari

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Lisa Berry Lisa Berry Blackstock 10 days ago
Hi Mari, To the best of my knowledge, a person in any state with assets exceeding the Medi-Cal threshold will not qualify for any type of public healthcare assistance. The LGBTQ community is well organized in the Bay Area, and may provide financial assistance on a private basis. I would check with their local organizations; keep in mind that any grants might also be dependent upon financial need. — Every LTC policy has an elimination period, and requires proof of payment by the insured as part of the policy’s authorization process. A limit of $650/day sounds as though the LTC policy doesn’t carry an annual inflation endorsement; this should be confirmed by reading the entire policy (and not the policy Summary of Benefits.) I would also verify the policy allows assets other than the insured’s to cover the elimination period. The elimination period of 90 days, at $650/day, equals $58,500, which can be covered by your client’s assets if he is required to pay. LTC policies all contain language regarding caregiving coverage by formal and informal caregivers. Understanding policy guidelines in this regard is crucial. — I didn’t see any mention of the cause of your client’s medical decline. If another party was involved (i.e. an accident, premature discharge, improper diagnosis) the opportunity may exist to explore the LTC policy elimination period coverage by the other responsible party. Good luck.