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Medi-Cal Eligibility and Long-Term Custodial Care

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Medicare and Skilled Nursing in Long-Term.

If we think of life as a "terminal" condition, we are left with two basic conclusions: We will all die, and some of us will get very sick before we die. Our loved ones who get very sick often face financial destitution due to the high costs of long-term custodial care in a skilled nursing facility (SNF).

At $10,000 to $14,000 per month, private pay takes most of us only so far before we are broke. Consequently, most patients in long-term "custodial" care in an SNF end up on Medi-Cal. Medicare is federally funded health insurance for the elderly and disabled. As such, it has no income or resource requirements to meet. If you are 65, or if your disability meets certain criteria, you will qualify for Medicare. Most people also secure supplemental insurance to help pay for Medicare deductibles and co-pays.

Medicare coverage in an SNF is limited to "skilled" (versus "custodial") nursing or rehab services. Most of us don't get the full 100 days of coverage because when we "plateau" or cease improving, care becomes custodial, not rehab.

What to Do If You're Told Your Medicare Rehab Will End Early

If you are in an SNF getting Medicare rehab services, and someone tells you that your Medicare rehab will end before the 100 day period is up, do this:

Google "Jimmo v. Sebelius Summary," access the Settlement Agreement Fact Sheet, and make a copy of it.
Take the copy of the fact sheet to the SNF administrator who told you your Medicare rehab services were about to end.
Give them the fact sheet and cite the following quoted language from the Fact Sheet -- "When skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration."

If you still need "skilled nursing care" to maintain your condition or to prevent your condition from deteriorating, you should get the full 100 days.

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Medi-Cal Eligibility for Custodial Care in Skilled Nursing Facilities.

According to The Scan Foundation, there were over 102,000 Californians in skilled nursing in 2010. Their numbers will increase as the demographic tidal wave called "baby boomers" age. The 2024 Average Pay Rate for Medi-Cal patients in skilled nursing is $12,608 or more than $150,000 per year! Private pay by individuals not covered by Medi-Cal can be even higher. Though most SNFs in California are Medi-Cal certified, some are not. If you run out of money in a Medi-Cal certified facility you cannot be evicted for converting to Medi-Cal. Such is not the case in non Medi-Cal certified facilities.

Remember though, converting to Medi-Cal will mean you lose your private room, unless you and your family can pay the difference between the Medi-Cal rate (for a shared room) and the private room rate. Due to the high costs of custodial care in a Skilled Nursing Facility (SNF), Medi-Cal has become a primary source of funding for many of California's long-term care patients.

Understanding Traditional vs. Expanded Medi-Cal

Medi-Cal ("Medicaid" everywhere else!) is a "needs based" (or "means tested") federal-state partnership providing healthcare for folks unable to afford medical care. Traditional Medi-Cal planning focuses on three areas: (1) eligibility issues; (2) share of cost issues; and (3) estate recovery issues. Consequently, the goal of planning for long-term Medi-Cal for custodial care in an SNF emphasizes becoming eligible, paying as little as possible and avoiding an estate recovery by the state, before the Medi-Cal beneficiary dies.

A recent implementation of "California Care" has shifted many low-income people into "expanded Medi-Cal". Interestingly, expanded Medi-Cal is not "means tested", meaning that your assets and money aren't relevant, your income is the primary determining factor.

For disabled and sick people under age 65, California Care will also pay for custodial care in an SNF without the asset rules of traditional Medi-Cal. However, your estate can still be subject to a potential recovery claim when you die. You can review eligibility for expanded Medi-Cal if you google "California Care Eligibility Rules" and click on "California/Medicaid.gov".

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2024: New Laws Eliminate Medi-Cal Asset Limits

Effective January 1, 2024, Medi-Cal no longer asks about assets for any Medi-Cal program. Going forward, Medi-Cal will only ask questions regarding income. Since Medi-Cal will now focus on your income, much of traditional Medi-Cal planning is now essentially obsolete.

Gifting of Assets: If Medi-Cal no longer cares what you own, then there is no need to gift or transfer assets in order to qualify for Medi-Cal.
Annuity Purchases: The need to "shelter" assets in some form of annuity is unnecessary.
Spousal Transmutations: We no longer need to transfer assets from the "institutionalized" spouse to the at-home "well" spouse, in order to secure eligibility (transfers for income allocation remain viable).

Going forward, I do see an increased need for revocable living trusts, which will avoid probate and thus completely eliminate Medi-Cal recovery claims.

Also, court-ordered income allocations, "orders of support," will be increasingly necessary to avoid spousal impoverishment.

The best presentation of the new laws is set forth by my friends at the California Advocates for Nursing Home Reform 9CANHR) (updated by CANHR as of April 12, 2024):

2024 Medi-Cal Asset Elimination Frequently Asked Questions

Posted on Friday, April 12th, 2024

California Assembly Bill 133 was signed into law in 2021, which began a process to remove the asset limit for Non-Modified Adjusted Gross Income (Non-MAGI) Medi-Cal programs, including the Long-Term Care, Aged Blind Disabled, Medically Needy and Working Disabled Programs. The state temporarily increased the asset limit in July of 2022, and on January 1, 2024, California completely eliminated asset limit requirements altogether. This means that as of 2024, Medi-Cal only asks about income and no longer asks about assets for any Medi-Cal program.

Historically, seniors and people with disabilities who applied for Medi-Cal had to keep their assets below $2,000 for a single person and $3,000 for couples. In 2022, the asset limits were temporarily increased to $130,000 for an individual and $195,000 for a couple. Beginning January 1, 2024, California no longer considers assets as part of the eligibility determination for all Medi-Cal programs.

Assets are things that you own, such as bank accounts, stocks, retirement accounts, cash, vehicles, and property. Income is money received, typically on a regular basis, from sources such as work, retirement accounts, Social Security, state disability insurance, IRA distributions, stock dividends, rent, or interest and dividends from investments. Medi-Cal applies different eligibility criteria based on the source of your income. Some types of income may not be counted for specific programs; for example, income from VA Aid and Attendance is not counted for Medi-Cal eligibility purposes.

Each Medi-Cal program has specific income limits, and income rules and limits remain the same. The Medi-Cal program for people ages 65 and older or who are disabled has an income limit of $1,732 (as of April 2024). For applicants with income over that amount, they may still be eligible with a shared monthly cost (formerly known as a share of cost). Medi-Cal requires applicants and beneficiaries to report income from all sources, including income received from assets such as retirement or investment income, stocks, annuities, and rental income. To learn more about the income limits for common Medi-Cal programs for older adults or people with disabilities, read CANHR’s fact sheet on Community-Based Medi-Cal Programs and Overview of Long-Term Care Medi-Cal.

Medi-Cal requires applicants and beneficiaries to report income from all sources. Income received from some assets may be counted toward shared monthly costs, while others may be excluded from the calculation. Examples of income from some assets that would be included in the share of cost calculation include:

Rental property income
Periodic payments and required minimum distributions from IRAs, retirement plans for self-employed individuals, and work-related
pension funds
Payments distributed from an annuity
Interest and dividends received from investments, savings accounts, etc.
Read ACWDL 23-21 for a full list of countable and excluded income sources.

Beginning January 1, 2024, counties will no longer use information about the assets of applicants or their spouses or registered domestic partners (RDP), in determining eligibility. Counties will also no longer determine the Community Spouse Resource Allowance (CSRA) if the applicant’s initial month of eligibility is on or after January 1, 2024. This means that the “community spouse” (or RDP) can have unlimited assets in their name. It is important to remember that under spousal impoverishment rules, the income of the spouse or RDP who is on Medi-Cal will be used to determine eligibility and share of cost, and any income generated by assets in the name of that person must be reported to Medi-Cal. Income received in the name of the “community spouse” alone would not be counted toward the SOC of the spouse who requires nursing home or home and community-based services.

Example: Jose has Parkinson’s disease and wants to apply for Medi-Cal in January of 2024 to pay for in-home care through a Home and Community-Based Services program. Jose and his wife Theresa have $50,000 in joint savings, and Theresa has an investment account of $200,000 on which she earns $5,000 a year. Jose could be eligible for Medi-Cal, as there is no longer an asset limit, and under spousal impoverishment rules, the income received in Theresa’s name alone is not counted towards Jose’s monthly share of cost.

No transfer of assets after January 1, 2024, will result in a period of ineligibility for nursing facility level of care. Spousal impoverishment under Medi-Cal has special income rules that offer flexibility in arranging income to the benefit of the couple. In some cases a property transfer between spouses resulting in a change of ownership of income could reduce or eliminate share of cost. To learn more about spousal impoverishment, read our fact sheet.

Properties titled in the name of the trust (i.e., trust principal) will not be counted for purposes of Medi-Cal eligibility and re-determination starting January 1, 2024. However, payments from the trust or trust income (interest from brokerage accounts, annuities, etc.) that are paid to the trust beneficiary are considered income for eligibility purposes, unless an exemption applies or the income is unavailable (ACWDL 23-22E). Payments made from the trust to third parties for the benefit of the beneficiary for housing, utilities, or food are counted as in-kind income if the payment is for the full amount. As long as the beneficiary pays even a portion of their cost for housing, utilities, or food, trust payments to supplement those costs will not be counted. Payments made to third parties for the purchase of items other than housing, utilities, or food are not counted as in-kind income or used in the Medi-Cal eligibility determination.

