Medicaid is a national health insurance program that provides low-income, low-asset Americans with access to basic health care services. The federal and state governments fund Medicaid, and in California, the program is called Medi-Cal. The California Department of Health Care Services administers Medi-Cal.
Seniors who meet the income and asset limits of Medi-Cal may qualify for free coverage under the Aged and Disabled Federal Poverty Level Program. To qualify, seniors must be 65 and older, blind or disabled according to Supplemental Security Income standards.
Individual applicants must also own less than $2,000 in nonexempt assets, while couples applying together must have less than $3,000 in nonexempt assets. Countable monthly income limits are $1,242 for an individual and $1,682 for a couple and include income from pensions, wages and alimony. In California, Medi-Cal applicants do not have to add their principal residence in the asset calculation as long as one of the owners intends to continue living there.
Like all other states, California has a Medicaid look-back period; however, it is the only state that looks back 30 months rather than 60 months. Any assets that a Medi-Cal applicant gave away or sold during the look-back period may be appraised, and the value of these assets can be used to levy a period of Medicaid ineligibility.
Seniors who have incomes that exceed Medi-Cal limits may obtain Medicaid coverage on a Share of Cost basis; however, in many cases, the cost of purchasing Medi-Cal out of pocket is greater than comparable private insurance costs. Alternatively, seniors who earn more than Medicaid permits may reduce their income by buying enough private health insurance to decrease their Medi-Cal countable income to a level that meets the Medi-Cal limits for free coverage.
Assisted Living Waiver
Medi-Cal-eligible seniors who require the level of care provided in a nursing home may receive funding for assisted living costs and supplemental support services through an Assisted Living Waiver.
Services offered under an ALW help prevent or delay nursing home placement. Each senior’s needs as identified by a registered nurse through a Care Coordination Agency (CCA) determines the level of service. ALW services may include:
- Personal care and assistance with activities of daily living
- Homemaker services
- Medication management and administration
- Transportation to medical appointments
- Provision of a personal emergency response device
Seniors do not need to apply for an ALW; the CCA screening determines eligibility. Note that Medi-Cal members who have Cost of Share coverage are ineligible for the ALW.
For more information on Medi-Cal and Assisted Living Waivers, contact the Los Angeles County Department of Public Social Service, Customer Service Center at (866) 613-3777 to locate your nearest district office.