We understand that navigating the Medi-Cal process in California can be overwhelming and confusing. With ever-changing regulations, complex eligibility requirements, and lengthy application procedures, many families struggle to secure the benefits they need. That is why we have compiled this FAQ page—to provide clear, straightforward answers to some of the most common questions about Medi-Cal eligibility, applications, and benefits.
Whether you are applying for the first time, dealing with a denial, or concerned about Medi-Cal recovery, our goal is to help you make informed decisions with confidence. If you need personalized assistance, the M.R.S. team is here to guide you and your family every step of the way.
M.R.S. provides expert consulting and advocacy services to assist families with the planning and application process for Medi-Cal eligibility.
If M.R.S. can assist, we schedule a one-hour telephone consultation for $95. This phone consultation allows all family members, regardless of location, to participate and ask questions directly to the M.R.S. consultant.
Before the consultation, we send a preliminary questionnaire requesting general information about the applicant and their spouse (if applicable). This helps us assess eligibility and outline specific Medi-Cal programs that may be beneficial. We also provide a financial "budget" for the programs the applicant may qualify for, ensuring families have a clear understanding of their options.
During the consultation, our consultant reviews the provided information, clarifies eligibility details, and presents available options. Families gain a comprehensive view of where the applicant stands regarding Medi-Cal eligibility. At the end of the consultation, we answer any remaining questions from family members.
Families also have the option to retain M.R.S. as their Authorized Representative throughout the application process. After reviewing the specifics of each case, we provide a quote for our retainer agreement, which guarantees Medi-Cal approval.
Families will be offered the option to retain M.R.S. as their Authorized Representative throughout the application process. After reviewing the specifics during the Initial Consultation, the M.R.S. Consultant will provide a quote for a one-time retainer Service Agreement, which includes a guarantee an approval of the Medi-Cal application.
For clients who retain our services, M.R.S. provides:
Navigating the Medi-Cal process is inherently complex and stressful, especially for family caregivers already managing their loved one's transition into senior care. With over 30 years of experience, M.R.S. simplifies the process, eliminates bureaucratic frustrations, and provides families with peace of mind.
Most importantly, we are confident enough to guarantee approval for our clients. Let M.R.S. handle the complexities of Medi-Cal so you can focus on what truly matters—your loved one's care and well-being.
Contact M.R.S. today to get started!
When a prospective family first contacts M.R.S., and it is established that M.R.S.'s services are appropriate, we schedule a one-hour $95 Initial Consultation for all Care Managers as a starting point for the process. Our consultations are conducted over the phone, allowing all family members to participate, regardless of their location, and allows them to ask their questions directly to the M.R.S. Consultant, while also providing the convenience of not having to travel for an in-person meeting.
For a discounted rate of $95, an M.R.S. Consultant will evaluate your potential for Medi-Cal benefits and answer the pressing questions that often cause unnecessary stress, such as:
After completing our Initial Consultation, you will gain invaluable knowledge about your specific situation. With this understanding, you will be able to approach the application process with confidence and control—something many people lack when navigating Medi-Cal eligibility without guidance.
You will know exactly where you stand and how to represent your family throughout the Medi-Cal application process. You will be empowered, ensuring that you are not left in the dark or easily intimidated by deadlines and overworked eligibility workers at the Department of Health Services.
In addition to the consultation, you also have the option of retaining M.R.S. to act on your behalf as your Authorized Representative throughout the entire application process. At the conclusion of the consultation, after assessing the specifics of your family's case, we will provide a retainer quote in our Service Agreement to act on your family's behalf.
Our fees for complete representation throughout the Medi-Cal application process typically range between $1,800 to $2,900, depending on the complexity of the family's situation and the specific Medi-Cal Program being applied for.
M.R.S. clients receive:
If a Medi-Cal eligibility worker contacts the family, they can simply direct the call to M.R.S.'s toll-free number.
With many decades of experience in Medi-Cal, we are confident enough to guarantee an approval of the Medi-Cal application, in our Service Retainer Agreement, to our clients!
At the conclusion of M.R.S.'s consultation ($95 fee), families have the option to retain M.R.S. as their Authorized Representative throughout the Medi-Cal application process.
After assessing the specifics of your family's case during the consultation, our consultant will provide a retainer quote for hiring M.R.S. to act on your behalf. This ensures that your Medi-Cal application is handled efficiently and correctly, increasing the likelihood of approval.
You may wonder how someone seeking Medi-Cal can afford to pay for M.R.S.'s services. The answer depends on the complexity of the case:
Many families privately pay for the first month of long-term care because they are focused on helping their loved one transition into the new care environment. However, by hiring M.R.S., we work to secure Medi-Cal approval for that first month's expenses, helping families avoid paying out-of-pocket from their personal savings.
