Medicaid is a national health plan that provides low-income children, adults with disabilities, pregnant women and seniors with access to essential health services. It’s funded through the federal and state governments and administered at the state level.
All Medicaid programs must include certain mandatory benefits, such as:
- Nursing facility services
- X-rays
- Laboratory services
- Transportation to Medicaid-funded services
- Emergency care
- Inpatient and outpatient hospital services
- Doctor visits
Individual states may also offer optional Medicaid benefits, such as:
- Dentures and dental care
- Eyeglasses and optometry services
- Prosthetics
- Respiratory therapy
- Chiropractic services
- Assistance with activities of daily living
- Skilled nursing
- Case management
- Prescription medication coverage
- Hospice care
Qualify for Long-term Medical In California, the Medicaid program is called
Medi-Cal, and seniors need to meet the following income and asset limits to qualify for long-term care coverage:
- 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 assets are excluded from these limits, including:
- A life insurance policy worth no more than $1,500
- An irrevocable, prepaid burial plan and plot
- Household items
- One vehicle
- A home owned and occupied by the applicant and/or their spouse
Medi-Cal Share of Cost Seniors who have assets that fall within the Medi-Cal limits but are deemed ineligible for enrollment due to excess income may be able to enroll through a Share of Cost agreement.
Also referred to as a Medicaid spend-down program, SOC is similar to an insurance deductible. Seniors must use a predetermined amount of their excess income on approved medical expenses each month in order to reach their SOC limit. Once they have reached their monthly SOC limit, Medi-Cal coverage is activated for the rest of that month.
It’s important to note that Medi-Cal participants who have a SOC agreement are excluded from Medi-Cal home and community-based waiver programs.
Assisted Living Waiver The
Assisted Living waiver is a Medi-Cal nursing home diversion program for seniors who meet the clinical criteria for nursing home placement and are able to reside in assisted living facility with additional supports. Applications are accepted from seniors who need placement in a long-term care facility as well as from seniors who currently live in a nursing home.
ALW services include adult day programming, personal care, housekeeping, transportation and medication management. Supports include provision of a medical alert system, prepared meals and snacks and individual case management.
ALW services are delivered in specific assisted living facilities that participate in the program, however, the program is statewide. There are currently no placements available in Solano County, so seniors who are accepted must agree to a placement outside of the county.
For more information on Medi-Cal enrollment, the SOC and the ALW, contact the Solano County Public Assistance Department by calling (707) 784-8050.