Medicaid is the government health plan that provides about 25% of California residents with no-cost access to basic health services, such as doctor’s visits, inpatient and outpatient hospital services, X-rays and blood tests and nursing facility care. Individual states may also offer enhanced Medicaid services, such as community-based care and nursing home diversion programs through Medicaid waivers.
In California, a Medicaid-expansion state, the program is known as Medi-Cal, and it’s administered through the Department of Health Care Services. To qualify for no-cost, long-term Medi-Cal services, seniors can earn up to $1,242 per month ($1,682 per couple) in income from pensions, alimony, wages and investments.
Medi-Cal applicants must also have no more than $2,000 per person and $3,000 per couple (if both spouses are seeking coverage) in countable assets. If only one spouse in a couple is applying, the non-applicant can retain up to half of their joint assets, worth up to $126,420.
Some specific assets are not included in the Medi-Cal limits, such as one vehicle, a prepaid burial contract and an owner-occupied home. Notably, California’s Medicaid program doesn’t limit the assessed value of the applicants’ home in determining Medicaid eligibility.
Share of Cost
Seniors with monthly income that exceeds Medi-Cal limits may be able to enter into a Share of Cost agreement to enroll in Medi-Cal. The SOC program is similar to the deductible on a private insurance plan. The participant must pay a predetermined amount towards approved care costs each month. Once that amount has been spent, Medi-Cal coverage is in effect for the remainder of the month. In many cases, the SOC amount may be higher than what a senior may pay to purchase private health care coverage.
Note: SOC Medi-Cal participants cannot participate in Medicaid waivers.
To learn more about Medi-Cal enrollment and the SOC program, contact the Orange County Social Services Agency at (800) 281-9799.
Assisted Living Waiver
Seniors who qualify for full-scope, no-cost Medi-Cal coverage and meet the criteria for Medicaid-funded nursing home placement may be eligible for additional community-based supports through the Assisted Living Waiver.
This Medicaid home and community waiver lets seniors age in place in an assisted living setting by funding enhanced medical and nonmedical services. Seniors who already live in a Medicaid-funded nursing home are eligible for this waiver, and if accepted, they can be provided with transitional support to move into an assisted living facility.
ALW services are assigned based on medical need, and may include:
- Assistance with activities of daily living, such as bathing, eating and grooming
- A personal emergency response device
- Skilled and intermittent nursing
- Medication management and administration
- Medical supplies and durable medical equipment
- Rehabilitation therapy
- Transportation to medical appointments
Note: Seniors accepted into the ALW program must live at a participating ALW facility in Orange County to receive waiver services.
For more information on the ALW, Costa Mesa seniors can contact Access TLC Home Health Care, the
Orange County Assisted Living Waiver Care Coordinator Agency, at (818) 551-1900.