Medicaid, the nationwide health protection plan jointly funded through state and federal governments, provides free basic health coverage for one in four California children, adults and seniors. Medicaid is administered by each state and is known as Medi-Cal in California.
Medi-Cal provides coverage for some medically necessary preventive, emergency and rehabilitative services, hospitalization, chronic disease management and limited nonemergency medical transportation. Medi-Cal long-term services include personal care services, skilled nursing facility services and home and community-based services.
Seniors aged 65 and older who are on Social Security benefits are automatically registered for no-cost Medi-Cal coverage. Low-income seniors may be eligible for Medi-Cal if they earn less than $1,242 per month when applying as an individual or less than $1,682 per month as a couple. Income from all sources is counted, including alimony, pension payments and any investment income.
Medi-Cal also has asset limits set at a maximum of $2,000 for an individual and $3,000 per couple. Countable assets include all cash and bank account balances, stocks, bonds and any real estate aside from the applicant’s principal residence, regardless of the value of that home. Also excluded is one vehicle owned by the applicant(s), household furnishings, clothing and a non-revocable burial trust.
Seniors with incomes that exceed Medi-Cal limits may still be able to qualify for Medi-Cal coverage on a Share of Cost basis. Also referred to as Medicaid spend-down, this program lets seniors pay a portion of their excess income toward their medical expenses to reduce their income to reach Medi-Cal eligibility limits each month. Note that Share of Cost cannot be used to reduce excess assets.
For more information and application assistance, contact Covered California at (800) 300-1506.
Assisted Living Waiver
Low-income seniors who qualify for no-cost Medi-Cal coverage and meet the criteria for nursing home placement may qualify for the Assisted Living waiver, a Home and Community-Based Services Medicaid waiver.
The ALW is designed to reduce rates of nursing home placement among low-income seniors by funding additional services within an assisted living setting. To apply, seniors or their representatives need to request an assessment through the local Care Coordination Agency. A registered nurse will evaluate the applicant’s suitability for ALW services and, if approved, prescribe medically necessary services to be delivered to the senior within an assisted living setting.
For more information and to request an ALW assessment, contact the Riverside County Care Coordination Agency, Archangel Home Health Inc., at (562) 861-7047.