Example: Jane decides to use some of the money in her trust to pay for a kitchen remodel. Each time she pays for services, she writes a check directly from her trust account to the vendors. These payments will not be counted as income because they were made directly to vendors (third parties) and are not for housing, utilities, or food. (22 CCR §§ 50489.5(f)(3), 50513.)

The lookback period only applies to those applying for Medi-Cal coverage in a skilled nursing facility. A lookback period will no longer apply to transfers made on or after January 1, 2024. Transfers made prior to January 2024 may be subject to transfer penalties. Counties will review the 30 months prior to application for Long Term Care Medi-Cal services for any transfers of property but will not penalize those transfers made from 2024 forward.

Example: Josh enters a nursing home in October 2024. He transferred $150,000 in August of 2024 to his brother. The county will not consider the months of January through October of 2024 but will review the 21 months prior to January 1, 2024, for transfers of property made during that time. Because the transfer happened in 2024, there is no transfer penalty.

Transfers of exempt property (as per rules of the time of the transfer) would not result in ineligibility. For example, there would be no transfer penalty for someone who had $125,000 in total assets in 2023 and made a transfer of $100,000, which was under the $130,000 asset limit for that time period.

Please note that a transfer penalty would only be applied to those entering a nursing home on Medi-Cal and not to applicants or beneficiaries living in the community. Per current policy, all possible transfer penalties must be reviewed for undue hardship before imposing a period of ineligibility.

Example: In December of 2023, Maya cashed out her retirement account and transferred the entire $250,000 to her daughter after receiving incorrect advice on how to become eligible for Medi-Cal. In June of 2024, she applies for Long Term Care Medi-Cal after ending up in a nursing home. As the county will review the 25 months prior to 2024, the transfer could create a period of ineligibility, and Maya could possibly apply for undue hardship as outlined in ACWDL 90-01, section 50096.5.

Scheduled periodic distributions, whether monthly or annual, or payments of interest and dividends, are considered income in the month received. In the following month after receipt, those funds are considered assets. Distributions that are received once per year can be counted in the month received, or you can ask Medi-Cal to amortize (evenly break up) the amount over a 12-month period if it would help you to lower or avoid a share of cost. Lump sum withdrawals that are separate from a regularly scheduled periodic distribution are considered converted property and should be treated as an asset. (ACWDL 02-51)

Lawsuit settlement funds will be counted as income in the month received and considered an asset the following month. Additionally, the Department of Health Care Services (DHCS) can seek repayment for any services that Medi-Cal paid for on behalf of a beneficiary who is involved in a personal injury, class action, or medical malpractice lawsuit. Medi-Cal recipients are required by law to notify DHCS in writing within 30 days of filing a lawsuit. (W&I Code sec. 14124.70, 14124.73).

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Overview of Medi-Cal for Long Term Care.

Once again CANHR provides the best overview article. I reproduced it in full, with thanks to those fabulous minds at CANHR:

A. Medi-Cal vs. Medicare

Medicare Coverage of Skilled Nursing Care

Medicare does not pay for all medical expenses and usually must be supplemented with private insurance (“Medigap”), or consumers can enroll in an HMO plan that contracts with Medicare. After 3 days of prior hospitalization, Medicare will pay up to 100% for the first 20 days of skilled nursing care. For the 21-100 days, the patient will pay a co-payment. The premiums and copayments are increased every year. There will be no Medicare coverage for nursing home care beyond 100 days in any single benefit period.

It should be noted that Medicare only pays for “skilled nursing care,” does not pay for “custodial care,” and the average stay in a nursing home under Medicare is usually less than 24 days. Thus, few can look to Medicare to pay for any substantial nursing home costs.

For more information on Medicare coverage, contact your local Health Insurance Counseling and Advocacy Program (HICAP).

Medi-Cal for Long Term Care

Medi-Cal is a need-based program designed to help low-income people pay for medical care. Unlike Medicare, Medi-Cal recipients must apply and meet certain eligibility criteria to receive coverage. This fact sheet focuses primarily on Medi-Cal for Long-Term Care, which helps cover services in a skilled nursing facility or nursing home. For information on community-based Medi-Cal, Medi-Cal coverage for someone at home or in the community, please read CANHR’s fact sheet on Aged & Disabled, Medically Needy, and Working Disabled Medi-Cal Programs.

B. Medi-Cal Eligibility

As of January 1, 2024, Medi-Cal will no longer count assets to determine eligibility. This means that anyone, regardless of how much they own, may receive Medi-Cal benefits, including:

Individuals in skilled nursing or intermediate care facilities or those who qualify for home and community based services
People who are 65 or over, blind or disabled
Low-income persons with dependent children
Children under 21
Pregnant women
SSI and other categorically related recipients are also automatically eligible for Medi-Cal.

C. Monthly Resident Cost (formerly known as “Share of Cost”)

Skilled nursing facility residents must agree to pay the facility a portion of their income each month. This is called the monthly resident cost and is treated much like rent. The resident is responsible for paying their monthly resident cost to the facility, and Medi-Cal will then cover the remaining costs for the month.

The monthly resident cost is calculated by taking the individual’s gross monthly income, deducting any out-of-pocket medical premiums, and deducting the Personal Needs Allowance of $35. This is the amount that a skilled nursing resident can keep for themselves while the remainder of their income is paid to the facility. If the resident is on SSI, the personal needs allowance is increased to $50. If the resident is receiving VA Aid and Attendance benefits, they are entitled to receive a total of $125 because they receive an additional $90 on top of the $35.

All Medi-Cal beneficiaries who have a Medi-Cal share-of-cost of more than $500 will no longer have their Medicare Part B premium covered by Medi-Cal, it will automatically be deducted from the beneficiary’s Social Security check. This does not apply to Medi-Cal eligible nursing home residents, as their Part B premium will continue to be covered by Medi-Cal.

Example: Medi-Cal in a Nursing Home

Seth enters a skilled nursing facility. His income is $1,800/month, and pays $50 a month for a supplemental vision plan.

$ 1,800 Gross unearned income

-$50 Medical premium

-$35 Personal Needs Allowance

$ 1,715 Seth’s monthly resident cost to be paid each month to the nursing home or for medical costs not covered by Medi-Cal.

* The remaining $35 is Seth’s Personal Needs Allowance.

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Other Deductions from the Share of Cost:

In addition to the “any income deduction” and the monthly maintenance need level, any monthly medical premiums can also be deducted before the monthly resident cost is determined, such as your Medicare Part B premium or supplemental vision and dental insurance. Other deductions can also be made, depending on the circumstances.

For example, under a legal settlement, Hunt v. Kizer, recipients may use old, unpaid medical bills that they have to reduce the monthly Medi-Cal resident cost. Original documentation showing the billing statement is an outstanding balance should be provided to the county eligibility worker.

The documentation should include the following information:

Name and address of the provider who provided the service
Name of the person who received the medical service
Brief description of the medical service received
A “procedure code,” which is a medical reference number associated with the service provided.
Provider’s Medi-Cal Provider Identification Number or Provider License Number
Date(s) the medical service was provided
Date on which the bill was issued. If the bill is an unpaid, old medical bill, the billing date must be within 90 days of the date the county receives the bill. If the bill is older than 90 days, the Medi-Cal recipient can ask the provider for a more recent bill.
The amount owed solely by the individual and not subject to third-party coverage.

How Monthly Resident Costs Can Be Adjusted Under Medi-Cal

The monthly resident cost will be adjusted to reflect the cost of the outstanding balance, which could, for example, mean no monthly resident cost until the old, unpaid bills are paid off. This is not automatic and should be discussed with the Medi-Cal county eligibility worker.

Under the Johnson v. Rank settlement, recipients may use their monthly resident cost to pay for medically necessary supplies, equipment, or services not covered under the Medi-Cal program. This deduction is only applicable to long-term care residents. A current physician’s prescription is necessary and must be put in the recipient’s record at the facility. This prescription must be a part of the physician’s plan of care. After a copy of the prescription and the bill is presented to the facility, the facility will deduct the cost from that month’s resident cost and bill the resident for the remaining monthly resident cost.

D. What Does Medi-Cal Cover?

Medi-Cal pays for health care services which meet the definition of “medically necessary.” Services include: some prescriptions (although the Medicare Part D program now covers most prescriptions), physician visits, adult day health services, some dental care, ambulance services, X-ray and laboratory costs, orthopedic devices, eyeglasses, hearing aids, etc. Some services, such as home health care, durable medical equipment, and some drugs, require prior authorization.

Nursing home care is covered if there is prior authorization from the physician/health care provider. Residents are admitted on a doctor’s order, and their stay must be “medically necessary.”

If the individual qualifies for Medi-Cal, they do not need private “medigap” or HMO insurance to pay for costs, though if such insurance is carried, the premiums are deducted from income when computing the monthly resident cost and therefore costs the beneficiary nothing. If the HMO coverage includes drug benefits, maintaining the HMO coverage may become more important, as the beneficiary will continue to receive drug benefits from the HMO, which may be more comprehensive than the Medicare Part D coverage.

