California Medicaid (Medi-Cal) Multipurpose Senior Services Program: Benefits, Eligibility & How to Apply

Last updated: March 26, 2024


Overview of the Multipurpose Senior Services Program

The Multipurpose Senior Services Program (MSSP) Waiver provides home and community based services for elderly California residents who require a Nursing Home Level of Care, but prefer to remain at home. Intended to prevent and / or delay the need for nursing home care, MSSP provides in-home personal care assistance, home delivered meals, and personal emergency response systems to promote safe independent living. Adult day care and respite care are also available program benefits and often supplement care one’s family is already providing. In addition to being a nursing home diversion program, MSSP also assists current nursing home residents in transitioning back home.

 MSSP often provides additional long-term services and supports to CA residents who are enrolled in the Medi-Cal In-Home Supportive Services (IHSS) Program. IHSS provides personal care and homemaker services in one’s home. Furthermore, MSSP is not available statewide, and in the counties where it is not available, persons should consider the IHSS Program as an alternative.

While many Waiver programs offer a self-directed option, allowing program beneficiaries to select their own caregivers, MSSP does not. Instead of the ability to hire friends and family members, care services are provided by licensed agency providers.

MSSP is not an entitlement program. Applicants who meet eligibility requirements are not guaranteed immediate receipt of program benefits. There are a limited number of participant enrollment slots, and when these slots are full, a waitlist forms.

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The Multipurpose Senior Services Program is a 1915(c) Medicaid Waiver. In California, the Medicaid program is called Medi-Cal.


Benefits of the Multipurpose Senior Services Program

In addition to care management, follows is a list of the benefits available via the Multipurpose Senior Services Program Medi-Cal Waiver. An individualized service plan determines which services a program participant will receive, and the frequency with which they are received.

– Adult Day Care – non-medical daytime care in a community-based center
– Assistive Technology – to maintain or improve one’s ability to function
– Communication Devices – i.e., adaptations for light fixtures, intercoms, room monitors
– Consultive Clinical Services – nutritional, social services, legal, pharmacy, and monitoring of vital signs
– Counseling and Therapeutic Services – group or individual counseling, money management, and social support
– Homemaker Services – housekeeping, laundry, shopping, and meal preparation
– Home Modifications – addition of wheelchair ramps & grab bars and modifying a bathroom for wheelchair access
– Meal Services– home delivered or congregate
– Non-Medical Home Equipment – items necessary for safety and independence due to a functional limitation
– Personal Care – non-medical assistance with daily living activities, such as bathing, dressing, toileting, and eating
– Personal Emergency Response Systems – 24/7 emergency communication
– Respite Services – in-home & out-of-home care to give an unpaid primary caregiver, often a family member, a break
– Supplemental Protective Supervision – in-home non-medical supervision to prevent immediate nursing home placement
– Telehealth
– Transitional Services – payment of security deposits, utility set-up fees, and moving services for persons moving from a nursing home back home
– Translation /Interpretation Services
– Transportation – non-medical and medical

MSSP services are available in one’s home or the home of a family member or friend. Program beneficiaries cannot reside in Residential Care Facilities for the Elderly (RCFE). RCFE’s can be thought of as assisted living facilities or adult foster care homes.


Eligibility Requirements for Multipurpose Senior Services Program

MSSP is for California residents who are 65 years of age or older. Applicants must reside in a geographic area in which the program is offered. At the time of this writing, MSSP services are available in the following California counties:

California Counties in which the Multipurpose Senior Services Program is available (Updated Mar. 2024)
Alameda Amador Butte Calaveras Contra Costa El Dorado Fresno Glenn Humboldt
Imperial Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa
Mendocino Merced Modoc Monterey Napa Orange Placer Riverside Sacramento
San Bernardino San Diego San Francisco San Joaquin Santa Barbara Santa Clara Santa Cruz Shasta Siskiyou
Sonoma Solano Stanislaus Sutter Trinity Tulare Tuolumne Ventura Yolo

See a Service Area Map. As program rules and availability can change, it is best to contact one’s local county Area Agencies on Aging (AAA) office to confirm or deny MSSP is available in one’s geographic region.


