Medicaid is a government-sponsored program that provides health coverage to qualified Americans, such as children, pregnant women and seniors. The federal government and the states jointly fund the program. In California, Medicaid is known as Medi-Cal. Medi-Cal provides coverage for many essential medical services, including:
- Physician services
- Hospital services, including emergency room services
- Ambulance services
- Medical supplies and equipment
- Physical therapy
- Podiatry
- Skilled nursing facility services
- Home health services
In addition to these services, Medi-Cal may offer coverage for assisted living care through two waiver programs. These programs, the Multipurpose Senior Service Program and the Assisted Living Waiver, are explained in detail below.
Anaheim residents may qualify for Medi-Cal if they meet certain
income and resource requirements. One-person households are limited to $16,146 in yearly income and $2,000 in
countable resources. Two-person households may qualify if they earn less than $21,892 per year and have less than $3,000 in resources. Resources include bank balances and stocks and exclude the primary residence and one motor vehicle.
In addition, the program has citizenship requirements. Participants need to be either U.S. citizens, U.S. nationals, legal aliens or permanent residents.
Seniors whose income is over the Medicaid limit may be eligible if they pay a
Share of Cost. In this program, seniors pay their excess income toward their medical bills, and once they’ve spent enough, Medi-Cal kicks in. The share of cost resets every month.
To apply for Medi-Cal, fill out an
online application or call (800) 300-1506. Seniors who get Supplemental Security Income usually get Medi-Cal automatically and don’t need to apply.
Multipurpose Senior Service Program The Multipurpose Senior Service Program is offered to seniors who qualify for nursing home care but who would rather live at home or in an assisted living facility. The program provides a variety of services to help seniors safely live in the community. These include:
- Adult day health care
- Personal care assistance
- Protective supervision
- Transportation
- Meal services
Seniors who are aged 65 or older may qualify for this program if they’re eligible for Medi-Cal coverage and live within an
MSSP site’s service area. When making eligibility determinations, MSSP sites also consider the cost of a senior’s care. MSSP services must be provided at a lower price than nursing home care, so seniors with very high health care needs may not be eligible.
The MSSP site for Anaheim and the rest of Orange County is CalOptima. Seniors who want to participate in the program can call CalOptima at (714) 246-8400 to apply or to learn more. It’s important to note that the MSSP program can only serve 11,789 seniors per month. Interested seniors should apply as soon as possible since there may be a waiting list.
Assisted Living Waiver Program Like the MSSP, the
Assisted Living Waiver program is for seniors who require a nursing home level of care but want to live somewhere else. Seniors who live in their own homes or in an assisted living facility have access to three benefits through this waiver:
- Assisted living services, which provides for personal care, skilled nursing, medication assistance, meals and housekeeping
- Care coordination, which includes identifying and coordinating services that seniors need
- Nursing facility transition care coordination, which helps nursing home residents move back into the community
Seniors may be eligible for the ALW program if they’re enrolled in Medi-Cal with full coverage. Medi-Cal participants who have a spend-down requirement (also called share of cost) aren’t eligible.
Seniors who already have Medi-Cal coverage can apply by contacting a
Care Coordination Agency. Registered nurses at CCAs conduct assessments to determine seniors’ care needs. Orange County’s CCA is Access TLC Home Health Care, and it can be reached at (818) 551-1900.
Seniors who don’t have Medi-Cal coverage need to apply before they can
receive ALW services. When applying, seniors should mention the need for long-term care.