Medicaid and Long-Term Care Benefits

Medi-Cal and Long-Term Care: What California Families Need to Know

For millions of California families, Medi-Cal — California's Medicaid program — is the only realistic path to covering the ongoing cost of nursing home or other long-term care. It is also one of the most complex, misunderstood programs in elder care planning.

This guide explains how Medi-Cal works for long-term care, what it covers, how eligibility is determined, and what families should know about planning.

What Medi-Cal Covers for Long-Term Care

Medi-Cal covers a range of long-term care services, including:

Skilled Nursing Facility (SNF) care — Full coverage for eligible individuals in Medi-Cal-certified nursing homes. This is the most significant benefit and the primary reason Medi-Cal matters in senior care planning.

In-Home Supportive Services (IHSS) — A Medi-Cal-funded program that provides home care services to eligible seniors to help them remain at home. Services include personal care, domestic support, and paramedical services.

Community-Based Adult Services (CBAS) — Adult day health centers providing health monitoring, therapy, and social services.

Multipurpose Senior Services Program (MSSP) — Provides case management and supportive services to help Medi-Cal recipients avoid nursing home placement.

Assisted Living Waiver (ALW) — A limited program providing Medi-Cal coverage in participating assisted living communities, as an alternative to nursing home placement. Waitlists exist in most counties.

Eligibility: Income and Assets

Medi-Cal eligibility for long-term care (also called "Medi-Cal Long-Term Services and Supports") involves both income and asset tests.

Income For nursing home Medi-Cal, most income is paid toward the cost of care, with a small monthly allowance retained by the resident. The state covers the rest.

Assets (Resource Limits) California has made significant changes to its asset limits in recent years:

• As of January 2024, California eliminated the asset test for most Medi-Cal programs, including long-term care Medi-Cal
• This is a major change — previously, individuals had to spend down savings to under $2,000 to qualify

Exempt assets that were historically protected (and remain relevant for Medi-Cal Estate Recovery purposes):

• Primary residence (subject to estate recovery)
• One vehicle
• Personal belongings
• Irrevocable burial plan
• Spouse's assets up to the Community Spouse Resource Allowance (CSRA)

Spousal Protections

When a married person enters a nursing home and applies for Medi-Cal, the community spouse (the one remaining at home) has specific financial protections:

Community Spouse Resource Allowance (CSRA) — The community spouse may retain a portion of the couple's assets, up to a federally defined limit (approximately $154,140 in 2024).

Minimum Monthly Maintenance Needs Allowance (MMMNA) — The institutionalized spouse's income can be partially redirected to the community spouse to ensure they have adequate monthly income for living expenses.

Medi-Cal Estate Recovery

California's Department of Health Care Services (DHCS) may file a claim against the estate of a deceased Medi-Cal recipient to recover costs paid for long-term care services.

Estate recovery applies to:

• Medi-Cal long-term care costs
• For individuals age 55 and older

Recovery is typically from the deceased person's estate — most commonly, the family home.

Estate recovery can be deferred when a surviving spouse, minor child, or disabled adult child lives in the home. It does not apply during the lifetime of a surviving spouse.

Medi-Cal Planning: When to Seek Professional Help

Medi-Cal planning involves complex legal and financial strategies. Professional guidance from a California elder law attorney is strongly recommended when:

• Significant assets exist that need to be protected
• A spouse remains in the community
• A family home is involved
• Care needs are likely to be long-term

Common Medi-Cal planning strategies include annuities, caregiver agreements, spousal refusal, and trusts — all of which require careful legal implementation.

How CareGrade™ Can Help

CareGrade™ profiles include care type data to help families identify Medi-Cal-certified Skilled Nursing Facilities. Clara Concierge™ can provide general guidance on how Medi-Cal intersects with care options, and help families formulate questions for an elder law attorney.