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Under the Affordable Care Act (“ACA”), low income persons under age 65 may enroll in the expanded Medi-Cal in order to meet the federal requirement that everyone have health care insurance.
At age 65, Medicare covers doctor visits, hospital visits and some prescription drugs. Medi-Cal, however, remains relevant for long-term residential custodial care in a skilled nursing home.
Expanded Medi-Cal targets a whole new population, including young and middle-aged persons without disability and/or with assets.
For example, someone who lost his or her job might become eligible for such expanded Medi-Cal based on low income (i.e., at or below 130 percent of poverty level).
A major concern among persons enrolling in the expanded Medi-Cal program is whether their assets, including their home, might later become answerable to Medi-Cal for reimbursement when they die.
Unlike traditional Medi-Cal, eligibility for the new expanded Medi-Cal is based entirely on income. An applicant’s assets, age, disability and whether the applicant is pregnant are irrelevant.
Federal ACA legislation provides that persons participating in the expanded Medi-Cal program are subject to different estate recovery rules than those persons participating in traditional Medi-Cal.
On Feb. 21, the federal Centers for Medicare and Medicaid Services (“CMS”) stated that while estate recovery also applies to individuals in the expanded Medi-Cal that CMS intended, as much as legally possible, “… to eliminate recovery of Medicaid benefits consisting of items or services other than long term care and related services … .”
That is, with respect to any services received by persons while under age 55, CMS does not want to recover costs paid for physician visits, prescriptions and hospital stays and only wants to recover costs paid for skilled nursing home services (which involves custodial care).
However, because Medicaid/Medi-Cal is a combined federal and state program much is left up to the individual states to decide.
Washington and Oregon already have enacted legislation that prevents estate recovery for their residents who enroll in the Medicaid expanded program for all services except for skilled nursing home care, as is required since 1993 under federal law.
Presently, California is also considering legislation that would limit California’s estate recovery regarding expanded Medi-Cal to what is required under federal law.
The proposed limitations would prevent recovery for any and all expanded Medi-Cal services received before age 55.
For those between ages 55 and 65, the proposed legislation would allow recovery both for skilled nursing home care services and also for community based services (i.e., hospital and prescription drug services) as is required by federal law.
Such persons might, in order to avoid possible estate recovery, decide to enroll in Covered California. However, anyone eligible for expanded Medi-Cal who participates in Covered California would receive no government subsidies and so pay the full premium.
Dennis A. Fordham, attorney (LL.M. tax studies), is a State Bar Certified Specialist in Estate Planning, Probate and Trust Law. His office is at 870 S. Main St., Lakeport, California. Fordham can be reached by e-mail at
Scientists combined observations from two NASA missions to check out the moon's lopsided shape and how it changes under Earth's sway – a response not seen from orbit before.
The team drew on studies by NASA's Lunar Reconnaissance Orbiter, which has been investigating the moon since 2009, and by NASA's Gravity Recovery and Interior Laboratory, or GRAIL, mission.
Because orbiting spacecraft gathered the data, the scientists were able to take the entire moon into account, not just the side that can be observed from Earth.
“The deformation of the moon due to Earth's pull is very challenging to measure, but learning more about it gives us clues about the interior of the moon,” said Erwan Mazarico, a scientist with the Massachusetts Institute of Technology in Cambridge, Mass., who works at NASA's Goddard Space Flight Center in Greenbelt, Md.
The lopsided shape of the moon is one result of its gravitational tug-of-war with Earth.
The mutual pulling of the two bodies is powerful enough to stretch them both, so they wind up shaped a little like two eggs with their ends pointing toward one another.
On Earth, the tension has an especially strong effect on the oceans, because water moves so freely, and is the driving force behind tides.
Earth's distorting effect on the moon, called the lunar body tide, is more difficult to detect, because the moon is solid except for its small core.
Even so, there is enough force to raise a bulge about 20 inches (51 centimeters) high on the near side of the moon and similar one on the far side.
The position of the bulge actually shifts a few inches over time. Although the same side of the moon constantly faces Earth, because of the tilt and shape of the moon's orbit, the side facing Earth appears to wobble.
From the moon's viewpoint, Earth doesn't sit motionless but moves around within a small patch of sky. The bulge responds to Earth's movements like a dance partner, following wherever the lead goes.
“If nothing changed on the moon – if there were no lunar body tide or if its tide were completely static – then every time scientists measured the surface height at a particular location, they would get the same value,” said Mike Barker, a Sigma Space Corp. scientist based at Goddard and co-author of the new study, which is available online in Geophysical Research Letters.
A few studies of these subtle changes were conducted previously from Earth. But not until LRO and GRAIL did satellites provide enough resolution to see the lunar tide from orbit.
To search for the tide's signature, the scientists turned to data taken by LRO's Lunar Orbiter Laser Altimeter, or LOLA, which is mapping the height of features on the moon's surface.
The team chose spots that the spacecraft has passed over more than once, each time approaching along a different flight path. More than 350,000 locations were selected, covering areas on the near and far sides of the moon.
The researchers precisely matched measurements taken at the same spot and calculated whether the height had risen or fallen from one satellite pass to the next; a change indicated a shift in the location of the bulge.
A crucial step in the process was to pinpoint exactly how far above the surface LRO was located for each measurement.
To reconstruct the spacecraft's orbit with sufficient accuracy, the researchers needed the detailed map of the moon's gravity field provided by the GRAIL mission.
“This study provides a more direct measurement of the lunar body tide and much more comprehensive coverage than has been achieved before,” said John Keller, LRO project scientist at Goddard.
The good news for lunar scientists is that the new results are consistent with earlier findings. The estimated size of the tide confirmed the previous measurement of the bulge.
