Medi-Cal is California’s Medicaid system. This state and federally funded health insurance program is available to low-income adults, seniors and disabled individuals in Orange County. It covers the cost of medical care, including hospital stays, doctor’s visits, prescription medications and skilled nursing services. It may also help with the cost of assisted living and home-based services using federally authorized waivers created under the Social Security Act.
To qualify for Income-Based or Aged & Disabled Medi-Cal, the applicant’s household income must be at or below 138 percent of the Federal Poverty Level, which is $16,395 per year for individuals and $22,108 for couples. Orange County residents who are aged, blind or disabled but aren’t financially eligible may qualify for the Medically Needy Medi-Cal cost-sharing program, which requires members to use some of their own money for health care. To apply for Medi-Cal benefits, call the Orange County Social Services Agency at (800) 281-9799.
Assisted Living Waivers
Assisted Living Waivers are an extension of California’s Medicaid program that’s available to current Medi-Cal members. They pay for the cost of personal assistance provided in residential care facilities. However, they do not cover the cost of room and board. ALWs include three connected services:
- Transition benefitsto help nursing home residents return to the community or move into an assisted living facility
To qualify for any of these waiver services, adults in Orange County must be enrolled in Medi-Cal and have medical needs similar to most nursing home patients. Because this is a 1915(c) program that covers optional non-Medicaid services, the state processes a large number of applications. There is an enrollment cap, and most new applicants are added to a waiting list.
Medi-Cal members cannot apply for these benefits directly. Referrals are submitted through Care Coordination Agencies that assess candidates individually. The Department of Health Care Services maintains a full list of CCAs that serve Orange County.