Medicaid is a national health insurance program designed to provide low-income, low-asset Americans with access to basic health care services. It’s jointly funded by federal and state governments.
In California, Medicaid is known as Medi-Cal and is operated by the California Department of Health Care Services (DHCS). Seniors who qualify for Supplemental Security Income (SSI) automatically qualify for free Medi-Cal coverage, while seniors age 65 and older who have incomes and assets below the maximums set by Medi-Cal, may be eligible for full-scope coverage through the Aged and Disabled Federal Poverty Level Program (A&D FLP).
Individual senior Medi-Cal applicants may earn no more than $1,242 per month and own no more than $2,000 in countable assets, while couples applying together must earn less than $1,682 per month and own less than $3,000 in countable assets to qualify for free Medi-Cal coverage under the A&D FLP.
Countable income includes money from all sources, such as pensions, wages and alimony, while countable assets are cash, bank account balances, stocks, bonds and all real estate, except for the applicant’s principle residence, regardless of the current market value of the home.
Personal belongings like clothing, jewelery, furniture and one vehicle are exempt, as are non-revocable burial trusts.
There is also a 30-month look-back period that audits any assets that were given away or sold by the applicant in the 30 months immediately preceding the Medi-Cal application in the asset evaluation. This look-back period is designed to deter seniors from disposing of assets that could have been used to fund their health care coverage.
Medi-Cal applicants who disposed of countable assets during the look-back period may be penalized with a period of ineligibility for Medi-Cal coverage as determined by a formula that divides the total value of the assets by the current monthly private-pay nursing home rate.
Seniors with monthly income and/or countable assets which exceed the allowable limits under the A&D FLP may still qualify for Medi-Cal Share of Cost (SOC) coverage through the Aged, Blind and Disabled – Medically Needy Program (ABN-MN).
The ABN-MN program requires that seniors contribute towards the monthly cost of their Medi-Cal coverage. The monthly SOC rates are based on the applicants’ income, and in many cases this can make the cost of Medi-Cal coverage prohibitively high.
Seniors aged 65 and older who qualify for no-cost Medi-Cal coverage and require the level of senior care normally provided in a nursing home due to medical needs may be eligible for additional support services through the Assisted Living Waiver (ALW) program.
The ALW program aims to reduce the number of California seniors placed in nursing homes by providing extra care services to seniors in an assisted living environment or public subsidized housing. Cost of Share Medi-cal members are not eligible for the ALW program.
Seniors who meet the ALW eligibility criteria and would prefer to reside in an assisted living environment rather than a nursing home can contact the local Care Coordination Agency (CCA), Norcal, and ask to be assessed by a registered nurse.
ALW services vary based on each senior’s needs as outlined in an Individual Service Plan (ISP). Services may include:
- Homemaker and/or home care aide services
- Skilled intermittent nursing
- Medication management and/or administration by an RN or LVN
- Medical transportation and escorts to medical appointments
- An emergency call system that connects seniors with an on-site staff member
- Physical, speech, occupational and/or respiratory therapy
There are a limited number of ALW slots statewide. Seniors who are approved for the program may be on a wait-list.
To learn more about the Assisted Living Waiver program for seniors living in Elk Grove and Sacramento County, contact Norcal at (916) 386-2784.
For Medi-Cal inquires and application assistance, call the Medi-CalFresh Service Center at (916) 874-3100.