One in four California residents are enrolled in Medicaid, the state-administered, federally mandated health plan. By law, Medicaid must provide coverage for physician, hospital, nursing facility and home health services. Each state has the option to offer additional benefits that may include prescription medications, vision and dental care, enhanced health screenings and diagnostic services and personal care.
California is a Medicaid-expansion state, and the California Medicaid program is called Medi-Cal. To qualify for free, long-term care services, including home and community-based nursing home diversion programs, seniors must meet the following criteria:
- Have a monthly income at or below $1,242 when applying as an individual, or
- Have a combined monthly income at or below $1,682 when applying with a spouse, and
- Own a maximum of $2,000 in countable assets, such as cash and investments, or
- Own a maximum of $3,000 in joint countable assets when applying with a spouse, and
- Be a legal, permanent California resident with U.S. citizenship or qualifying immigration status
Exempt Assets When only one spouse needs Medi-Cal coverage, the non-applicant’s (community spouse) income is disregarded. The community spouse may also keep up to half of the couple’s joint assets worth up to $126,420.
Some assets aren’t counted when calculating Medi-Cal eligibility, including:
- One personal vehicle
- Household furnishings
- Clothing and personal items
- Most life insurance policies worth less than $1,500
- Prepaid, non-revocable burial plots and funeral contracts
- A home in which the applicant and/or their spouse lives, irregardless of the assessed value
Applicants who don’t have immigration/citizenship status may qualify for emergency Medi-Cal services only.
Share of Cost Seniors who have high recurring medical expenses and a monthly income that exceeds Medicaid eligibility limits may qualify for Medi-Cal enrollment on a
Share of Cost basis.
Also referred to as Medicaid spend-down or a medically-needy program, SOC allows seniors to spend a portion of their income on approved medical services and supplies each month up to an amount agreed upon. Once the monthly spending limit has been reached, Medicaid benefits are activated for the remainder of the month.
Note: Seniors who enroll in Medi-Cal under an SOC agreement are excluded from Medicaid home and community-based waivers.
For more information on Medi-Cal enrollment and the SOC/Medicaid spend-down program, contact the
Los Angeles County Department of Public Social Services at (866) 613-3777.
Assisted Living Waiver Seniors with long-term Medi-Cal coverage who meet the criteria for nursing home placement and can safely reside in a noninstitutional setting with support may qualify for the
Assisted Living Waiver.
The ALW pays for medical and nonmedical services that let seniors live in a participating assisted living facility. These services are assigned on an as-needed basis and could include adult day health programs, personal care and housekeeping, physical therapy, mobility aids and skilled nursing. Participants are assigned a case manager and services are regularly reviewed and updated.
Medi-Cal covered seniors who already live in a nursing home can apply for the ALW, and if accepted, they’re provided with transitional support to help them move into an assisted living facility.
Note: Seniors who enroll in the ALW must pay the room-and-board portion of their monthly living costs.
To learn more about the ALW, Palmdale seniors can call Access TLC Home Health Care, the Los Angeles County
Assisted Living Waiver Care Coordinator Agency, at (818) 551-1900.