California

What Is California Medicaid (Medi-Cal) and What Does It Cover?

California’s Medicaid program, Medi-Cal, offers healthcare coverage to low-income individuals, including residents aged 65 and older. This guide focuses on the long-term care services available to seniors. Medi-Cal covers care in nursing homes and assisted living facilities, as well as non-medical services designed to help older adults remain safely in their homes.

There are three main types of Medi-Cal long-term care programs that California seniors may qualify for:

• Institutional/Nursing Home Medi-Cal – A guaranteed benefit for those who meet eligibility criteria. Care is provided in licensed nursing homes.
• Home and Community-Based Services (HCBS) Waivers – These programs are limited by enrollment slots and are designed to prevent or delay nursing home placement by offering care at home or in the community.
• Aged, Blind, and Disabled (ABD) Medi-Cal – Another entitlement program for those who qualify, offering services such as personal care assistance and adult day care.

Medi-Cal is jointly funded by the state and federal governments but is managed in California by the Department of Health Care Services (DHCS).

Tip: Seniors can take a quick online test to check their Medi-Cal eligibility.

What Are the Income and Asset Limits for Medi-Cal Long-Term Care?

Medi-Cal’s financial and medical eligibility rules vary depending on the specific program, marital status, and changes in law. Here’s a simplified overview:

2025 Eligibility Requirements for Single Nursing Home Applicants:

• Almost all monthly income must go toward the cost of care.
• A Nursing Facility Level of Care (NFLOC) must be medically necessary.

Medi-Cal Long-Term Care Financial Limits (April 1, 2025 – March 31, 2026)

*Applicants must pay nearly all monthly income toward care, keeping only minimal allowances.
†SSI eligibility can also qualify someone for full Medi-Cal coverage.

Will Asset Limits Return?

Yes. California plans to reinstate the Medi-Cal asset limit no earlier than January 1, 2026:

• $130,000 for an individual
• $195,000 for a couple

Some programs like Pickle, DAC, and DW will remain exempt.

What Income Does Medi-Cal Count—and What’s Exempt?

Most sources of income—such as wages, pensions, Social Security, and investment earnings—are considered when determining eligibility. However, certain payments, including Holocaust restitution and California’s VA Aid and Attendance, are excluded.

For married couples:

• If only one spouse applies for Nursing Home Medi-Cal or HCBS Waivers, only the applicant’s income is counted.
• The non-applicant may receive a Monthly Maintenance Needs Allowance (MMNA), up to $3,948/month in 2025.
• For ABD Medi-Cal, both spouses’ incomes are considered, and there is no MMNA.

How Does Medi-Cal Treat Assets for Eligibility Purposes?

As of January 1, 2024, Medi-Cal removed the asset limit for most non-MAGI programs. While this allows seniors to keep assets regardless of value, any income those assets generate may still count toward income limits.

Upcoming Change:

The asset limit is scheduled to return no sooner than Jan. 1, 2026.

Important: Even without an asset limit, estates are still vulnerable to Medi-Cal recovery after death unless proactive planning is done.

What Is Medi-Cal’s Look-Back Rule and Is It Still Enforced?

California’s Look-Back Rule used to examine asset transfers within 30 months before a nursing home Medi-Cal application. While this rule no longer applies to transfers made after Jan. 1, 2024, it is gradually phasing out for transfers made before that date.

Timeline of the Look-Back Phase-Out:

• Jan. 2024: 30 months
• July 2026: 0 months (completely phased out)

Transfers made during the Look-Back period could still lead to a penalty period of up to 30 months of ineligibility.

Can Medi-Cal Collect From My Estate After I Die?

Yes. Medi-Cal can seek reimbursement for long-term care costs from the estate of a deceased recipient, especially for services provided after age 55 or for those who were permanently institutionalized.

This process typically occurs through probate, and the recipient’s home is not automatically protected unless proper Medicaid-compliant planning is in place.

What Medical Criteria Must Be Met for Long-Term Care Coverage?

To receive Medi-Cal long-term care benefits, a senior must demonstrate a medical need. For Nursing Home and HCBS programs, this means meeting the Nursing Facility Level of Care (NFLOC) standard. For ABD Medi-Cal, needing assistance with basic activities of daily living (ADLs) is typically enough.

What if I Earn Too Much for Medi-Cal?

1. Medically Needy (Share of Cost) Option

California’s Aged, Blind, and Disabled – Medically Needy (ABD-MN) program allows seniors with higher incomes to qualify by paying part of their income toward medical expenses.

• $600 for individuals
• $934 for married couples

After paying their “Share of Cost” for the month, the individual becomes eligible for Medi-Cal for the remainder of that month.

2. Medi-Cal Planning

For seniors who have too much income or assets yet cannot afford care, working with a Medi-Cal Planning Professional can help. Strategies may include asset protection, income redirection, or helping the non-applicant spouse retain adequate income.

What Long-Term Care Programs Does Medi-Cal Offer in California?

In addition to institutional care, Medi-Cal provides several community-based programs designed to support seniors at home or in assisted living:

• In-Home Supportive Services (IHSS) – Offers caregiving and homemaking help; family members may be hired as caregivers.
• Assisted Living Waiver (ALW) – Supports residents in assisted living or memory care; limited availability.
• Community-Based Adult Services (CBAS) – Provides day health services in certified adult day care centers in select counties.
• Multipurpose Senior Services Program (MSSP) – Offers in-home assistance and helps residents transition from nursing homes (not available statewide).
• Home and Community-Based Alternatives Waiver (HCBA) – Statewide program similar to MSSP, also helps those with medical or technological needs.
• Program of All-Inclusive Care for the Elderly (PACE) – Combines Medicaid and Medicare services, including dental and vision care.
• Enhanced Care Management (ECM) & Community Supports – Coordinates care for high-need seniors and supports nursing home transitions without enrollment caps.
• Money Follows the Person (MFP) / California Community Transitions (CCT) – Helps institutionalized Medi-Cal recipients return to the community.

How Can I Apply for California Medi-Cal?

California seniors can apply for long-term care Medi-Cal in the following ways:

• Online: Covered California
• Phone: 1-800-300-1506
• In-Person: Contact your local county Department of Social Services office

For those applying for HCBS programs, the first step is enrolling in Aged, Blind, and Disabled Medi-Cal. After that, additional assessments and enrollment steps may be required for the specific program.

Tip: Seniors who are close to or above the income limit may benefit from Medicaid planning before applying.