Q. I need to qualify my mother for a Medi-Cal subsidy to help pay for her nursing home care, due to her progressive dementia. However, she has about $20,000 in a bank account with just her name on it, and no power of attorney in place to allow me to draw upon it. I was told that these funds will place her over the Medi-Cal resource ceiling and prevent eligibility. What can I do?

A.  It is unfortunate that your mother had not previously arranged for you to have access to that account, and now with her dementia she likely does not have sufficient mental capacity to arrange for your access now. That said, recall the old expression: “If life deals you lemons, turn them into lemonade”! That adage may have particular application to your situation. Here’s why:

As you may know, Medi-Cal typically divides the world of resources into two (2) categories, i.e. those which are exempt [such as a home, furnishings and the like], and those which are countable [such as savings and a second home].  In order to qualify an unmarried individual for a Medi-Cal nursing home subsidy, the applicant’s “countable” resources must be less than $2,000. Note: In this analysis, countable resources determine eligibility, and monthly income is only considered afterwards in calculating applicant’s co-pay (“share of cost”).

But, in fact, there is a little known third category, which embraces resources which are considered “unavailable”. If an asset is unavailable, it is – during the period that it remains unavailable – treated the same as an asset that is exempt! Most social workers, and even many Medi-Cal eligibility workers, either are not aware of this third category or forget to apply it in appropriate situations, such as yours.

An asset is unavailable when it cannot be readily accessed to pay for the care of the proposed beneficiary.  This rule would apply to your mother’s situation, and here’s why: (1) she previously set up her bank account so that only she can access the funds and she does not have the capacity to do so now, on her own;  (2) there is no existing power of attorney in place to permit you to access it on her behalf; and (3) she does not now have sufficient mental capacity to either add your name to the account or to sign a Durable Power Of Attorney to allow you access. Under these circumstances, it would be deemed “unavailable” under relevant Medi-Cal regulations. Further, for so long as it remains unavailable, it would be treated the same as an exempt asset and not counted toward her $2,000 Medi-Cal resource allowance.

There are indeed other situations where ‘unavailability” may come into play. Examples: where an asset, such as a second home or a promissory note, cannot be readily redeemed for cash and must be first marketed for sale; and, where the applicant owns only a partial interest in a rental property and the other co-owners refuse to sell.

For cases like yours, it is best to engage a knowledgeable elder law attorney for assistance, as it may be necessary to first lay appropriate groundwork to justify the claim of “unavailability”, to then educate the Medi-Cal eligibility worker as to its application in the particular case, and to thereafter shepherd the Medi-Cal application through to approval.