Financial Criteria: Income & Assets

The applicant income limit is equivalent to 138% of the Federal Poverty Level (FPL). While the FPL increases annually in January, the income limits for CA Medicaid increase each April. Effective 4/1/24, the monthly income limit for MSSP for a single applicant is $1,732. When both spouses are applicants, the income limit is $2,352 / month for the couple. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,732 / month. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance. In 2024, the maximum amount that can be transferred is $3,854 / month and is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own monthly income equal to or greater than $3,854 are not entitled to a Spousal Income Allowance.

There is no asset limit (effective 1/1/24). An applicant’s assets, regardless of value, are not considered in the eligibility process.

There is a Look-Back Period during which Medi-Cal scrutinizes past asset transfers of persons applying for Medicaid-funded nursing home care, but it is not applicable to persons applying for the Multipurpose Senior Services Program. However, if one may require Nursing Home Medicaid in the near future, it may be applicable. With the elimination of the asset limit, assets transferred on or after 1/1/24 are not considered. Assets transferred prior to 1/1/24 are still being scrutinized, but the 30-month “look back” is being phased out month-by-month and will no longer exist by July of 2026.

While all assets are disregarded when determining Medi-Cal eligibility, one’s assets are not necessarily safe from the Medicaid Estate Recovery Program (MERP). Following the death of a long-term care Medicaid beneficiary, the state attempts reimbursement of long-term care costs for which it paid for that individual via their remaining estate. This may include one’s home. With the utilization of proper planning strategies, one can protect their home and other assets from being used as reimbursement and instead go to loved ones as inheritance. Contact an Experienced Medi-Cal Planner for assistance.


Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the Multipurpose Senior Services Program, an in-person assessment called the MSSP Level of Care Certification Form is completed by a registered nurse to determine if this level of care need is met. An applicant’s ability to independently complete Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is one area of consideration. Examples of ADLs and IADLs include personal hygiene, mobility, dressing, meal preparation, and housework. Relevant to persons with Alzheimer’s disease or a related dementia, cognitive deficits, such as memory, decision making, and judgment, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

 Learn more about long-term care Medicaid in California. 


Qualifying When Over the Limits

Having income over Medicaid’s limit does not mean an applicant cannot still qualify for the Multipurpose Senior Services Program. Medi-Cal has a Share of Cost Program, also called a Medically Needy Program. With this program, an applicant with income over Medi-Cal’s income limit has to pay towards the cost of their care services / medical expenses. This is their “share of cost”. It can be thought of as a deductible and is based on one’s monthly income. Once one has paid their share of cost for the month, MSSP will pay for services and supports the remainder of the month. Professional Medicaid Planners can assist persons in lowering their “share of cost”. Find a Medicaid Planner.


How to Apply for the Multipurpose Senior Services Program

Before You Apply

Prior to submitting an application for MSSP, applicants need to ensure they meet the eligibility criteria. Applying when over the income limit may be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

As part of the application process, applicants will need to gather documentation for submission. Examples include proof of income and copies of Social Security and Medicare cards. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since the Multipurpose Senior Services Program is not an entitlement program, there may be a waitlist for program participation. The MSSP is approved for a maximum of approximately 11,370 beneficiaries each year. In the case of a waitlist, an applicant’s access to a participant slot might be based on the immediate need for program services.


Application Process

To apply for MSSP, one must complete an Application for Health Insurance and be determined eligible for Medi-Cal. The box, “Do you need help with long-term care or home and community-based services?” should be marked yes. Persons who require assistance with completing the application can call Covered California’s Customer Service Center at 1-800-300-1506. Persons can also apply online at or over the phone / in person at one’s Department of Health Care Services county office. As part of the application process for MSSP, an in-person functional assessment is completed by a registered nurse at one’s local MSSP site.

For additional information about the Multipurpose Senior Services Program Waiver, click here and here. Alternatively, persons can contact their local DHCS county office. Another option is to contact the Area Agencies on Aging (AAA) at 1-800-510-2020 or contact one’s local AAA. The MSSP Waiver is administered by the California Department of Health Care Services (DHCS) and the California Department of Aging (CDA). MSSP services are provided by approximately 40 local agencies that contract with the CDA.


Approval Process & Timing

The Medi-Cal application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists may exist, approved applicants may spend many months or even years waiting to receive benefits.

 What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. Meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

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