Who Qualifies for Medicaid in California? Medi-Cal Eligibility Requirements

Who Qualifies for Medicaid in California? Medi-Cal Eligibility Requirements

Posted on June 5th, 2024.

Navigating the complexities of Medicaid can be a challenging process, especially when it comes to understanding eligibility requirements. 

For residents of California, Medicaid is known as Medi-Cal, and it offers various programs tailored to meet the diverse needs of its population. 

This blog post will explore who qualifies for Medicaid in California, the specific programs available, and the eligibility requirements for Medi-Cal.

Understanding Medicaid and Medi-Cal

Medicaid is a federal and state program designed to provide healthcare coverage to low-income individuals and families. In California, the Medicaid program is referred to as Medi-Cal. Medi-Cal provides a wide range of services, including doctor visits, hospital care, long-term care, and preventive care for children, adults, seniors, and people with disabilities.

Medi-Cal serves as a crucial safety net for millions of Californians, ensuring that they have access to necessary medical services. The program is jointly funded by the federal and state governments and administered by the California Department of Health Care Services (DHCS).

Specific California Medicaid Programs

California offers several Medicaid programs, each catering to different needs. In addition to paying for nursing home care, Medi-Cal offers the following programs and HCBS Waivers relevant to the elderly, assisting them in living in their homes or in assisted living residences:

In-Home Supportive Services (IHSS)

Provides personal care and homemaker services to individuals in their homes. Family members, including spouses, can be hired as personal care providers.

Medi-Cal Assisted Living Waiver (ALW)

Though not available statewide, this program helps to pay for services and supports in assisted living, including memory care. There is currently a waitlist for participant enrollment.

Community Based Adult Services (CBAS) Program

Provides persons with daytime care and supervision in adult day health care centers certified as CBAS centers. There are CBAS centers in approximately 28 CA counties.

Multipurpose Senior Services Program Waiver (MSSP)

Provides California seniors with assistance for home modifications, personal emergency response services, homemaker services, personal care assistance, and other in-home supports. This program also helps persons transition back into the community from a nursing home. MSSP is not available statewide.

Home and Community-Based Alternatives (HCBA) Waiver

Provides similar services to MSSP, but is available statewide. In addition to targeting medically fragile individuals, technology-dependent persons are also targeted.

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

Combines the benefits of Medicaid, including long-term care services, and Medicare into one program. Additional benefits, such as dental care and eye care, may be available.

CalAIM’s Enhanced Care Management (ECM) & Community Supports Benefits

Through California Advancing and Innovating Medi-Cal (CalAIM), Medi-Cal Managed Care Plans (MCPs) provide ECM for persons in a high-needs group. This includes seniors who are at risk of nursing home admission and eligible for long-term care, as well as current nursing home residents who wish to return home. Via ECM, all of one’s care needs and services are coordinated. MCPs may also offer Community Supports, such as Nursing Home Transition and Diversion to Assisted Living. Unlike with the Assisted Living Waiver, participant enrollment slots are not limited.

Money Follows the Person (MFP)

Also called California Community Transitions (CCT) in CA. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

As you see, Medi-Cal offers a wide range of programs that provide comprehensive care and support to elderly and disabled individuals, helping them live independently or in assisted living facilities. Next, we'll explore Medi-Cal eligibility requirements.

Medi-Cal Eligibility Requirements

To qualify for Medi-Cal, individuals must meet certain income and asset criteria, among other requirements. Here are the key eligibility requirements:

1. Income Limits

Medi-Cal eligibility is primarily based on income. For adults, the income limits are as follows:

  • Single adults: Monthly income limit is $1,482
  • Couples: Monthly income limit is $2,004

For the elderly, blind, and disabled, the income limits are slightly higher:

  • Single individuals: Monthly income limit is $1,733
  • Couples: Monthly income limit is $2,829

2. Asset Limits

In addition to income limits, Medi-Cal applicants must also meet asset requirements. Generally, single individuals can have up to $2,000 in assets, while couples can have up to $3,000. Certain assets, such as a primary residence, personal belongings, and one vehicle, are exempt from these limits.

3. Citizenship and Residency

Applicants must be U.S. citizens or legal residents and reside in California. Undocumented immigrants may qualify for limited Medi-Cal benefits, such as emergency services and pregnancy-related care.

4. Medical Necessity

For some Medi-Cal programs, applicants must demonstrate a medical need for the services provided. This includes programs like the In-Home Supportive Services (IHSS) and the Assisted Living Waiver (ALW).

5. Age and Disability

Certain Medi-Cal programs are specifically designed for elderly or disabled individuals. For example, the Multipurpose Senior Services Program (MSSP) and the Program of All-Inclusive Care for the Elderly (PACE) cater to seniors and disabled persons who require long-term care services.

6. Enrollment in Managed Care Plans

Most Medi-Cal beneficiaries are required to enroll in a managed care plan, which coordinates their care and provides access to a network of healthcare providers.

7. Long-Term Care Eligibility

For long-term care services, such as nursing home care, applicants must meet additional eligibility criteria, including functional limitations that require a level of care provided in a nursing home or similar facility.

Related: A Very Simple Planning Guide For Medicare

Wrapping Up

Medi-Cal provides a lifeline for many individuals and families, offering comprehensive services to meet their healthcare needs. This program ensures that low-income Californians, including seniors, people with disabilities, and children, have access to essential medical services. 

With a wide range of programs, including In-Home Supportive Services, the Assisted Living Waiver, and the Program of All-Inclusive Care for the Elderly, Medi-Cal addresses diverse healthcare requirements and supports the well-being of vulnerable populations.

At Johns Medicare, based in Redondo Beach, California, we specialize in providing Medicare products and services, life insurance, long-term care insurance, short and long-term disability insurance, and annuities. We are dedicated to helping you navigate your healthcare options and find the best solutions for your needs.

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