Low-income Californians who have limited financial resources may be eligible for Medicaid, the nationwide government health plan that covers essential health services. California’s Medicaid program is called Medi-Cal, and in accordance with federal law, all Medi-Cal plans include primary, hospital and long-term care benefits.
Some additional state-specific benefits, such as prescription drug coverage, case management, adult day health services and hospice care, may be offered through waivers and special programs.
Qualifying for Long-Term Medi-Cal Services
To qualify for no-cost Medi-Cal coverage with access to home and community-based waivers, seniors aged 65 and older must be U.S. citizens or qualified immigrants who are full-time California residents. The income limit for singles is $1,242 per month and $1,682 per month for couple’s applying together.
If only one spouse in a couple needs care, the non-applicant isn’t expected to contribute towards the cost of care, therefore, their income is disregarded by Medi-Cal.
Asset limits are set at $2,000 per person and $3,000 per couple and include on-hand cash, bank account balances and investments. Applicants can keep some assets and still qualify for Medi-Cal. Most notably, a home that’s owned and occupied by the applicant and/or their spouse, irregardless of the home’s value, is rated as a Medi-Cal exempt asset.
Seniors with monthly earnings that exceed the Medi-Cal limits who need long-term care may be able to enroll in a Share of Cost basis, also referred to as Medicaid spend-down program. Under a SOC agreement, seniors must agree to pay a predetermined amount towards their monthly medical costs. Once this amount is reached, Medi-Cal benefits cover eligible costs for the remainder of that month.
For more information about Medi-Cal, call (800) 541-5555 or apply online.
Medi-Cal Assisted Living Waiver
Seniors aged 65 and older who meet the clinical criteria for placement in a nursing facility may qualify for the Assisted Living Waiver, a Medi-Cal nursing home diversion program. Seniors who are already in a nursing home can also apply for the ALW.
Note: Medi-Cal Share of Cost participants are not eligible for the ALW.
ALW gives fragile seniors the option to remain in a designated assisted living facility by providing seniors with additional medical and nonmedical support services. Under the ALW, seniors are responsible for the room-and-board portion of their monthly assisted living costs.
To receive ALW services, seniors must complete a care assessment conducted by the area Care Coordination Agency. If applicants are eligible for the ALW, they may be provided with one or more of the following:
- A case manager
- Personal care services to help with activities of daily living
- Laundry and housekeeping
- Prepared meals and snacks
- Recreational programming
- Transportation
- Intermittent skilled nursing
- Assistance with medication management
- Transition services (for seniors moving from a nursing facility)
There are two
ALW participating facilities in Santa Clara County with a combined maximum capacity of 132, therefore, wait lists may be in place.
To learn more about the ALW, contact the
Institute on Aging, Santa Clara County, at (408) 474-0679.