E. Assets

Although assets are no longer considered for eligibility purposes, applicants must remember that income generated from assets (e.g., rental income) may be included in the monthly resident cost calculation. Medi-Cal requires applicants and beneficiaries to report income from all sources. Income received from some assets may be counted toward the monthly resident cost, while others may be excluded from the calculation. Examples of income from some assets that would be included in the calculation include:

Rental property income
Periodic payments and required minimum distributions from IRAs, retirement plans for self-employed individuals, and work-related pension funds
Payments distributed from an annuity
Interest and dividends received from investments, savings accounts, etc.
Please see ACWDL 23-21 for a full list of countable and excluded income sources.

Income from Real Property

If a Medi-Cal beneficiary receives rental income from real property, including the principal residence, the “net” income from the property is used in determining what will be counted toward the monthly resident cost. Certain expenses are deducted from the gross rental income to determine the net income. These include taxes and assessments, interest payments (not principal), insurance, utilities, and upkeep and repairs.

Upkeep and repairs are the greater of either the actual amount expended for upkeep and repairs during the month or 15% of the gross monthly rental, plus $4.17 per month. (22 CCR §50508). Note that other calculations are used for income from rental of rooms, rental of unit(s) in a multiple dwelling unit, or other dwellings on the property (22 CCR §50508).

F. Transfer/Gifting Assets

A transfer of non-exempt assets can result in a period of ineligibility if the divided value of the transferred assets and the average private pay rate (APPR) is one or more months. The current APPR is $12,608 (effective January 1, 2024).

Example: Transfers made on or after January 1, 2024

Josh enters a nursing home in October 2024. He transferred $150,000 in August of 2024 to his brother. The county will not consider the months of January through October of 2024 but will review the 21 months prior to January 1, 2024, for transfers of property made during that time. Because the transfer happened in 2024, there is no transfer penalty.

Please note that a transfer penalty would only be applied to those entering a nursing home on Medi-Cal and not to applicants or beneficiaries living in the community. Prior to imposing a period of ineligibility, the applicant’s case must be reviewed for “undue hardship” by the Medi-Cal caseworker and receive approval from the DHCS, Medi-Cal Eligibility Division. (ACWDL 23-28)

Example: Transfers made prior to January 1, 2024

In December of 2023, Maya cashed out her retirement account and transferred the entire $250,000 to her daughter. In June of 2024, she applies for Long-Term Care Medi-Cal because she entered a nursing home. As the county will review the 25 months prior to 2024, the transfer could create a period of ineligibility. To find out the period of ineligibility, please see the calculation below:

$250,000 (amount transferred) $12,608 (APPR) = 19.82

Maya’s period of ineligibility will be 19 months because Medi-Cal does not count partial months. Per ACWDL 23-28, the county has to submit the period of ineligibility for approval to DHCS. DHCS will review if the period of ineligibility will impose undue hardship.

Assets in any amount can be transferred at any time to a blind or disabled child of any age. The child’s disability must meet the requirements under the Social Security Act, i.e., the child must meet the disability requirements for SSA or SSI disability benefits. Transfers of a home or any asset to a blind or disabled child will not affect the Medi-Cal beneficiary or applicant’s eligibility. However, a transfer of liquid assets may impact the benefits of a child who is receiving SSI benefits, in which case an SSI specialist should be consulted. Assets can also be transferred at any time to a spouse without any penalties.

G. Spousal Impoverishment Laws

Skilled nursing residents who are married or have a registered domestic partner may be eligible for spousal impoverishment protections. Under spousal impoverishment, the spouse at home (also referred to as the “community spouse”) can keep any income received in their name without having to contribute to the institutionalized spouse’s monthly resident cost in the nursing home. For example, if the community spouse receives a monthly income of $5,000, they can keep it all without contributing to the Medi-Cal recipient’s monthly resident cost.

However, if the community spouse is low-income, California law allows the community spouse to keep a minimum monthly maintenance needs allowance (MMMNA). The current (2025) MMMNA is $3,948 and increases annually. If the community spouse makes less than the MMMNA of $3,948, they can receive an allocation from the institutionalized spouse’s income until they reach the $3,948 MMMNA.

Example:

Seth and Logan are registered domestic partners. Seth recently entered a nursing home and was approved for Long-Term Care Medi-Cal with spousal impoverishment. Seth’s monthly income is $3,000. Logan’s monthly income is $1,435, which is below the MMMNA, allowing him to receive an allocation from Seth.

Step 1: Find Maximum Allocation to Community Spouse

$3,948 MMMNA

-$1,435 Community Spouse Income

$2,513 Max. Allocation to Community Spouse

Seth can allocate to Logan up to $2,419 of his own income so that Logan can meet the MMMNA.

Step 2: Calculate Monthly Resident Cost

$3,000 Institutionalized Spouse Income

-$2,513 Max. Allocation to Community Spouse

$487 Remaining income after allocation

-$35 Personal Needs Allowance

$452 Institutionalized Spouse’s Monthly Resident Cost

Seth’s monthly resident cost to the facility is $546 after allocation to Logan.

The couple can also file for a fair hearing to increase the MMMNA to generate additional income and/or obtain a court order to obtain additional income-generating resources.

H. Family Allocation

Under federal and state laws, Medi-Cal recipients can allocate additional income for the support of a dependent “family member” when there is a community spouse at home. Family members include only natural or adopted minors or dependent children or dependent parents or siblings of the institutionalized or community spouse who are residing with the community spouse. For the children to receive the maximum family member allocation, there must be a community spouse. Grandparents who have legal guardianship over grandchildren have been hit hard by this onerous rule, and foster children are not considered “children” or even “family members” for the purposes of long-term care Medi-Cal.

The family member base allocation amount, which is used to determine how much income the long-term care beneficiary may allocate to family members, is increased annually. The current amount, $2,555, is effective July 1, 2024, through June 30, 2025. Of course, the allocation is only possible if the institutionalized spouse has sufficient income left over after the spousal allocation to the community spouse.

The family allocation is calculated separately for each family member. Any income is deducted from the maximum allocation, and the remainder is divided by 3 to arrive at the total maximum allocation. If the child or children receive no income, the maximum family allocation amount would be $821 for each child.

$2,555 (maximum family allocation)

-300 (Social Security income received by child)

$2,255 divided by 3 = $751 maximum family allocation for each child

(source: ACWDL 24-07; Form MC 176 W, section IX)

I. Medi-Cal Recovery

Medi-Cal applicants, beneficiaries, and their spouses should always be aware of the Medi-Cal recovery rules and plan ahead if they want to avoid recovery on their home or other assets. For detailed information on the Medi-Cal Recovery program, see CANHR’s consumer booklet on Medi-Cal Recovery,
https://canhr.org/wp-content/uploads/Medi-Cal_Recovery.pdf

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In-Home Support Services (IHSS) Program.

The new "No Assets" Medi-Cal will also mean many more cases of eligibility for In-Home Support Services (IHSS). The best article applying the new eligibility rules to IHSS is put out by the American Council on Aging, updated as of March 19, 2025. I reprint it here in its entirety:

Overview of Medi-Cal’s In-Home Supportive Services Program

Available benefits include personal care assistance and homemaker services to assist these individuals in living safely and independently in their home or the home of a loved one. Program participants have the option to self-direct their care, which allows them to choose and hire their own caregivers, including friends and relatives.

The In-Home Supportive Services (IHSS) Program is a statewide Medi-Cal program that provides long-term services and supports for California residents who are aged, blind, or disabled and at risk of nursing home placement. Available benefits include personal care assistance and homemaker services to assist these individuals in living safely and independently in their home or the home of a loved one. Program participants have the option to self-direct their care, which allows them to choose and hire their own caregivers, including friends and relatives.

Within IHSS, there are 4 programs, the first two of which serve the majority of IHSS program beneficiaries.

Community First Choice Option (CFCO)—for Medi-Cal-eligible persons who require a Nursing Home Level of Care.
Personal Care Services Program (PCSP)—for Medi-Cal-eligible aged, blind, or disabled individuals who require personal care assistance, but do not require the level of care that is provided in a nursing home.
IHSS Plus Option Program (IPO)—provides payment to spouses or parents of Medi-Cal eligible persons who do not need a Nursing Home Level of Care, but require care assistance and receive it from a spouse or parent. Prior to becoming a Medi-Cal State Plan Option, this program was called the IHSS Plus Waiver.
IHSS Residual Program (IHSS-R)—provides a pathway of eligibility for persons who are not eligible for Medi-Cal, but require In-Home Supportive Services.

The In-Home Supportive Services Program is available through California’s Regular State Medicaid Plan. In California, the Medicaid program is called Medi-Cal.

While Home and Community Based Services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid plan, HCBS through Medicaid State Plans are an entitlement. Meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant to require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.

Following is a list of benefits available via the In-Home Supportive Services Program. Program beneficiaries only receive the services required to safely remain in their homes. A needs assessment determines the services a program beneficiary requires and the number of monthly service hours a program beneficiary can receive. Maximum hours are approximately 195/month for those without severe impairments, while persons severely limited in their functional ability can receive up to approximately 283 hours of care per month.

Homemaker Services—housecleaning, laundry, shopping, errands, and cooking
Paramedical Services—wound care, catheter care, injection assistance, blood sugar checks
Personal Care Services—non-medical assistance with daily living activities, such as bathing, dressing, toileting, and eating
Protective Supervision—supervision for cognitively or mentally impaired persons to help prevent accidents and injuries
Teaching / Demonstration Services—provider taught tasks to teach beneficiary to do housework, prepare meals, bathe, etc.
Transportation Assistance—escorting to & from medical appointments

IHSS services may be received in one’s home or the home of a family member. Persons cannot live in a community care facility or long-term care facility. This includes assisted living residences and adult foster care homes. Note: Persons who reside in long-term care facilities and have a planned discharge to return home can apply for IHSS prior to being discharged. Another option that California residents might want to consider is the Medi-Cal Community-Based Adult Services Program. Although not available statewide, this program offers out-of-home daytime care and supervision at designated CBAS centers.

