Health care costs seem to be increasing every year. For most people who are 65 years or older, Medicare and/or other private health insurance can cover the cost. For others who may have limited financial resources, however, there are programs available to help them obtain the healthcare they need. Medi-Cal is one of them. This fact sheet will provide general information on Medi-Cal and programs under Medi-Cal through which seniors may qualify for coverage.
What is Medi-Cal?
Medi-Cal is a health care coverage program for certain California residents who have limited incomes and assets. Medi-Cal, known as Medicaid in most other states, is a federal program funded jointly by the federal and state governments. In 1965, through Title XIX of the Social Security Act, Medicaid was established to assist individuals and families in paying for medical expenses. In California, it is administered by the Department of Health Care Services. Applications and eligibility are handled at local social service agencies.
Who is eligible for Medi-Cal?
If you qualify for Supplemental Security Income (SSI), then you automatically qualify for full Medi-Cal coverage. If your income is above the SSI limit, you may qualify for Medi-Cal if your assets are within the Medi-Cal limits. This includes:
- Persons in the Aged and Disabled Federal Poverty Level Program (A&DFPLP)
- Persons in the In Home Supportive Services Program (IHHS)
- Low-income persons in skilled nursing or intermediate care.
What is SSI?
SSI (Supplemental Security Income) is a program funded by the state and federal governments which provides cash assistance for a U.S. citizen, or a non-citizen who has been lawfully admitted for permanent residence and meets certain special conditions, and who is a U.S. resident. Eligibility criteria include being elderly, blind, disabled, or a person whose income is low and assets are limited. Income and asset limits for a single person are $907 per month and $2000 respectively. For a married couple, income limit is $1579 per month and asset limit is no more than $3000. Since limits might change periodically, please check with your local Social Security office for the most current information.
The following resources are exempt from being counted towards the asset limit: the home (home one is living in), one car, burial plot and funds for immediate family, household goods and personal effects, and life insurance.
Applications for SSI are handled at local Social Security Offices.
What is A&D FPL?
A&D FPL (the Aged and Disabled Federal Poverty Level) program was reinstated in 2001 by the State of California in order to provide Medi-Cal coverage to elderly and disabled persons who meet SSI’s resource limits, but have a higher income than SSI limits. Income limits are $867 per month for a single person and $1167 per month for a married couple (as of January 2009). The same asset limits for SSI apply for this program.
What is IHSS?
Those who are low-income and need non-medical services due to functional impairments in order to stay home safely may qualify for IHSS (In Home Supportive Services), which provides non-medical services such as housekeeping chores, paramedical services, supervision, personal care, and transportation to medical appointments.
What is Medi-Cal Long Term Care?
Medicare pays for skilled nursing or rehabilitative services in a nursing home for a short term (100 days maximum) if the person is admitted from a hospital and meets other criteria. On the other hand, if a person is 65 years or older, blind or disabled and in a skilled nursing facility for long-term custodial (personal) care, Medi-Cal pays for care in the nursing home as long as he or she meets the income and asset limits specifically established for long term care benefits.
To be qualified for Medi-Cal long term care, if you are single and already in a nursing home, you can have assets up to $2000. You are allowed to keep $35 from your income every month as a personal allowance, and the rest of your income will be paid to the nursing home.
If you are married, the rules are quite different. The spouse living at home is allowed to keep no more than $109,560 as assets and an unlimited monthly income. The spouse who resides in a nursing home can have assets up to $2,000 and a monthly income (personal needs allowance) of $35.
You might have heard the term “transfer of assets.” Some people “spend down” their assets by transferring or giving to others in order to meet the asset limit to qualify for Medi-Cal. However, you should do this with caution because you may face a potential period of ineligibility if the transfer is not done according to the rules. For assistance in transferring assets, please contact the Legal Aid Society at (800) 834-5001, elder law attorneys, or certified financial planners.
What is Share of Cost?
If your income is higher than the income limits for SSI or A&D FPL programs, but you meet the asset requirement, you may be eligible for Medi-Cal with a share of cost (SOC). Your SOC is based on your monthly countable income. The higher your countable income, the higher your SOC. If your medical expenses meet or exceed your SOC, Medi-Cal pays for any remaining medical expenses for that month.
Where can I get more information?
Eligibility for each program may be different by county and change periodically. Please contact your local social service agency for current information:
Los Angeles Department of Public Social Services
Orange County Social Services Agency
CalOptima (administers Medi-Cal in Orange County)
For Medi-Cal questions that are related to Medicare, please contact the following agencies:
Council on Aging – Orange County
Center for Health Care Rights – Los Angeles County
The following websites provide more information on Medi-Cal:
The Centers for Medicare & Medicaid Services
Department of Health Care Services
(916) 552-9200 (Medi-Cal eligibility)