In California, the state Medicaid program is Medi-Cal. This program is designed to help low-income seniors and disabled people pay for various services, such as nursing homes, doctors and hospitals, prescription drugs, dental, rehab, adult day health care and in-home personal care services.
Medi-Cal may pay for all of the applicable services (full scope) or only some of them (partial scope) depending on qualifications. The process is further complicated by the addition of over 90 categories of eligibility, such as income-based, SSI linked and medically needy.
The most common eligibility categories for seniors in San Bernardino are:
Applicants for Medi-Cal must meet the following general eligibility requirements:
- Legal resident of California
- At least 65 years old, blind or disabled (by Social Security standards)
- Maximum income of 138 percent of the federal poverty level ($1,436 per month for an individual as of 2019 or $1,936 for couples)
- Maximum countable assets of $2,000, including cash, bank accounts, investments and real estate (excludes current residence and vehicle as well as other exemptions)
The general requirements listed here should be viewed as a starting point for further research at the linked websites for individual categories of coverage.
Receiving benefits to pay for an assisted living facility is not considered an entitlement in California, and Medi-Cal won’t directly cover the associated costs. However, through the use of waivers it’s possible to receive assistance with the costs of some services at assisted living facilities. Benefits for seniors living at home, in a nursing facility or adult day care are entitlements in California, so there’s no waiting list for applicants who meet the eligibility requirements.
Seniors or their caregivers can apply for benefits, including Medi-Cal, through the
Department of Health Care Services website. Alternatively, residents of San Bernardino can contact the
Transitional Assistance Department (TAD) by phone at (877) 410-8829 or visit in person for more information on Medi-Cal.
Medi-Cal Assisted Living Waiver Program (ALW) Medi-Cal’s
Assisted Living Waiver (ALW) makes it possible for eligible residents to receive coverage for some expenses. The ALW is designed to help seniors who require a nursing facility level of care but would rather receive services in an assisted living facility.
Benefits of the ALW program include
assisted living services such as health and social services, recreation, meals, housekeeping, laundry and transportation. Participants in the ALW will also receive care coordination and assistance transitioning out of a nursing facility if appropriate.
Anyone enrolled in a Medi-Cal category with a share of cost (SOC) cannot enroll in the Assisted Living Waiver program. Applicants for the Assisted Living Waiver (ALW) must be enrolled in Medi-Cal and must be assessed and determined to require a nursing facility level of care.
To apply for the ALW, seniors or their caregivers should contact one of the
local Care Coordination Agencies (CCA) for San Bernardino, such as
Partners in Care Foundation at (818) 837-3775. A registered nurse will make the determination on the level of care required.