The other value of great interest to researchers is the overall stiffness of the moon, known as the Love number h2, and this was also similar to prior results.
Having confirmation of the previous values – with significantly smaller errors than before – will make the lunar body tide a more useful piece of information for scientists.
“This research shows the power of bringing together the capabilities of two missions. The extraction of the tide from the LOLA data would have been impossible without the gravity model of the moon provided by the GRAIL mission,” said David Smith, the principal investigator for LRO's LOLA instrument and the deputy principal investigator for the GRAIL mission. Smith is affiliated with Goddard and the Massachusetts Institute of Technology.
LRO is managed by Goddard for the Science Mission Directorate (SMD) at NASA Headquarters in Washington. NASA's Jet Propulsion Laboratory in Pasadena, Calif., managed the GRAIL mission for SMD.
LAKE COUNTY, Calif. – The California Highway Patrol has released its initial report into the fatal big rig crash that occurred on Highway 20 east of Lucerne early Friday morning.
The driver of the 2010 Peterbilt semi was killed in the wreck. The CHP has not released the name of the 54-year-old Citrus Heights man pending notification of kin.
The CHP report said the driver was traveling westbound on Highway 20 west of Cora Drive, pulling a 2003 TCRFT flatbed trailer hauling four 10,000-pound concrete culverts at an unknown rate of speed.
For unknown reasons, at approximately 5:42 a.m. the driver allowed the semi to make an unsafe turning movement in a sweeping left turn, with the truck overturning and spilling its load, the report stated.
The semi continued sliding eastbound until it hit a dirt embankment, which the CHP said caused major intrusion into the cab of the truck.
The CHP said nearby residents heard the crash and responded to give aid, but found the driver trapped in the cab and unresponsive. The report said the driver was wearing his seat belt.
Northshore Fire Protection District personnel who arrived a short time later found the driver had died of his injuries, according to the report and fire officials.
With the truck and tractor having come to rest off the roadway, the CHP said the highway remained open during the majority of the incident.
However, during the recovery of the semi and the body of the driver on Friday afternoon, Highway 20 was limited to one-way traffic control with the assistance of Caltrans, the CHP said.
The CHP said all emergency personnel and equipment cleared the scene at 2:20 p.m.
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CLEARLAKE, Calif. – A Clearlake man is in custody after stabbing a man to death early Friday morning.
Nicholas Paonessa, 20, was arrested for the murder, according to Clearlake Police.
Just before 1:30 a.m. Friday Clearlake Police officers were dispatched to a report of a stabbing at Flyers Gas station, located at 15010 Lakeshore Drive in Clearlake, police said.
Officers responded to the scene and located a male victim with numerous apparent stab wounds to his upper torso. Medical personnel arrived on scene and rendered first aid to the victim, who police said was then transported to Santa Rosa Memorial Hospital via air ambulance.
Witnesses on scene advised the victim attempted to intervene in a dispute between Paonessa and a female, later identified as 23-year-old Rosalinda Castaneda of Clearlake, according to police.
Police said the male victim and Paonessa got into a verbal argument along with several other subjects. The male victim and Nicholas got into a physical confrontation resulting in the apparent stabbing.
Witnesses reported that Paonessa then fled the scene on foot west on Palmer Avenue, police said.
Police are not releasing the male victim’s name pending notification of the family.
Flyers Gas Station and a small portion of Old Highway 53 were closed for several hours for processing of the crime scene, police said.
Officers searched for several hours and located Paonessa at 14500 block of Lakeshore Drive. Police said he was taken into custody without incident.
Paonessa is currently in custody for homicide, police said. The case is ongoing and more charges are forthcoming.
Citizens are encouraged to contact Det. Ryan Peterson at 707-994-8251, Extension 320 if they have any information regarding this incident.
LAKE COUNTY, Calif. – A big rig crash early Friday morning claimed the life of the truck's driver.
The crash occurred shortly before 5:45 a.m. on East Highway 20 near Cora Drive, east of Lucerne, according to radio and California Highway Patrol reports.
The big rig rolled over in the westbound lane and smashed into the hillside, dropping a load of cement culverts, according to Northshore Fire Chief Jay Beristianos.
A deputy was reported to have arrived at the scene ahead of firefighters to find an unconscious male trapped in the overturned big rig's cab, radio reports indicated.
Northshore Fire and Cal Fire responded and requested an air ambulance land at Lucerne Harbor Park to pick up the crash victim.
However, a short time later Beristianos canceled REACH 6 – which was heading across the lake to the landing zone – after it was confirmed that the truck driver had died.
Beristianos said shortly before 7:30 a.m. that the highway wasn't blocked, although it was anticipated that once a tow truck arrived to upright the truck, that stretch of Highway 20 would be closed for an extended period of time.
He said the concrete culverts needed to be secured before moving the truck or they would roll away.
Northshore Fire and Cal Fire units are expected to be committed to the scene for a few more hours, Beristianos said.
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UPPER LAKE, Calif. – An early morning crash involving a truck and utility lines didn't injure anyone but has caused a roadway closure.
At around 5 a.m. a truck was reported to have hit the lines in the area of Highway 20 and Scotts Valley Road, according to the California Highway Patrol.
A utility pole was snapped and the downed lines blocked both lanes of traffic, the CHP said.
Shortly after 7 a.m., the CHP said that westbound Highway 20 at Scotts Valley Road is closed due to the downed lines in the roadway.
The CHP did not have an estimated time for the roadway reopening.
In the meantime, the CHP said traffic will be diverted onto Scotts Valley Road.
Pacific Gas and Electric had not reported any outages in the area as of 7 a.m.
Email Elizabeth Larson at