Medicaid is a national health insurance program that is jointly funded by federal and state governments. It provides limited coverage for essential health care services, such as doctor visits, hospitalization and emergency services for Americans of all ages with low income and assets.
The California Department of Health Care Services (DHCS) administers Medicaid, known also as Medi-Cal. Seniors aged 65 and older are eligible for full-scope Medi-Cal coverage under the Aged and Disabled Federal Poverty Level Program (A&D FLP).
To qualify, seniors must have a countable income below $1,242 (individual) or $1,682 (couple) and own less than $2,000 in nonexempt assets (individual) or $3,000 (couple).
Income includes monies received from all sources such as pensions, wages and investment interest, while countable assets include cash, bank account balances and bonds. Medicaid asset exemptions include personal effects, furniture, one automobile, non-revocable burial trusts and a primary residence that either the Medicaid applicant and/or their spouse reside in.
Unlike many other states, California does not cap the value of the primary residence in determining Medicaid eligibility. There is a look-back period of 30 months prior to applying for Medi-Cal. Any assets that applicants gift or sell during this time will be appraised, and the market value will be added to the total assets assigned to the applicant. This may result in a penalty assessed as a period of Medi-Cal ineligibility.
Seniors over the age of 65 who are ineligible for Medi-Cal under the A&D FLP due to excess income, may be eligible for coverage through the Aged, Blind and Disabled – Medically Needy Program (ABD-MN), which is a Medi-Cal Share of Cost program.
Under the ABD-MN program, applicants are required to pay a monthly share of cost towards their Medi-Cal coverage. The monthly share is determined by subtracting a needs allowance from the applicant’s countable monthly income. In cases where the share is prohibitively high, applicants may have the option of purchasing additional health insurance in order to reduce their countable income down to the Medi-Cal A&D FLP maximum income rate.
California Assisted Living Waiver
Seniors who are 65 and older and currently members of Medi-Cal may be eligible for help with assisted living costs through the Assisted Living Waiver (ALW) program.
The ALW program is designed to reduce nursing home placement rates among seniors in California through additional funding, enabling them to live in assisted living facilities or public subsidized housing. This Medicaid waiver program is open to Medi-Cal eligible seniors who require nursing home level of care as a result of their medical needs.
Seniors who are already enrolled in Medi-Cal don’t need to submit an additional application to the ALW program; however, potential ALW candidates do need to contact a Care Coordination Agency (CCA) through the County of Santa Cruz Employment and Benefit Services Division to request a CCA assessment.
Registered nurses assess the needs of each applicant to determine eligibility for nursing home level care in an independent living setting, develop an Individualized Service Plan (ISP) and monitor service delivery.
Services under the ALW program can include:
- Assistance with creating and maintaining a current ISP
- Home care aide and homemaker services
- Meal preparation and service
- Skilled intermittent nursing services
- Supervision of self administered medications
- Medication administration by a licensed registered nurse or licensed vocational nurse
- Daily recreational programming
- Medical transportation
- Provision of an emergency call system
Individuals who are enrolled in Medi-Cal on a Share of Cost (SOC) basis are excluded from the Assisted Living Waiver program. There are a limited number of ALW slots available statewide, and seniors who qualify for the Assisted Living Waiver may be placed on a waiting list.
For more information about Medi-Cal coverage and the Assisted Living Waiver program, contact the County of Santa Cruz Human Services Department, Employment and Benefit Services Division at (888) 421-8080.