The applicant income limit is equivalent to 138% of the Federal Poverty Level (FPL). While this figure increases annually in January, for California Medicaid, the income limits increase each April. Effective 4/1/25, the monthly income limit for the IHSS program for a single applicant is $1,801. When both spouses are applicants, there is a couple income limit of $2,433/month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,801/month.

There is no asset limit (effective 1/1/24). An applicant’s assets, regardless of value, are not considered in the eligibility process.

There is a Look-Back Period, during which Medi-Cal scrutinizes past asset transfers of persons applying for nursing home care, but it is not applicable to persons applying for the In-Home Supportive Services Program. However, if one may require Nursing Home Medicaid in the near future, it may be applicable. With the elimination of the asset limit, assets transferred on or after 1/1/24 are not considered. Assets transferred prior to 1/1/24 are still being scrutinized, but the 30-month “look back” is being phased out month-by-month and will no longer exist by July of 2026.

While all assets are disregarded when determining Medi-Cal eligibility, one’s assets are not necessarily safe from the Medicaid Estate Recovery Program (MERP). Following the death of a long-term care Medicaid beneficiary, the state attempts reimbursement of long-term care costs for which it paid for that individual via their remaining estate. This may include one’s home. With the utilization of proper planning strategies, one can protect their home and other assets from being used as reimbursement and instead go to loved ones as inheritance. Contact a Certified Medi-Cal Planner for assistance.

A Nursing Home Level of Care is not necessarily a requirement to receive care services via Medi-Cal’s In-Home Supportive Services Program

An applicant must have a medical need for care services and be at risk of institutionalization (nursing home care) without program assistance. Recall that within the In-Home Supportive Services Program there are 4 subprograms. To be eligible for the Community First Choice Option, an applicant must require a Nursing Facility Level of Care (NFLOC). Upon application for the IHSS program, a needs assessment is completed by the social services agency in one’s county. As part of the assessment, an applicant’s care needs are ranked from 1 to 6. A ranking of 1 indicates that an individual can function independently, while a ranking of 6 indicates an individual requires the greatest level of care available through the program. An applicant’s ability to independently complete Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting) is one area that is considered during the assessment. Relevant to some persons with Alzheimer’s disease or a related dementia, cognitive functioning, such as one’s capacity to retain information or problem solve, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

Having income over Medicaid’s limit does not mean an applicant cannot still qualify for the In-Home Supportive Services Program. Medi-Cal has a Share of Cost program, also called a Medically Needy Program. With this program, an applicant with income over Medi-Cal’s income limit qualifies for the program by paying a “share of cost” for their care services / medical expenses (i.e., paying their IHSS caregiver). This can be thought of as a deductible and is based on one’s monthly income. Once one has paid their share of cost for the month, the IHSS Program will pay for services and supports the remainder of the month. Professional Medicaid Planners can assist persons in lowering their “share of cost”. Find a Medi-Cal Planner.

Prior to submitting an application for the IHSS Program, applicants need to ensure they meet the eligibility criteria. Applying when over the income limit may be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

Applicants will need to gather documentation to be submitted with their application. Examples include proof of income and copies of Social Security and Medicare cards. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.

To apply for the In-Home Supportive Services Program, applicants should contact the IHSS office in their county and submit an Application for In-Home Supportive Services (SOC 295). Persons not currently enrolled in Medi-Cal must apply via the Application for Health Insurance. Persons can apply for Medi-Cal independently of applying for the IHSS Program or at the same time.

As part of the IHSS application process, an in-home functional needs assessment is completed by a county social worker to determine if services are required to safely live at home, and if so, the level of assistance required. A Health Care Certification Form (SOC 873) must be completed and submitted by a licensed health care professional prior to services being provided. Program applicants will receive a notice of action (NOA) indicating whether they have been approved or denied for IHSS services. If approved, the authorized services and total monthly hours of services permitted will be included.

Learn more about the In-Home Supportive Services Program. Alternatively, persons can contact their local IHHS county office.

The In-Home Supportive Services Program is administered by the California Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS).

The Medi-Cal application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.

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Using California's Spousal Impoverishment Rule for Home and Community Based Services

A very significant aspect of Med-Cal law now becomes even more important. As more people qualify for home and community based services (thanks to the new asset elimination law)protecting income allocation will be vital. CANHR has put out an updated article (as of August 22, 2024) explaining how spousal impoverishment rules can be used to acquire IHSS and other Medi-Cal benefits. I thank CANHR for their skillful presentation.

Using California's Spousal Impoverishment and Rule for Home and Community Based Services CANHR

Rule for Home and Community Based Services

Private paid community support or in-home care can range from an average of $1,842 to $7,055 monthly. The high cost of these services, in addition to the high cost of living in California, can quickly deplete the resources of an elderly couple on a fixed income. Congress enacted the spousal impoverishment provisions to prevent the impoverishment of the healthy spouse, otherwise known as the “community spouse,” when the other spouse or registered domestic partner (RDP) has high care needs and would qualify for institutional care. Spousal impoverishment protections were expanded to include Medi-Cal Home and Community-Based participants in 2014. These protections allow married couples and RDPs with incomes higher than the traditional Medi-Cal income limit to access Medi-Cal coverage for in-home and community support.

Who can benefit from spousal impoverishment?

Married couples or RDPs with income over the Medi-Cal income limit

If you are interested in applying for Medi-Cal to assist with in-home care expenses but are worried that your income may be too high, and you are married or in a registered domestic partnership, the “Spousal Impoverishment Protections” described below may help you. As of January 1, 2024, assets are no longer used to determine Medi-Cal eligibility.

Married couples or RDPs enrolled in Medi-Cal with a Shared Monthly Cost

If one or both of you are enrolled in Medi-Cal and eligible with a share of cost, you may want to evaluate if you could benefit from the application of the spousal impoverishment provisions to reduce or eliminate your shared monthly cost.

How do spousal impoverishment protections work?

Under the spousal impoverishment protections, Medi-Cal calculates the two spouses' incomes separately. The income of the community spouse (the spouse not seeking benefits) is not counted towards the calculation unless it would benefit the couple. Every year the federal government sets a Minimum Monthly Maintenance Needs Allowance (MMMNA), allowing married Medi-Cal recipients enrolled in HCBS programs or waitlists to transfer some or all their income to a low-income spouse to prevent them from being impoverished.

Spousal Impoverishment when the Community Spouse’s Income is ABOVE the MMMNA: If their income is above the MMMNA, they are not eligible to receive an allocation; however, their income will not negatively impact the HCBS spouse’s eligibility. Medi-Cal will only use the income that comes in the HCBS spouse’s name to determine if there will be a shared monthly cost.

Spousal Impoverishment when the Community Spouse’s Income is BELOW the MMMNA: If their income is below the MMMNA, they are eligible to receive an allocation up to the MMMNA. The MMMNA for 2024 is $3,854. After an allocation is made from the HCBS spouse, the leftover income is used to determine the HCBS spouse’s countable income.

Looking at the HCBS Spouse’s Countable Income: The income limit for one person is used to determine the HCBS spouse’s eligibility. The Medi-Cal income limit for one person in 2024 is $1,732.

The HCBS spouse’s income is below $1,732, there will be no shared monthly cost. If the HCBS spouse’s income is over $1,732, they will have a shared monthly cost. To calculate that amount, subtract a $600 maintenance need, any monthly health insurance premium costs, and an additional $20 income deduction; the remainder is the shared monthly cost.

In summary, spousal impoverishment provisions guarantee that the spouse or registered domestic partner not seeking services can keep all of their own income, but if their income is below the MMMNA, they could be eligible for allocation from the HCBS spouse. These provisions may help the couple eliminate or reduce their shared monthly cost.

Low-Income Community Spouse Example:

Jose lives with his wife, Virginia, who needs help to take care of her husband at home. Jose receives $2,000 a month and Virginia receives $2,000 a month. If Jose applies for Medi-Cal and HCBS, Virginia would be considered the community spouse. Because her income is less than the MMMNA ($3,854), she can keep all of her own income and receive an allocation from her husband. Virginia can receive an allocation of $1,854, leaving Jose with only $146 dollars in countable monthly income. Since Jose’s new income is under the $1,732 limit for one person, he will not have a shared monthly cost.

High Earning Community Spouse Example:

Mike and Jody are married. Jody has Medi-Cal and needs HCBS. Mike receives $4,000 in monthly income, and Jody receives $2,000 in retirement income. Mike is the community spouse. Mike’s income is more than the MMMNA of $3,854. Although he is not eligible for an allocation from his wife, he can keep all the income he receives in his name. Because Jody receives more than the $1,732 limit for one person, she will have a shared monthly cost. To determine her shared monthly cost, Medi-Cal deducts a $600 maintenance need and a $20 income deduction. Jody’s shared monthly cost would be $1,380. Tip: It may be possible to eliminate or reduce a shared monthly cost. See CANHR’s fact sheet for more information.

