Medi-Cal, the California Medicaid program, is administered by the Department of Health Care Services and provides free or low-cost coverage to approximately one-quarter of the population.
Medi-Cal enrollees receive a range of health care benefits such as physicians visits, hospital, outpatient and emergency services, preventive care, physical therapy and lab services.
To qualify for coverage, applicants must be U.S. citizens or legal California residents with an income below 138% of the federal poverty level or:
- $16,395 annually or $1,366 per month for individuals
- $22,108 annually or $1,842 per month for couples
Income from all sources counts for Medi-Cal eligibility purposes, including wages, Social Security payments, Social Security disability benefits, stock dividends, IRA withdrawals and pension payments.
Escondido seniors with income over the allowed limit may qualify through Medi-Cal’s Aged, Blind and Disabled Medically Needy program. Under the program, an applicant can spend down excess monthly income on health care premiums or medical bills based on a predetermined share of cost.
Married applicants with high income may still qualify if just one spouse applies because Medi-Cal allows the transfer of up to $3,160.50 to the non-applicant spouse as a monthly maintenance needs allowance.
The Medi-Cal program also has asset limits of $2,000 per person and $3,000 for married couples.
Many assets are excluded, such as a primary home, household and personal effects, burial trusts and one vehicle. Excess assets can’t be spent down or disposed of by individual applicants to qualify for coverage. However, Medi-Cal does let a non-applicant spouse retain up to $126,420 in jointly held assets, which may help a married senior qualify.
Seniors who qualify for SSI and SSP benefits are automatically enrolled in Medi-Cal and receive full-scope coverage.
Those who need long-term care in a nursing facility qualify for institutional coverage without regard to income if they meet Medi-Cal asset guidelines.
Residents of Escondido can
apply for Medi-Cal online, by calling (800) 300-1506 or by visiting the
North Inland Family Resource Center.
Assisted Living Waiver Program California’s Medicaid program only covers room and board in nursing homes, but the state does offer a home and community-based
assisted living waiver that pays for various services in a non-medical facility.
Covered services include transition assistance, transportation, care coordination, personal care, medication administration and help with daily living activities. Basic facility services are also covered, such as housekeeping and laundry, prepared meals and snacks as well as social and recreational programs.
To qualify, seniors must be enrolled in Medi-Cal without a share of cost and be assessed as needing an intermediate level of nursing care. Applicants also must be able to live safely in an assisted living setting with the waiver’s support services.
The ALW isn’t an entitlement program and may not be available at all assisted living facilities in the Escondido area. Depending on enrollment numbers, qualified applicants may be placed on a waiting list.
Seniors interested in the ALW program can contact one of the four
Care Coordination Agencies serving San Diego County to schedule an assessment and start the application process.