Dr. Mari Pantoja-Smith, DHSc - RN

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.