Step by Step Instructions:

HOW TO APPLY FOR MEDI-CAL TO PAY FOR HCBS AND RECEIVE SPOUSAL IMPOVERISHMENT PROTECTIONS

To apply for Medi-Cal to pay for HCBS, and to ensure that the spousal impoverishment protections are properly applied to your case, you must:

Complete a Medi-Cal application.
Indicate on the application that you are interested in or have a need for HCBS.
On the SAWS 2 PLUS Application, Page 6, you would answer “yes” to question 6j “Does
this person need help with activities of daily living through personal assistance or a
medical facility?”
On the benefitscal.com portal, you would indicate that the person needs help with activities
of daily living through personal assistance or a medical facility or home and community
based services.
Identify the community spouse on the application. To receive the full benefit of the spousal
impoverishment provisions the spouse not needing the HCBS services should ensure that they are
not also requesting Medi-Cal benefits on the application.

Additional Application Tips:

Many prospective applicants report being incorrectly denied, having their shared monthly cost calculated incorrectly, or their case processed incorrectly. To improve your chances of having the provisions appropriately applied, you may want to write explicitly on your Medi-Cal application, “Applicant is applying for Medi-Cal using the Home and Community Based Services and spousal impoverishment provisions outlined in ACWDL 18-19,” and include a copy of the ACWDL 18-19.

Second, you must establish that you meet the clinical eligibility requirements for HCBS, meaning you must demonstrate that you require a nursing facility level of care. To do this, you have two options:

A. Have your doctor complete a Doctor’s Verification Form, which the Medi-Cal office should send as soon as you indicate that you are interested in HCBS. (You can also download the Doctor’s Verification Form online at https://www.dhcs.ca.gov/formsandpubs/forms/Forms/MC604MDVENG.pdf) After your doctor completes the form, she must send it directly to the county Medi-Cal office. OR

B. Contact an HCBS program to begin the application process. The HCBS program will complete a needs assessment to determine whether you meet the clinical criteria for nursing home care. Once the needs assessment is complete, the HCBS program staff should communicate directly with your county Medi-Cal office to verify that you meet the clinical criteria for enrollment.

Is In-Home Supportive Services (IHSS) a qualifying HCBS program?

It depends on which IHSS program you are enrolled in. IHSS has several different programs. A large percentage of people enrolled in IHSS are enrolled in the Community First Choice Option (CFCO). If you are enrolled in IHSS’ CFCO program, then you are entitled to spousal impoverishment protections. IHSS recipients can call their county Medi-Cal office to verify whether they are enrolled in CFCO. Individuals enrolled in CFCO will have a “2k” Aid Code. If they are not enrolled in CFCO, they should contact their IHSS office to ask for a reassessment of eligibility.

All County Letter 14-60 explains the eligibility requirements for the CFCO program:
www.cdss.ca.gov/lettersnotices/EntRes/getinfo/acl/2014/14-60.pdf.

What if the HCBS program I am interested in has a waitlist?

Spousal impoverishment protections apply to HCBS applicants on waitlists.

Dealing with Incorrect Shared Monthly Cost Determination or Denial?

If Medi-Cal incorrectly determines your shared monthly cost or denies you when you should have been eligible, the best course of action is to file for a fair hearing immediately once you receive the Notice of Action (NOA). The NOA contains information about your eligibility for Medi-Cal and the action that Medi-Cal has taken on your case. Information on how to file a fair hearing should be on the notice. If you did not receive the NOA, contact your county office and ask them to send it to you. In the request for a fair hearing, it is recommended to include information for the hearing officer about spousal impoverishment provisions, citing guidance on the provisions available in ACWDL 17-25 and 18-19.

What if I already have Medi-Cal?

If you are already enrolled in Medi-Cal and you are not currently enrolled in one of the HCBS programs described above, you may contact an HCBS provider to begin the application process. Once you begin the application process for HCBS and demonstrate you meet the clinical eligibility for HCBS (either by completing the HCBS needs assessment or by having your doctor complete a verification form), the spousal impoverishment protections should be applied to your Medi-Cal case.

If you are already enrolled in Medi-Cal and you are also already enrolled in one of the HCBS programs listed above, you are entitled to spousal impoverishment protections retroactive to January 1, 2014. If you believe you are entitled to retroactive spousal impoverishment, please call CANHR at
(800) 474-1116 and ask to speak with an advocate.

Medi-Cal Assisted Living Waiver Program: Benefits and Eligibility

The Assisted Living Waiver (ALW) program is available in 15 California counties and is the rare program where Medi-Cal will actually pay for assisted living stays. The American Council on Aging has put together the best article on the subject, updated as of March 18, 2025.

Medi-Cal (California Medicaid) Assisted Living Waiver: Benefits, Eligibility & How to Apply American Council on Aging

Overview of the Medi-Cal Assisted Living Waiver

The Medi-Cal Assisted Living Waiver (ALW) provides assisted living services for California residents who are elderly or disabled and require a nursing home level of care but prefer to reside in an assisted living environment instead of a nursing home. The ALW provides personal care assistance, homemaker services, and home health aides in Adult Residential Facilities (ARFs), Residential Care Facilities for the Elderly (RCFE), and, limited to Los Angeles, also Public Subsidized Housing (PSH).

Many waiver programs offer a participant-directed option, allowing program beneficiaries to select their own caregivers, including friends and relatives. The ALW does not. Assisted Living Waiver services are provided by licensed home health agency providers or staff employed by the residential care facility.

The ALW is not available statewide and, currently, is available in 15 CA counties. However, persons can move to an assisted living setting within a county that offers the program.

The Assisted Living Waiver is not an entitlement program. There are a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms. Currently, there is a significant waiting list. As of November 2024, there are 6,287 persons on the waiting list.

Wait List Alternatives: Are you interested in connecting with a Medicaid planning professional to discuss alternatives to Medi-Cal’s Assisted Living Waiver? Waitlists can last from months to years, but there are other Medicaid programs that offer immediate care outside of nursing homes. The Assisted Living Waiver is a 1915(c) Medicaid Waiver. In California, the Medicaid program is called Medi-Cal.

Historically, Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care/adult family living. Waivers can target specific groups who require a nursing home level of care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. Meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

The following is a list of the benefits available via the Assisted Living Medi-Cal Waiver. An individualized service plan determines which services a program participant will receive and the frequency with which they are received.

Activities—recreational, therapeutic, and social
Care Coordination / Management
Homemaker Services—housekeeping and laundry
Medication Oversight
Personal Care—non-medical assistance with daily living activities, such as bathing, dressing, toileting, and eating
Prepared Meals and Snacks
Residential Habilitation—one-on-one care assistance with a focus on improving socialization, self-help, and adaptive skills in regards to behavioral issues
Skilled Nursing / Home Health Aides—on an as-needed basis
Transitional Assistance—from nursing facility to assisted living
Transportation / Coordination of Transportation

The ALW does not cover the cost of room and board in assisted living settings. The Assisted Living Waiver has a significant waitlist that dates back to 2019. Medi-Cal offers additional long-term care programs in which CA seniors might be interested. The In-Home Supportive Services Program provides in-home personal care and homemaker assistance, and the Multipurpose Senior Services Program offers a variety of home and community-based assistance options.

The ALW is for California residents who are elderly (aged 65+) or between the ages of 21 and 64 if disabled. Applicants who are nursing home residents must have been there a minimum of 60 days. Applicants must be willing to reside in a CA county that has an assisted living residence that participates in the ALW program. Currently, ALW services are available in the following California counties:

Alameda
Contra Costa
Fresno
Kern
Los Angeles
Orange
Riverside
Sacramento
San Bernardino
San Diego
San Francisco
San Joaquin
San Mateo
Santa Clara
Sonoma

Income

While the Assisted Living Waiver itself has no income limits, one must be eligible for full-scope Medi-Cal without a Share of Cost in order to be eligible. This income limit is equivalent to 138% of the Federal Poverty Level (FPL). While this figure increases annually in January, Medi-Cal’s income limits increase each April. Effective 4/1/25 – 3/31/26, a single applicant can have a monthly income up to $1,801. When both spouses are applicants, the income limit for the couple is $2,433 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,801/month.

In limited circumstances, persons who exceed the Medi-Cal income limits can still be eligible for the Assisted Living Waiver.

ALW participants must contribute towards their room and board costs. The amount is based on their income. In CA, in 2025, state residents who receive SSI and live in an assisted living setting receive a monthly payment of $1,599.07. Of this amount, an individual can retain $179/month as a Personal Needs Allowance, while the remaining $1,420.07/month must be paid to the residence for room and board. If an applicant has income over $1,599.07/month, $1,420.07/month goes towards room and board, and the individual can keep $179 / month.

Assets

There is no asset limit (effective 1/1/24). An applicant’s assets, regardless of value, are not considered in the eligibility process.

There is a look-back period, during which Medi-Cal scrutinizes past asset transfers of persons applying for nursing home care, but it is not applicable to persons applying for the Assisted Living Waiver. However, if one may require Nursing Home Medicaid in the near future, it may be applicable. With the elimination of the asset limit, assets transferred on or after 1/1/24 are not considered. Assets transferred prior to 1/1/24 are still being scrutinized. However, the 30-month “look back” is being phased out month-by-month and will no longer exist by July of 2026.

