Low-income Americans with limited resources who can’t afford health insurance may qualify for coverage through the jointly funded federal and state program known as Medicaid. The California Medicaid program is called Medi-Cal, and it serves the health care needs of one-fifth of the state population, including over 1.5 million disabled and elderly residents.
Qualifying for Medi-Cal Long-Term Care Coverage
Simi Valley residents must be U.S. citizens or legal immigrants to qualify for Medi-Cal coverage. Applicants also must be aged 65 or older or disabled or blind if younger and have no more than:
- $2,000 in countable assets and $1,242 of income per month as a single person
- $3,000 in total countable assets and $1,682 in monthly income as a married couple if both need coverage
Under Medi-Cal rules, all sources of income count against the monthly limit, but certain assets are excluded, such as a primary home, irrevocable burial trusts, personal effects, household goods and one vehicle.
Exceptions to Medi-Cal Financial Limits Individuals who successfully apply for
Supplemental Security Income benefits are immediately enrolled in Medi-Cal with full-scope coverage. Seniors assessed as needing nursing home care qualify at any income level if they meet the program’s eligibility requirements and asset limits.
Seniors with incomes exceeding the Medi-Cal limits may qualify on a
share of cost basis. To meet the SOC requirements, Medi-Cal applicants must spend a predetermined amount of their income on allowable medical expenses. Once this figure has been reached, Medi-Cal coverage can begin.
Simi Valley seniors can
apply for Medi-Cal online or call (805) 584-4842 for more information or assistance.
California Assisted Living Waiver Medi-Cal-eligible Simi Valley residents who meet the requirements for nursing home admission may apply for the
Assisted Living waiver, which offers the alternative of receiving care services in a
state-licensed assisted living facility.
To be eligible for the ALW, applicants must meet the Medi-Cal enrollment criteria with zero share of cost. The program doesn’t pay facility room-and-board fees, but it does provide case management and various services, such as:
- Personal care
- Medical equipment and supplies
- Intermittent skilled nursing care
- Nonmedical transportation
- Medication management
The waiver is only available in 15 California counties, and Ventura County doesn’t offer the program. Simi Valley seniors who prefer to live in a community setting can still apply if they’re willing to relocate to a nearby participating county, such as Kern, Los Angeles, Riverside, Orange or San Bernardino.
Not all assisted living facilities accept the waiver, and the statewide enrollment number is capped, so seniors willing to relocate may have to wait to receive services based on availability.
Interested Simi Valley residents can learn more about the ALW program and how to begin the application process by contacting a state-approved
Care Coordination Agency in the county of their choice.