Medicaid is the nationwide health coverage program that provides basic health services to low-income, low-asset Americans of all ages. It is jointly funded by the federal and state governments, and in California, Medicaid is known as Medi-Cal.
To qualify for no-cost Medi-Cal coverage applicants must meet income and asset limits. Seniors aged 65 and older can earn no more than $1,242 per month and have $2,000 in countable assets, while senior couples can earn no more than $1,682 per month and own $3,000 in countable assets.
Under Medicaid rules, income from all sources including employment, pensions, alimony and investment interest is included in the monthly income limit. Countable assets include all bank account balances, cash and real estate with the exception of the applicant’s principal residence. Applicants are also exempt from including one vehicle, a irrrevocable burial trust, clothing and household effects in their asset declaration.
Medi-Cal Share of Cost
California offers Medi-Cal coverage on a share of cost basis for seniors with incomes that exceed Medicaid limits. The SOC program allows enrollees to spend a predetermined portion of their monthly income on their medical expenses. Once the predetermined limit is reached, Medi-Cal coverage kicks in. An SOC cannot be used to dispose of assets that exceed Medicaid limits.
Note that seniors who enroll in Medi-Cal on an SOC basis are ineligible for Medicaid waiver programs.
To apply for Medi-Cal coverage, contact the County of Orange Social Services Agency Aliso Viejo Regional Center at (800) 281-9799.
Assisted Living Waiver
Seniors who qualify for free Medi-Cal coverage and meet the criteria for nursing home placement may be eligible for the Assisted Living waiver, a Home and Community-Based Services Medicaid waiver.
The ALW is designed to reduce nursing home placement rates among seniors on Medicaid by funding enhanced care services delivered within an assisted living facility. These services are designed to help seniors remain as independent as possible and may include skilled intermittent nursing, medication management, transportation, medical supplies and personal care.
Seniors in need of long-term care who prefer to reside in an assisted living facility rather than a nursing home can request an ALW assessment through the Care Coordination Agency serving Orange County. Seniors already living in a Medi-Cal-funded nursing home can also request a CCA assessment.
If a senior is found to have care needs that meet the criteria for nursing home placement and can be supported through the ALW program, they’ll be referred to one of the ALW program’s participating facilities.
Note that acceptance into the ALW program doesn’t guarantee placement. Program spots are limited and seniors may be placed on a waiting list.
For more information about the ALW in San Clemente, contact the Orange County CCA, Access TLC Home Health Care, at (818) 551-1900.