An applicant must require a Nursing Facility Level of Care (NFLOC). For the Assisted Living Waiver, a specialized, electronically scored assessment tool is administered by a registered nurse to determine if this level of care need is met. As part of the assessment, an applicant’s care needs are further determined on a tier level of one to five. Tier one indicates an applicant requires the minimal amount of support provided by the ALW, while a determination of tier five indicates one requires the highest level of support available. An applicant’s ability to independently complete Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting) is one area that is considered during the assessment. Relevant to some persons with Alzheimer’s disease or a related dementia, behavioral problems, such as regular attempts to leave the facility or removal of one’s clothes, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

Having income over Medicaid’s limit does not necessarily mean an applicant cannot still qualify for Medicaid. While Medi-Cal has a Share of Cost program, the Assisted Living Waiver does not allow applicants to qualify via this program. With “Share of Cost,” an applicant with income over Medi-Cal’s income limit has a set amount of income, a “Share of Cost,” that must be spent on medical expenses and supplies before qualifying for program benefits. However, in some situations, it may be possible to eliminate one’s share of cost, allowing them to be eligible for the ALW. Find an experienced Medicaid planner that can assist.

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How to Apply for the Medi-Cal Assisted Living Waiver

Before You Apply

Prior to submitting an application for the Assisted Living Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income limit may be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

As part of the application process, applicants will need to gather documentation for submission. Examples include proof of income and copies of Social Security and Medicare cards. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.

The Assisted Living Waiver is approved for a maximum of approximately 16,344 program participants, and currently, there is a statewide waitlist. Priority is given to nursing home residents who have been residents for 60+ days and are transitioning back into the community, as well as persons who have a referral from Adult Protective Services. Persons can contact an Assisted Living Waiver Care Coordination Agency to inquire as to the current average waiting period.

Application Process

In order to be eligible for the Assisted Living Waiver, an applicant must be a Medi-Cal recipient with zero Share of Cost. To apply for Medi-Cal, one must complete an Application for Health Insurance. Persons can also apply online at Covered California or over the phone / in person at one’s Department of Health Care Services county office.

To apply for the ALW, applicants must contact a participating Care Coordination Agency in their county or the county to which they would like to relocate, to fill out and submit a program application to CA’s Department of Health Care Services. Persons can see a list of participating RCFE’s and ARF’s by city and county here and a list of participating PSH facilities by city here. As part of the application process, a care needs assessment is completed by a registered nurse hired by the Care Coordination Agency. An over-the-phone prescreening is completed first to determine if the individual qualifies for the actual assessment.

There are currently no available assisted living beds via the Assisted Living Waiver. Applicants should complete a Waitlist Request Form to be put on a statewide waitlist. The Care Coordination Agency will be contacted by CA’s Department of Health Care Services (DCHS) when a participant slot becomes available. The applicant will have 60 days to submit a completed application to DHCS. It is possible that an applicant who currently receives Medi-Cal benefits but who does not yet meet the functional need for care be placed on the waiting list for the ALW.

Learn more about the Assisted Living Waiver. Alternatively, persons can contact their local DHCS county office.

The Assisted Living Waiver is administered by the California Department of Health Care Services (DHCS).

Approval Process & Timing

The Medi-Cal application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waitlist currently exists for the Assisted Living Waiver, approved applicants may spend years waiting to receive benefits.

We have provided a link to an excellent presentation by CANHR:
https://canhr.org/in-home-supportive-services-ihss/

Understanding Shared Monthly Cost for Medi-Cal

I present for your intellectual enjoyment a wonderful article by CANHR that explains Medi-Cal's shared monthly cost, updated as of September 4, 2024.

When you apply for Medi-Cal and are over the income limit for free Medi-Cal, you may still qualify for Medi-Cal with a shared monthly cost (formerly known as “Share of Cost”). A shared monthly cost (SMC) is the amount of money you must pay each month towards medical related services, supplies, or equipment before your Medi-Cal insurance pays anything. Think of it like a monthly “deductible.”

If your countable income is higher than 138% of the federal poverty level for Medi-Cal, currently $1,732 for an individual or $2,352 for a couple as of April 1, 2024, you may owe a shared monthly cost. This is calculated by deducting the maintenance need for the household from countable income. For a single beneficiary, the maintenance need is $600; for a couple, it is $934 monthly.

Example: Mary is single and her countable income is $1800 after deductions. Her shared monthly cost would be $1,800 – $600 = $1,200. Mary would need to meet her shared monthly cost of $1,200 before Medi-Cal provides coverage in the month she needs medical services.

Example: Seth and Linda are married with a combined countable income of $2,500 a month after deductions. Their shared monthly cost would be $2,500 – $934 = $1,566. They would need to meet their shared monthly cost of $1,566 before Medi-Cal can provide coverage in the month they need medical services.

You only need to pay your shared monthly cost during the months that you need coverage.

In months where you have fewer expenses than your shared monthly cost, you can pay out of pocket for services you need, and are not obligated to pay the entire shared monthly cost. If you don’t need to see your doctor or get any health care, you do not owe a shared monthly cost during that month.

Example: Lucy has Medicare and Medi-Cal with a shared monthly cost of $1,400. Medicare typically covers her regular doctor’s visits and prescriptions. However, she was recently hospitalized for seven days. Even though Medicare covers 80% of her stay, she has a daily copay of $250. The copays can be used to meet her shared monthly cost, and after paying the hospital $1,400, Medi-Cal will pay the remaining balance of her medical bills for that month.

The most common way to reduce or avoid a shared monthly cost is to purchase supplemental health insurance policies to lower countable income, such as supplemental dental, vision, or a Medicare Part D prescription drug plan. It’s important to note that not everyone can purchase these plans. The monthly cost of these health insurance plans lower your countable income, which may help you qualify for Medi-Cal with no shared monthly cost.

Submit proof of your health insurance premiums to the county Medi-Cal office, and ask them to recalculate your shared monthly cost. For assistance identifying policies available for purchase, contact Health Insurance Counseling and Advocacy Program (HICAP), which offers free registered health insurance counseling – 1-800-434-0222.

If you are married or in a registered domestic partnership,“Spousal Impoverishment” rules may allow you to have a higher monthly income and qualify for free Medi-Cal or a reduced shared monthly cost. This option is only available to couples where one spouse or partner is considered “institutionalized” – either by living in a nursing home or by being enrolled or on a waitlist for a participating Medi-Cal Home and Community Based Services Program. To learn more about accessing these programs, read CANHR’s Home and Community Based Services Quick Guide. To read more about spousal impoverishment protections when one person is in a nursing home, read CANHR’s Overview of Long-Term Care Medi-Cal. To learn more about options for couples at home or in the community, read our fact sheet on spousal impoverishment.

You can meet your required monthly shared monthly cost through healthcare expenses, including medical equipment, prescription drugs, or medical services. Other medical costs that Medi-Cal does not cover, such as providers that do not accept Medi-Cal and medical procedures or treatments denied by Medi-Cal can also be used toward the share of cost. Payments to In-Home Supportive Services (IHSS) caregivers count toward your share of cost, as well as home care services prescribed by a doctor that are beyond approved IHSS hours required for you to remain safely at home. To learn more about how IHSS works with a share of cost, visit: https://www.cdss.ca.gov/agedblinddisabled/res/FactSheets/IHSS_Share_of_Cost_Color.pdf

You may want to consider scheduling health and dental appointments within the same month to maximize your shared monthly cost. For example, if you have a surgery or other expensive service scheduled, try to schedule other visits, screenings, or labs or order prescriptions within that same month. Once you can submit proof that you have paid for enough health-related expenses equal to your required shared monthly cost, Medi-Cal will pay for any remaining services the rest of that month.

Residential Care Facilities for the Elderly (RCFEs), sometimes called assisted living or board and care, are not licensed as medical facilities and are usually paid privately, as they are not funded by Medicare or Medi-Cal. Many individuals who live in RCFEs could benefit from Medi-Cal to pay for doctors’ visits, copays, medical equipment, or medications, but they might be stuck with a large shared monthly cost if they make more than the income limit for no-cost Medi-Cal. RCFE residents may be able to use the Board and Care Deduction to help them qualify for no or low shared monthly cost Medi-Cal. Read our fact sheet on the deduction: https://canhr.org/board-care-medi-cal-deduction/

The 250% WDP provides Medi-Cal coverage for individuals who meet the Social Security definition of “disabled” with countable monthly income below 250% of the Federal Poverty Level. The program does not count disability related income such as SSDI, and eligible beneficiaries receive free Medi-Cal. To be eligible for the program:

You must meet the Social Security definition of “disabled” (without regard to the substantial gainful activity component of the definition).

You must also be working, with countable monthly income under 250% of the Federal Poverty Level. You have to be able to provide proof of employment and earnings, but there is no minimum work requirement — you can work for one hour a month and still be eligible.

Your unearned income (such as pension or investment income) must be less than the current income limit for the SSI/SSP program, however, you do not need to be eligible for SSI/SSP.

Yes. Skilled nursing facility residents must agree to pay the facility a portion of their income each month. This is called the monthly resident cost (formerly known as “Share of Cost”) and is treated much like rent. Once the resident pays their monthly resident cost to the facility, Medi-Cal will cover the remaining costs for the month. The monthly resident cost is calculated by taking the individual’s gross monthly income, deducting any out-of-pocket medical premiums, and deducting the Personal Needs Allowance of $35. For more information on monthly resident costs in a skilled nursing facility, refer to our Overview of Medi-Cal for Long-Term Care fact sheet.

