Approximately 14 million children, families and adults are covered under Medi-Cal, California’s Medicaid program. Established by the federal government on July 30, 1965 to improve health care for low-income Americans, Medicaid is funded by both the federal and state governments and every state has participated in Medicaid since 1982.
No-cost Medi-Cal coverage is automatically provided for all California seniors who receive Supplemental Security Income, while low-income seniors who own few assets may also be eligible for free or low-cost Medi-Cal health coverage.
Adults who are 65 and older need to meet the following requirements to qualify for free Medi-Cal coverage:
- Earn a maximum of $1,242 a month as an individual applicant or $1,682 a month when applying as a couple
- Own less than $2,000 (individual) worth of countable assets or $3,000 for a couple
All types of income are considered under Medi-Cal rules and countable assets include cash, investments and all real estate except for the applicants’ principal residence. Household furnishings, clothing, personal effects and one vehicle are exempt from the Medi-Cal asset limits.
There is a Medicaid look-back period in California that audits any assets an applicant has sold, gifted or otherwise disposed of during the 30-month period prior to seeking Medi-Cal coverage. This audit is designed to ensure that seniors use all their own resources to pay for their care before seeking government assistance. If assets are discovered during the audit, Medi-Cal applicants may be ineligible for a period of time that is determined based on both the value of the assets and the current monthly price of private nursing home care.
Seniors who have income or assets that exceed the limits for Medi-Cal coverage can opt to enroll in Medi-Cal on a
Share of Cost basis that requires them to pay their own medical bills up to an agreed limit before Medi-Cal will become effective. In many cases, this option is more costly than purchasing a private insurance plan.
California Assisted Living Waiver The
ALW is available to Medi-Cal eligible seniors who need the level of care provided in a nursing home. This program reduces the rates of nursing home placement among Medi-Cal covered seniors by providing additional care and medical services in an assisted living setting. Medi-Cal reimburses the cost of services provided in an assisted living setting except for the expense of room and board.
To enroll in the ALW seniors need to request an assessment through the San Diego Care Coordinator Agency. If accepted into the ALW program, seniors may be placed on a waiting list, as the demand for ALW services currently exceeds the number of statewide waivers offered.
Note: ALW is not available to seniors who are enrolled in Medi-Cal on a Share of Cost basis.
For more information about Medi-Cal coverage, contact the
San Diego County Health and Human Services Agency at (866) 262-9881.
To request as assessment for the ALW program, contact the
San Diego County Care Coordinator Agency at (888) 681-1559.