California Medicaid (Medi-Cal) Definition
Medicaid is a wide-ranging, federal, health care program for low-income individuals of any age. However, this page is focused on Medicaid eligibility, specifically for California residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in assisted living. Make note, Medicaid in California is called Medi-Cal. While Medicaid is often thought of as a health care program, Medicaid long term care in California pays for many non-medical support services that help frail seniors remain living in their homes.
Medi-Cal Income & Assets Limits for Eligibility
There are several different Medicaid long-term care programs for which California seniors may be eligible. These programs have slightly different eligibility requirements, as well as various benefits.
1) Institutional / Nursing Home Medicaid – is an entitlement program, meaning anyone who is eligible will receive assistance. Services are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Limited number of participants. Therefore, waitlists may exist. Assistance is provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement program, which means meeting eligibility requirements ensures services will be provided. Benefits are provided at home or adult day care.
Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that California offers multiple pathways towards eligibility. The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Medi-Cal program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: If one does not meet all the criteria below, it does not mean one is not eligible or cannot become eligible for California Medicaid. More.
|2019 California Medicaid / Medi-Cal Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||*No income limit.||$2,000||Nursing Home||*No income limit.||$3,000||Nursing Home||*No income limit.||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$1,242 / month||$2,000||Help with 2 Activities of Daily Living||$1,682 / month||$3,000||Help with 2 Activities of Daily Living||$1,242 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Help with 2 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$1,242 / month||$2,000||None||$1,682 / month||$3,000||None||$1,242 / month for applicant||$2,000 for applicant||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. (Click here for more information about how Medicaid counts income.) There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of January 2019, this figure may be as high as $3,161 / month. This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
*For nursing home Medicaid, as indicated in the chart above, there is no income limit. However, that does not mean that the nursing home resident is able to retain all of his or her income. Instead, the resident must pay a “share of cost” towards his or her care, and the higher his or her monthly income, the higher the share of cost. In simplified terms, the applicant’s share of cost is his or her monthly income minus $35 / month for a personal needs allowance. In addition, Medicare premiums and a spousal allowance (if applicable) can be deducted from the resident’s income. The remaining amount of income would be the amount that the resident must pay to the nursing home as a share of cost each month.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home (California does not have a maximum home equity value limit like most states). For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain up to a maximum of $126,420 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
One should be aware that California has a Medicaid Look-Back Period, which is a period of 30 months that dates back from one’s Medicaid application date (most states have a 60-month look-back). Therefore, during an application review, Medicaid checks to ensure no assets were sold or given away under fair market value for the 30 months preceding the application date. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility may ensue.
Qualifying When Over the Limits
For California residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In California, there is a program called Aged, Blind and Disabled – Medically Needy Program (ABD-MN) that is specifically intended for those that are categorically aged, blind or disabled that have income over the Medicaid limit. To be clear, persons applying for HCBS Medicaid waivers may also qualify for Medicaid through this pathway. In a nutshell, one may still be eligible for Medicaid services even if he or she is over the income limit by paying what is called a “Share of Cost”. (Taking one’s countable monthly income and deducting a predetermined Maintenance Need Allowance (MNA) from one’s monthly income is a simplified definition of how one’s share of cost is calculated. As of 2019, for those living in the community, the MNA is $600 for an individual and $934 for a married couple.) Also called a Spend Down program, the way this program works is one’s “excess income,” (the amount that is determined as one’s cost of share), is used to cover medical bills. Once one has paid his or her share of cost, Medi-Cal will kick in for the month. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets.
However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. When spending down assets, it’s important that one does not give away assets or sell them way under market value. This is because in California, Medicaid has a “Look-Back” period of 30 months, and if one is in violation, a period of Medicaid ineligibility may result.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific California Medicaid Programs
In addition to paying for nursing home care, Medi-Cal offers five programs / HCBS Waivers relevant to the elderly that helps them to remain living in their homes or in assisted living residences.
1. In-Home Supportive Services – Provides for a wide variety of support and care services to individuals in their homes and even permits family members to be hired as personal care providers.
2. Medi-Cal Assisted Living Waiver (ALW) – Though not statewide, this waiver helps pay for some of the cost of assisted living.
3. Community Based Adult Services (CBAS) Program – Available statewide, this program provides for adult day care and adult day health care.
4. Multipurpose Senior Services Program Waiver (MSSP) – Provides California seniors with assistance for home modifications, assistive technology and other in-home supports.
5. Home and Community-Based Alternatives (HCBA) Waiver – Provides similar services to MSSP but targets more persons who are temporarily living in nursing homes and wish to return home.