Medicaid is a federally mandated, state-administered government health plan for low-income children, adults with disabilities and seniors. It was established in 1965 and includes a number of mandatory benefits, such as hospital and nursing home care, primary physician care, X-rays, blood tests and home health services.
Each state has the option to provide additional, state-specific Medicaid benefits through special programs and waivers. These benefits may include prescription drug coverage, personal care, prosthetics, dental and vision care and hospice services.
In California, a Medicaid-expansion state, the program is called Medi-Cal, and it’s administered through the Department of Health Care Services.
Qualifying for Medi-Cal
California seniors who collect Supplemental Security Income benefits are automatically qualified for Aged, Blind and Disabled Medi-Cal coverage.
To be eligible for Medi-Cal Aged and Disabled Federal Poverty Level coverage with access to home and community-based waiver programs, seniors aged 65 and older must:
- Be permanent residents of California
- Have valid U.S. citizenship or qualifying immigration status
- Have a monthly income of $1,242 or less (individual), or
- Have a monthly combined income of $1,682 or less (couple applying together)
- Own $2,000 or less worth of countable assets, or
- Own $3,000 or less worth of joint countable assets when applying with a spouse
Some personal assets are not counted, such as:
- The home of the applicant and/or their spouse
- One vehicle
- A life insurance policy with a face value of $1,500 or less
- An irrevocable, prepaid burial plan and plot of any value
- A revocable, prepaid burial plan worth up to $1,500
- Furniture and household goods
- Clothing and personal items
Minimum Monthly Maintenance Needs Allowance Special rules apply to married couples when only one spouse needs Medi-Cal coverage to ensure the non-applicant spouse, called the community spouse, has enough money to live on.
If the community spouse earns less than $3,161 per month, money can be transferred from the applicant to raise the community spouse’s income up to $3,161. This is known as the minimum monthly maintenance needs allowance, and money the applicant transfers under the MMMNA can reduce their countable income on their Medi-Cal application.
The community spouse can also retain up to half of the couple’s countable joint assets at a maximum value of $126,420 under the community spouse resource allowance.
Medi-Cal Share of Cost Seniors who meet the asset limits for Medi-Cal enrollment, but are otherwise excluded due to excess income may be able to achieve Medi-Cal eligibility by entering into a
Share of Cost agreement.
SOC works like an insurance deductible. Each month, participants must spend a predetermined amount of their excess income on approved medical expenses. Once they have spent their SOC limit for the month, Medi-Cal coverage is in effect for the remainder of that month.
For more information on Medi-Cal enrollment and SOC, contact the
Alameda County Social Services Agency, Livermore Outstation, at (925) 455-0747.