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.

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. There are a limited number of participant enrollment slots, and when they are full, a waitlist forms.

The Multipurpose Senior Services Program is a 1915(c) Medicaid Waiver. While MSSP used to be restricted to limited CA counties, it became a statewide program effective July 1, 2024. In California, the Medicaid program is called Medi-Cal.

Benefits of the Multipurpose Senior Services Program

In addition to care management, the following benefits are available via the Multipurpose Senior Services Program Medi-Cal Waiver. An individualized service plan determines which services a program participant receives, 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, personal emergency response systems
– Consultive Clinical Services – nutritional, social services, legal, pharmacy, and monitoring of vital signs
– Counseling Services – group or individual counseling
– Homemaker Services – housekeeping, laundry, shopping, and meal preparation
– Meal Services– home delivered or congregate
– Minor Home Repairs / Maintenance / Modifications – may include addition of wheelchair ramps & grab bars and modifying a bathroom for wheelchair access
– Money Management
– Non-Medical Specialized Home Equipment – items necessary for safety and independence due to a functional limitation
– Personal Care – non-medical assistance with daily living activities (i.e., bathing, dressing, toileting, and eating)
– Respite Services – in-home & out-of-home care to give an unpaid primary caregiver, often a family member, a break
– Social Support
– Supplemental Protective Supervision – in-home non-medical supervision to prevent immediate nursing home placement
– Telehealth
– Therapeutic Services – massage therapy, swim therapy, foot care
– 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), which 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 aged 60+ who are at risk of institutionalization. Additional eligibility criteria follows.

Financial Criteria: Income, Assets & Home Ownership

Income
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 4/1/26, the monthly income limit for MSSP for a single applicant is $1,836. When both spouses are applicants, the income limit is $2,490 / 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 $1,836 / 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 2026, the maximum amount that can be transferred is $4,066.50 / 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 $4,066.50 are not entitled to a Spousal Income Allowance.

Assets
In 2026, the asset limit is $130,000 for an individual and $195,000 for a couple (with both spouses as applicants). When only one spouse is an applicant, the couples’ assets are still considered jointly owned. However, the applicant spouse can keep $130,000 in assets, while the non-applicant is allocated a larger portion of the couple’s assets to prevent spousal impoverishment. This is called a Community Spouse Resource Allowance and allows the non-applicant spouse to keep up to $162,660 in assets

Some assets are not counted towards Medi-Cal’s asset limit. This generally includes a primary home, household furnishings and appliances, and a vehicle.

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. Learn more.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For Medi-Cal eligibility purposes, the home is considered exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return home and indicates it in writing. California is set apart from the other states in that there is no home equity interest limit. Home equity interest is the current value of the home minus any outstanding mortgage.
– The applicant has a spouse living in the home.
– The applicant has a dependent relative, such as a disabled child (of any age) living in the home.
– The applicant has a child under 21 years old living in the home.

While one’s home is generally exempt from Medicaid’s asset limit, it is not necessarily safe from Medicaid’s Estate Recovery Program. Learn more about when Medicaid can and cannot take one’s home.

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 (i.e., memory, decision making, and judgment) are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

Qualifying When Over the Limits

Having income and / or assets over Medi-Cal’s limit(s) does not mean an applicant cannot still qualify for the Multipurpose Senior Services Program. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common. 

For persons over the income limit, Medi-Cal has a Share of Cost Program, also called a Medically Needy Program. With this program, an applicant with “excess” income pays towards the cost of their care services / medical expenses. This is their “share of cost”, which 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”.

When persons have assets over the limit, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid-Compliant Annuities, which turn countable assets into a stream of income. There are many other options when the applicant has assets exceeding the limit. 

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in California to meet Medi-Cal’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial eligibility criteria, but can also protect assets for family as inheritance. 

While these strategies often violate Medi-Cal’s Look-Back Period, the Look-Back Rule does not apply to the MSSP Waiver. Some persons, however, will go on to require Nursing Home Medicaid, and if this is the case, the Look-Back Period is relevant. Due to this, it is best to implement Medicaid planning strategies with careful planning and well in advance of the need for nursing home care. There are, however, some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Certified Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). 

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 and / or asset limit(s) may be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

As part of the application process, applicants need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, prior bank statements, and proof of income. 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 13,373 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, “Does this person 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 CoveredCA.com 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.

More on the Multipurpose Senior Services Program Waiver. Persons can also contact their local DHCS county office or their local Area Agencies on Aging (AAA) either directly or by calling 1-800-510-2020.

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.