If you need long-term care, such as in-home care, a nursing home, or an assisted living facility, the services can be very expensive. Most health insurance does not cover these costs. Long-term care insurance does pay some of these costs, but if you are like most people, you may not have purchased this type of policy. In California, you may qualify to have a portion of these expenses paid through the Medi-Cal program.

Eligibility Under the Medi-Cal Program

The Medi-Cal program is California’s Medicaid program and is funded by the federal and state governments. It can provide benefits to eligible residents, and the eligibility requirements will be different depending on the type of services you need. Here are some of the long-term care services that could be covered under the program:

  • Nursing home. Medi-Cal will pay for nursing home care when it is medically necessary. Under California law, medically necessary is defined as “reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain." For you to qualify, your doctor would have to prescribe skilled nursing home care because you need around-the-clock care or intermediate care. You must also meet income and asset eligibility requirements.
  • Share of Cost Medi-Cal. If you are over the income requirements for Medi-Cal benefits, you may qualify for Share of Cost Medi-Cal, where you commit to pay a certain portion of your income toward your nursing home costs, and Medi-Cal pays the balance owed.
  • Assisted Living Waiver. Assisted Living Waiver (ALW) is a Medi-Cal program that provides coordination of services benefits, and can pay for some of your assisted living expenses. You would still need to pay the majority of your income toward your care. To qualify, you must be eligible for Medi-Cal and need intermediate care. Only certain counties in California may offer this benefit.
  • Home health care. Medi-Cal will pay for home health care that is medically necessary. Skilled nursing care and medical equipment are covered. The In-Home Supportive Services program can help pay for non-skilled home care such as assistance with bathing, chores, and cooking.

These Medi-Cal programs have income and asset eligibility requirements. However, not all assets or income are included in the calculations to determine if you are eligible. In addition, you may be able to spend down some of your excluded assets.

An experienced elder law attorney can advise you on possible Medi-Cal programs that you may qualify for and on Medi-Cal planning that allows you to keep certain assets and income. To learn more, call our office today to schedule a free consultation.

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