Contact your Medi-Cal eligibility worker to discuss what may work for you to reduce or stop your share of cost. They should assist with making the changes to your Medi-Cal case. Find your local Medi-Cal Social Services office here.

Your Medi-Cal worker will need to see proof of your deduction expenses in order to get rid of your share of cost. This proof can include paperwork like

Health insurance premium statements
Bills or receipts for any out of pocket medical expenses
Unpaid medical bills
Your Admission Agreement from a licensed board and care facility

I contacted the Medi-Cal office and provided proof, but my shared monthly cost is the same.

You have the right to challenge their decision. Here are some ways you can challenge the decision:

Call your local Social Services office and ask to speak with your worker’s supervisor about the decision.

If you are not satisfied with the supervisor’s response, you can ask to speak with the director about the decision.

Request an appeal hearing. Visit the Medi-Cal Fair Hearing webpage for more information on how to file an appeal:

https://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx

Rosā Law Offices

2026 Asset Limit Reinstatement FAQ's

California's Governor and the Legislature recently reached a budget agreement which includes a major change for older adults and persons with disabilities who need Medi-Cal. Effective January 1, 2026, the asset limit will be reinstated for non-MAGI Medi-Cal programs, back to 2022 levels - $130,000 for an individual, and $65,000 for each additional household member. For couples receiving Spousal Impoverishment protections, additional asset limits will apply. CANHR is refreshing our fact sheets and will host training on this important topic, but we are waiting until the Department of Health Care Services (DHCS) issues written policy letters that confirm how they will implement these changes. In the meantime, below are answers to some of the frequently asked questions that may come up for you regarding this change.

What will the asset limit be?

As of January 1, 2026, the asset limit will be $130,000 for an individual and $195,000 for couples, plus $65,000 for any additional household members. It is important to note that for non-MAGI programs, Medi-Cal does not always count the people who live in the home for their definition of household. For couples with spousal impoverishment protections, the asset limits will be $130,000 for the "institutionalized" spouse, and the "community spouse" can have up to the Community Spouse Resource Allowance (CSRA) - this figure changes slightly every year, for 2025 it is $157,920.

When do assets need to be reported to Medi-Cal?

For new applicants, assets will need to be reported for all new Medi-Cal applications received on or after January 1, 2026.
Current Medi-Cal beneficiaries will need to provide information about their assets either during their next annual renewal that occurs after January 1, 2026, or during a change in circumstance (CIC) redetermination, if asset information was previously collected and can be verified via ex parte review. (See ACWDL 25-14 for sample scenarios).

For example, if a person's regular renewal month is August, they will not need to report assets this August of 2025. Assuming there are no changes to
their circumstances (such as income or living situation), they would be expected to report assets in August of 2026.

What assets will be counted in 2026?

Not all assets will be counted for Medi-Cal eligibility. Previous Medi-Cal rules for "exempt" or "non-exempt" assets will remain the same as they were prior to 2024. Assets that are considered exempt, and will not be counted include the primary residence, household goods and personal effects, jewelry,

one car, IRAs/work pension account balances when the person is receiving periodic payments of interest and principal, whole life insurance (face value $1,500 or less), term life insurance, burial plot, prepaid irrevocable burial plan, $1,500 in designated burial funds, other real property used for business

or self-support, and the $130,000 property reserve. For couples under Spousal Impoverishment protections, in addition to the Community Spouse Resource Allowance, the community spouse's IRA or work-related pension is not counted, regardless if they are taking regular distributions or not.

Will the return of the asset limit change the way my income is counted?

Possibly. Based on ACWDL 05-17, if an applicant or Medi-Cal beneficiary receives income from an asset that fits within their property reserve (ex. $130,000 for an individual), then the income is exempt, and should not be counted when determining their share of cost. For example:

Example: Jenny is on Medi-Cal. She has a bank account with $5,000, and a CD of $30,000 that generates income. Because Jenny’s “property reserve” is below the limit of $130,000, the income generated by the CD is not counted toward her share of cost.

Will the asset limits change if I am married or have a registered domestic partner?

Typically, married couples and registered domestic partners are subject to an asset limit of $195,000 because they are in the same household, or Medi-Cal Family Budget Unit (MFBU). The MFBU is the number of people Medi-Cal includes in your household when determining a person's or family's

eligibility and share of cost.

Married couples and registered domestic partners who qualify for Spousal Impoverishment protections are placed into two separate MFBUs, or households, allowing the Medi-Cal spouse to keep $130,000 in their name and the well-spouse to keep the CSRA of $157,920 (for 2025) in their name. For more

information on Spousal Impoverishment and to see if you qualify, please see our factsheet “Using Spousal Impoverishment Rule for Home and Community Based Services.”

Example of a couples in the same MFBU without Spousal Impoverishment:

Jose and Melia live together at home. Both receive Medi-Cal under the Aged and Disabled Program. Their combined asset limit is $195,000 ($130,000 + $65,000 = $195,000).

Example of a couples in separate MFBUs because of Spousal Impoverishment:

James is considered institutionalized as he is enrolled in a Home and Community-Based Services (HCBS) program. His husband Bruce is not on Medi-Cal. With Spousal Impoverishment, couples are separated into their own MFBUs, giving them separate asset limits. The community spouse retains up to the Community Spouse Resource Allowance (CSRA), and the Medi-Cal spouse retains up to the asset limit for a single person ($130,000). This offers the couple a larger property reserve of $130,000 plus the CSRA, which is currently $157,920 for 2025.
Marina and Dennis are married and want to apply for Medi-Cal because they each need in-home care, and each intends to apply for HCBS. Spousal impoverishment does not apply because they both will be considered “institutionalized.” They would each have a separate asset limit of $130,000.

Will transfer penalties be applied if I transfer assets in 2025?

DHCS has not yet released policy letters that confirm how they will reinstate the "lookback" period for transfers made in 2025. However, assets are completely exempt (not counted) in 2025. According to ACWDL 90-01, transfer of exempt property cannot be considered in determining a transfer penalty.

In 2026, Medi-Cal will begin to consider transfer penalties for individuals who transfer properties on or after January 1, 2026 for the purposes of becoming eligible for Long Term Care Medi-Cal, to cover a stay in a skilled nursing facility. Penalties will only apply to transfers larger than the Average Private

Pay Rate (APPR) ($13,656 for 2025). Transfers less than the APPR will not be counted. Additionally, transfers of exempt property (as per rules of the time of the transfer) would not result in a penalty.

For example, there would be no transfer penalty for someone who had $125,000 in total assets in 2026 and made a transfer of $100,000 because the amount transferred was below the $130,000 asset limit for that time period.

Transfer penalties can only be applied to those entering a nursing home on Medi-Cal, and not to applicants or beneficiaries living in the community.

Example someone without a transfer penalty:

Anthony has $125,000 in total assets in 2026 and makes a transfer of $100,000, which would be under the $130,000 asset limit for that time period. He has no transfer penalty because the amount transferred was from within his $130,000 property reserve, and is an exempt asset.
Carmen has $142,000 in total assets in 2026. She makes a transfer of $12,000 to meet the $130,000 asset limit and become eligible for Medi-Cal. She would not receive a penalty because the amount transferred was below the APPR.

Example of someone with a transfer penalty:

David has $150,000, and transfers $20,000 to his son in August, 2026. He applies for Medi-Cal in September of 2026. Because David is in a nursing home, and the amount transferred is over his asset limit of $130,000, a transfer period will be applied. The amount transferred is divided by the 2026 APPR (unknown at this time, but likely to be greater than $13,656). David will have a period of ineligibility of 1.5 months. California does not count partial months, so he will be ineligible for one month, running from the month of transfer - August, 2026. David will not be eligible for August, but he will be eligible as of September 1, 2026.

Is there anything else I need to know?

This change does not create new rules about what assets are countable or not countable for Medi-Cal eligibility.
SSI recipients still need to comply with SSI asset limit rules ($2,000 for an individual, $3,000 for a couple).
Be cautious about making quick decisions to give away your assets, there is still time to learn more about how the asset limit changes will affect your Medi-Cal eligibility. You may want to consult with an attorney or a tax expert to understand potential tax consequences of giving away your assets.
CANHR will be updating fact sheets and hosting live informational sessions on the asset limit changes in the coming months.

Rosā Law Offices

GLOSSARY:

Medi-Cal:

Medi-Cal is California’s version of the federal Medicaid program, providing health insurance to low-income individuals. In addition to paying for nursing home care, Medi-Cal also covers the cost of in-home caregiving, assistance with household chores, and other “home and community-based services” (HCBS). Home and Community Based Services: Home and community based services (HCBS) provide opportunities for Medi-Cal beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs serve a variety of targeted population groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses. Registered Domestic Partner: A registered domestic partner is a couple who has filed a Declaration of Domestic Partnership with the California Secretary of State's Domestic Partners Registry. Registered domestic partners in California have the same rights, responsibilities, and benefits as spouses. Shared Monthly Cost: When you apply for Medi-Cal and are over the income limit for free Medi-Cal, you may still qualify for Medi-Cal with a shared monthly cost (formerly known as “Share of Cost”). A shared monthly cost (SMC) is the amount of money you must pay each month towards medical related services, supplies, or equipment before your Medi-Cal insurance pays anything. Think of it like a monthly “deductible.

