Low-income children, families, adults and seniors who own very few assets, often have difficulty accessing health care due to costs. In 1965 the federal government created Medicaid – a nationwide health insurance program, to provide more than 70 million Americans with basic health coverage.
Medicaid is jointly funded by the federal and state government, and individual states have the option to administer Medicaid through a government agency or contract out the services to an insurance company.
In California, Medicaid is known as Medi-Cal, and seniors make up about 16 percent of all California Medicaid enrollees. Adults aged 65 and older who meet the income and asset criteria for Medi-Cal coverage may also be eligible for extended benefits that cover the cost of assisted living.
To qualify for free Medi-Cal, seniors must meet the following criteria:
- Earn less than $1,242 a month as a single applicant
- Earn less than $1,682 when applying as a couple
- Currently live in California and intend to remain in California on an indefinite basis
Additionally, applicants may own no more than $2,000 in countable assets when applying as a single or $3,000 with a spouse.
Under Medicaid rules, income from all sources must be reported. This includes wages, alimony payments and pensions. Countable assets include cash and bank account balances, investments and all real estate except for the applicant’s principle residence. Note: There is no upper limit on the value of an applicant’s home in California.
Other assets that are Medi-Cal exempt include:
- One vehicle
- Personal belongings
- Household furnishings
- A non-revocable burial trust
If a senior has assets that exceed the $2,000/$3,000 asset limits, they will be required to spend down the excess amount towards their care prior to receiving any coverage through Medi-Cal.
Medi-Cal also has a 30-month look-back period that audits any assets an applicant has gifted, sold or otherwise liquidated during the 30-month period prior to seeking Medi-Cal coverage. If a disqualifying asset transfer was made, the applicant is disqualified from Medi-Cal for a period of time that’s determined by dividing the value of the asset by the average monthly cost for nursing home care in the state.
If approved for no-cost Medi-Cal, seniors can maintain a property reserve of $2,000 cash for an individual and $3,000 per couple that can be used at their discretion.
California Medi-Cal Assisted Living Waiver Seniors who are both eligible for free Medi-Cal coverage and need the type of care normally provided in a nursing home may be eligible for additional services under the
Assisted Living Waiver program.
The ALW reduces nursing home placement rates among seniors covered through Medi-Cal by funding additional services and supports, helping seniors live in an assisted living facility rather than a nursing home.
To apply for the ALW program, seniors should contact a Care Coordination Agency to request an ALW assessment. If approved, seniors are assigned services based on their individual service plan.
ALW services may include:
- Medication management and administration
- Wound care
- Meal preparation
- Homemaker services
- 24-hour access to an on-site support person (in facilities with 7 or more beds)
- Recreational programming
- Assistance with activities of daily living, such as bathing, dressing, and toileting
- Transportation coordination
- Provision of a wearable call button to summon assistance
Note: seniors who receive Medi-Cal coverage on a
Share of Cost basis are not eligible for services through the ALW.
To enroll in Medi-Cal or learn more about the ALW, call the
Yolo County Health and Human Services Agency at (530) 661-2750.