By retaining M.R.S., families gain expert guidance, reduce financial strain, and increase their chances of securing Medi-Cal benefits—resulting in a net financial gain.
Contact M.R.S. today to learn how we can help you navigate the Medi-Cal process with confidence.
A fair hearing is a legal process that allows individuals to present their case before an Administrative Law Judge by filing a 3100 Petition. This request is typically used to retain additional income for the at-home spouse (also known as the "well spouse") when applying for Medi-Cal benefits.
If approved, a fair hearing grants the client full control over their financial assets, ensuring that they are not forced into financial hardship. In contrast, choosing a Medi-Cal annuity would lock away their money, providing only a fixed monthly payment with no flexibility. Under no circumstances would they be able to access more than the predetermined amount.
For those who qualify, a fair hearing can be a much better alternative to options like the "spend down" or "gifting" strategies, which require clients to give away their assets—permanently losing control of their finances.
This method is often used to protect the well-being of the at-home spouse, ensuring that they are not left in financial distress due to the limitations of Medi-Cal rules. By securing approval through a fair hearing, families can avoid the risk of poverty while still qualifying for the necessary long-term care benefits.
If you are already enrolled in Medi-Cal and visiting this website, you may be concerned about your monthly share of cost, a potential inheritance, or other changes that could impact your eligibility. It is natural to worry about how these factors might affect your continued access to Medi-Cal benefits.
If you are hesitant to report new financial information to your eligibility worker out of concern that it could negatively impact your benefits, M.R.S. can help. We offer a comprehensive half-hour evaluation for $250, during which we will:
Because each case is unique, we do not provide generalized advice without a complete evaluation. Offering guidance without thoroughly assessing an individual's situation could create unintended legal or financial consequences.
Contact M.R.S. today to schedule an evaluation and gain clarity on how to protect your Medi-Cal benefits.
If you have been denied Medi-Cal coverage and believe the denial was unjust, contact M.R.S.. We have successfully reopened numerous cases where errors were made in the initial determination, ensuring that clients receive the benefits they are entitled to.
Medi-Cal eligibility workers at the Department of Health Services (DHS) are often overworked and responsible for large caseloads, leading to mistakes in benefit determinations. These errors can result in inappropriate denials, leaving eligible individuals without the coverage they need. M.R.S. specializes in identifying these mistakes and working to have cases reopened, often securing reimbursement for our clients.
In some cases, entire counties may misinterpret Medi-Cal regulations, leading to widespread wrongful denials. One such example involved a county that incorrectly counted IRA values as assets, despite Medi-Cal regulations exempting properly structured IRAs from asset limits.
When a client of M.R.S. was denied due to this misinterpretation, Kathryn Humphres, leveraging her extensive experience as a DHS Eligibility Worker, took action:
Thanks to Kathryn's expertise, applicants in that county are no longer denied Medi-Cal benefits due to IRA misinterpretations.
If you have been denied eligibility, M.R.S. can review your case, identify errors, and fight for your rights. Contact us today to discuss your situation.
Answer: No.
Medicare does not cover long-term care at a convalescent home.
Medicare will only pay for the first 100 days of hospitalization and rehabilitation, and only if the patient is showing continuous improvement. Once the patient is no longer making progress, Medicare coverage stops.
At that point, the patient will either be released home or transferred to a convalescent home under custodial care. Custodial care costs are not covered by Medicare and must either be paid out of pocket or through Medi-Cal, if the patient qualifies.
Contact M.R.S. to learn how Medi-Cal can help cover long-term care expenses.
Answer: No.
The Department of Health Services (DHS) Medi-Cal Recovery Branch does not initially place a lien against an estate. However, they do have the authority to file claims for recovery against the estate of a deceased beneficiary who received Long-Term Care Medi-Cal benefits.
Importantly, Medi-Cal Recovery cannot initiate a claim until after the death of both spouses.
Additionally, if the primary residence is placed into a Living Trust, it is no longer subject to Medi-Cal Recovery. This strategy can help protect the home from estate recovery claims.
Contact M.R.S. to learn how to safeguard your assets and protect your estate from Medi-Cal Recovery.
Answer: Yes!
A Revocable Living Trust is a crucial tool to prevent the Medi-Cal Recovery Branch from initiating a claim against the estate of a deceased beneficiary who received Medi-Cal Long-Term Care benefits.
By properly funding your assets into a Revocable Living Trust, you can protect your estate from Medi-Cal Recovery and ensure that your property is passed on to your beneficiaries without the risk of claims from the state.
Contact M.R.S. to learn how a Revocable Living Trust can safeguard your assets.