Program for All-Inclusive Care for the Elderly (PACE):

The new laws will increase the availability of the PACE program as well, opening the door to IHSS, adult daycare, and other Medi-Cal paid services. Once again, I present a marvelous CANHR article that explains how the PACE program works, updated as of September 4, 2024.

Program for All-Inclusive Care for the Elderly (PACE) CANHR:

The Program for All-Inclusive Care for the Elderly (PACE) is a federally and state-funded program that coordinates all-inclusive medical and social services to meet the particular needs of eligible older adults who have remained in the community but would otherwise need to be in long-term care. PACE provides in-home care services in addition to transportation to adult day health care centers where participants can receive medical care, rehabilitative therapies, and social services.

PACE Providers

PACE services are only available in specific counties and zip codes. The Department of Health Care Services maintains a list of current PACE Counties and zip codes online: https://www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx.

Eligibi lity

In order to be eligible for PACE, the applicant must be at least 55 years old and able to live in the community safely, meeting the level of care requirements determined by the California Department of Health Care Services. The level of care requirements are identical to those needed for skilled nursing care. The applicant must also live in a service area served by the PACE program. (Go to www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx to view zip codes that are in service areas).

Payment Options

PACE is contracted with both Medi–Cal and Medicare. For those eligible for Medi-Cal, PACE services are covered at no additional cost. Medi-Cal beneficiaries who have a shared montly cost must still pay their individual required shared monthly cost. If applicants have Medicare but no Medi–Cal, they can pay for premiums that would normally be covered by Medi-Cal privately. If one spouse needs PACE services and the other spouse does not, it is important to note that the Medi–Cal spousal impoverishment provisions apply, which means that the non–PACE spouse may be able to retain additional income.

Services Provided

Participants of PACE are evaluated and comprehensive health care plans are developed according to individual needs. The following are among the services provided:

Medical Care:
Primary care from a physician on PACE’s interdisciplinary team.
Specialized care such as audiology, dentistry, optometry, podiatry, and speech therapy.
Prescription and non-prescription medication and necessary medical equipment.
Emergency care, nursing home care (if necessary), and hospitalization.
In-Home Care:
Assistance with daily living needs.
Light housekeeping.
Adult Day Health Center:
Rehabilitative services: physical and occupational therapies.
Meals and nutritional counseling.
Social services (case management).
Recreational and social activities.
An interdisciplinary team evaluates the participant and develops a treatment plan involving as many of the above services as possible. Participants cannot pick and choose which services they want to make use of. It is an all-inclusive program addressing various issues that seniors face in their daily lives concerning their health, brain function, social stimulation, and general quality of life. Every aspect works toward the ultimate goal of keeping more seniors living independently in the community.

The “Interdisciplinary Team” The PACE “interdisciplinary team” usually consists of:

Primary care physician
Clinic and home care nurses
Social workers
Transportation representatives
Healthcare workers
Occupation, physical, speech, and recreational therapists.

All health care services received by the PACE participant are provided exclusively by this team. If the participant needs to be admitted to a hospital or a nursing home, the interdisciplinary team will continue to supervise the treatment and care of the participant.

* PACE can contract with mental health specialists to provide mental health services. Important: You must use PACE healthcare providers. You cannot keep your own doctor.

PACE and RCFEs

If you are a resident in a Residential Care Facility for the Elderly, you can simultaneously be a participant in PACE. While PACE will not cover the costs of your room and board in the RCFE, it may pay for medical costs. It can an option for those who wish to continue living in an RCFE, and do not want to move to a skilled nursing home, but need additional care and have high medical bills. Since RCFEs do not accept Medi-Cal, PACE may be able to help ease the financial burden of residing in one by covering the resident’s medical costs.

How to Apply

PACE is funded by the Medi-Cal program. If you are not currently enrolled in Medi-Cal, you can apply at your local Social Services office.

Go to the DHCS website (www.dh s.ca.gov/individuals/Pages/PACEPlans.aspx) to determine whether or not you are in a PACE service area.

If you are, contact the PACE provider in your area. A representative will pay a home visit, giving you thorough information about the plan.

Tour the PACE site. Sign an Enrollment Agreement (lasting regardless of change in health status until death or voluntary/involuntary disenrollment). Schedule a medical and social assessment with the interdisciplinary team immediately after enrollment.

PACE Grievance Process PACE participants can discuss their concerns or dissatisfaction directly with PACE program staff, but they also have the right to appeal any decision related to covered services, including the denial or reduction of services. The PACE program should provide all participants with written information about the grievance and appeals process specific to their program. Contact your PACE program if you did not receive this information. PACE services should also continue during the grievance or appeals process. Some common reasons participants file a grievance include:

The quality of PACE services
Wait times to reach staff or be served at the program
Behavior of program staff or care providers.
PACE facilities
Quality of food provided
Transportation services
Violations of participant’s rights

For information about PACE participant rights, read Medicare’s guide on Your Rights in PACE.

If you are covered by Medi-Cal only or by Medi-Cal and Medicare, you are entitled to pursue your grievance with the Department of Health Care Services, by contacting or writing to one of the following departments:

Ombudsman Unit, Medi-Cal Managed Care Division

Department of Health Care Services

P.O. Box 997413, Mail Station 4412

Sacramento, CA 95899-7413

Telephone:1-888-452-8609

TDD/TTY:
1-800-735-2922

PACE Compliance Team Department of Health Care Services

iscdcompliance@dhcs.ca.gov

916-713-8444

Medi-Cal Eligibility and Long-Term Custodial Care

Medicare and Skilled Nursing in Long-Term.

If you are in an SNF getting Medicare rehab services, and someone tells you that your Medicare rehab will end before the 100 day period is up, do this:

Medi-Cal Eligibility for Custodial Care in Skilled Nursing Facilities.

Understanding Traditional vs. Expanded Medi-Cal

2024: New Laws Eliminate Medi-Cal Asset Limits

2024 Medi-Cal Asset Elimination Frequently Asked Questions

When did the asset limit change happen?

What were the previous asset limits?

What is the difference between assets and income?

Is there an income limit for Medi-Cal programs?

If my assets generate income, how will that affect my shared monthly cost?

Does asset elimination also apply to Supplemental Security Income (SSI)?

Will Medi-Cal still ask to be repaid for services I receive?

How will married couples and registered domestic partners be impacted by asset elimination?

Is there a benefit to transferring income generating property between spouses?

How is rental property treated?

How are trusts treated under the asset limit changes?

Will the 30 month lookback period still apply after January 1, 2024?

If I sell my home, will the proceeds be treated as income or assets?

If I withdraw a lump sum from an investment account, will it be counted as income?

How will an inheritance impact my Medi-Cal?

How will a lawsuit settlement impact my Medi-Cal?

Overview of Medi-Cal for Long Term Care.

A. Medi-Cal vs. Medicare

B. Medi-Cal Eligibility

C. Monthly Resident Cost (formerly known as “Share of Cost”)

Other Deductions from the Share of Cost:

The documentation should include the following information:

How Monthly Resident Costs Can Be Adjusted Under Medi-Cal

D. What Does Medi-Cal Cover?

E. Assets

Income from Real Property

F. Transfer/Gifting Assets

G. Spousal Impoverishment Laws

H. Family Allocation

I. Medi-Cal Recovery

In-Home Support Services (IHSS) Program.

Overview of Medi-Cal’s In-Home Supportive Services Program

Overview of Medi-Cal’s In-Home Supportive Services Program

HCBS Medicaid Waivers versus HCBS State Plan Medicaid?

Benefits of the In-Home Supportive Services Program

Eligibility Requirements for In-Home Supportive Services

Financial Criteria: Income & Assets Income

Assets

Medical Criteria: Functional Need

Qualifying When Over the Limits

How to Apply for In-Home Supportive Services Program Before You Apply

Application Process

Approval Process & Timing

Using California's Spousal Impoverishment Rule for Home and Community Based Services

Using California's Spousal Impoverishment and Rule for Home and Community Based Services CANHR

Rule for Home and Community Based Services

Who can benefit from spousal impoverishment?

How do spousal impoverishment protections work?

STEP 1: APPLY FOR MEDI-CAL AND INDICATE NEED FOR IN HOME CARE/HCBS

STEP 2: DEMONSTRATE YOU MEET THE CLINICAL CRITERIA

STEP 3: ENROLL IN A HOME AND COMMUNITY-BASED SERVICE PROGRAM

Is In-Home Supportive Services (IHSS) a qualifying HCBS program?

What if the HCBS program I am interested in has a waitlist?

Dealing with Incorrect Shared Monthly Cost Determination or Denial?

What if I already have Medi-Cal?

Medi-Cal Assisted Living Waiver Program: Benefits and Eligibility

What are 1915(c) HCBS Medicaid Waivers?

Benefits of the Medi-Cal Assisted Living Waiver

Eligibility Requirements for California’s Assisted Living Waiver

Financial Criteria: Income & Assets

Medical Criteria: Functional Need

Qualifying When Over the Limits

How to Apply for the Medi-Cal Assisted Living Waiver

Before You Apply

Application Process

Approval Process & Timing

Understanding Shared Monthly Cost for Medi-Cal

What is a shared monthly cost?

How is the shared monthly cost calculated?

How can I reduce or eliminate my shared monthly cost?

Options for married couples or registered domestic partners

How can I meet my shared monthly cost?

The Board & Care Deduction may help residents of Assisted Living Facilities