Medicaid is a national health plan for low-income individuals who have minimal assets. It’s jointly funded by federal and state governments and includes the following mandatory benefits:
- Inpatient and outpatient hospital services
- Nursing facility services
- Primary physician care
- X-rays and basic lab tests
- Transportation to Medicaid-funded appointments and services
Medicaid plans are administered at the state level, and each state has the option to provide additional benefits through waivers and special programs that may cover:
- Eyeglasses and dentures
- Prescription medications
- Case management
- Speech therapy
- Private duty nursing
- Hospice care
- Assistance with activities of daily living
- Respiratory therapy
- Additional disease prevention, screening and diagnostic services
California’s Medicaid program is called
Medi-Cal. Seniors aged 65 and older who require long-term Medi-Cal coverage must meet income and asset limits as follows:
- $1,242 in monthly income for an individual, or
- $1,682 in monthly income for a couple applying together, and
- A maximum of $2,000 worth of countable assets per person, or
- A maximum of $3,000 worth of countable assets per couple applying together
Unlike all other states, California excludes an owner-occupied home from Medi-Cal asset calculations, regardless of the assessed value of the home. Also excluded is one vehicle, a prepaid burial contract and most life insurance policies worth $1,500 or less.
Community Spouse Income and Asset Allowances When only one spouse (called the institutional spouse) in a married couple requires long-term Medi-Cal services, the income and some assets of the non-applicant, called the community spouse, are protected. The community spouse isn’t expected to contribute money towards their spouse’s care costs.
The minimum monthly needs allowance rule allows the institutional spouse to transfer their income to their spouse and deduct the transferred amount from their income for Medi-Cal eligibility. If the income of the community spouse is below $3,161 per month (the MMMNA limit), the institutional spouse can transfer income to their spouse to raise it to the MMMNA limit.
The community spouse resource allowance entitles the spouse to 50% of the couple’s joint assets, excluding Medi-Cal exempt assets, worth up to $126,420.
Assisted Living Waiver The
Assisted Living Waiver is a home and community-based services waiver that provides seniors with long-term care help in an assisted living setting. It’s designed to prevent institutionalization among Medi-Cal participants who would otherwise be placed in a nursing home.
Enrollment is statewide, however, there are currently no ALW providers in Butte County, so seniors must be willing to relocate to another county to participate in this waiver.
ALW provides a variety of services and supports that let fragile seniors remain in an assisted living setting, such as housekeeping, personal care, skilled nursing and day programming. Seniors who currently reside in a nursing facility also qualify for transition care.
Note: The ALW doesn’t cover the cost of room and board.
For more information on the ALW and Medi-Cal, contact
Passages, the Area Agency on Aging, at (800) 822-0109.