Medi-Cal is the state of California’s public health insurance Medicaid program. This program is available to many low-income seniors and other individuals in the state who meet certain eligibility requirements. Providing essential health benefits, Medi-Cal offers health care services including chronic disease management, doctors visits, hospitalization, nursing care, mental health services, physical therapy and prescription drugs.
To qualify for Medi-Cal, seniors should be over age 65, blind or disabled. They may also be eligible if they meet the income and asset requirements or one of the other criteria stated below:
- Have income under $16,395 per year for an individual and under $22,108 per year for a married couple
- Have assets totaling $2,000 or less for an individual or $3,000 or less for a married couple (necessary items such as a home, one car, furnishings and personal items are excluded)
- Reside in and receive care in a skilled nursing or intermediate care facility
- Enrolled in a Refugee Assistance program
- Receive Supplemental Security Income
Chula Vista residents can
apply for Medi-Cal online or call the San Diego County Office at (866) 262-9881.
California has two Medi-Cal waiver programs that may provide additional benefits for those receiving care in an assisted living facility.
Assisted Living Waiver Residents of San Diego County may qualify for the
Assisted Living waiver if they’re fully eligible for Medi-Cal, want to live in an assisted living community and require care equivalent to that received by nursing facility residents enrolled in Medi-Cal.
To enroll in the ALW, Medi-Cal members should contact their local
Care Coordination Agency to receive an assessment of care needs. Once enrolled, waiver participants receive an individualized service plan that meet their health needs and level of care. An assisted living provider then delivers services, including help with medication administration, transportation and activities of daily living, such as eating, bathing and dressing.
The ALW does not pay for room and board, but based on
2018 data, participants pay a standard rate of $1,039.37 if they receive an SSI income of $1,173.37 or $1,059.37 if their income is greater than $1,193.37.
Multipurpose Senior Services Program The
Multipurpose Senior Services program is an alternative Medi-Cal waiver program that aims to delay seniors over age 65 who require a nursing home level care from having to enter a nursing home facility.
Care management services provided through the program include chore and personal care assistance, such as help with bathing, dressing and other activities of daily living, respite, transportation and meal services.
Chula Vista residents can find out more about the MSSP by calling San Diego County’s
Aging and Independent Services at (800) 339-4661.
Because the ALW and MSSP aren’t entitlement programs, qualified Medi-Cal participants may be placed on a wait list to receive services.