California Medicaid Long Term Care Eligibility in 2025

California Long Term Care (Medi-Cal) for 2025

california-medicaid

Applications take anywhere between 45-90 days with both financial and health qualifications that must be met. The program covers, but is not limited to, nursing home daily rates after income has been applied, doctor’s visits, medical equipment such as diapers, and dental care. Unfortunately, rates at senior residences, board and care facilities, and assisted living facilities are not covered unless enrolled in specific waivers.

Medical Qualifications:

To qualify medically, an individual must receive a Nursing Facility Level of Care (NFLOC) for longer than thirty days. This determination is based on the applicant’s ability or inability to complete at least four out of six Activities of Daily Living (ADLs) without help. The ADLs test includes: mobility, bathing, feeding, using the restroom unaided, dressing, and regulating/taking medication. If the individual can’t perform at least three out of six ADLs unaided, then they may qualify for Medi-Cal benefits for long-term care.

Income and Asset Qualifications:

Effective January 1, 2024, California no longer has an asset limit for Medi-Cal eligibility. For nursing home care, beneficiaries are required to contribute nearly all their income to the cost of care, minus a Personal Needs Allowance of $35/month, health insurance premiums, and potentially a Spousal Income Allowance. Applicants for HCBS Waivers or Regular Medi-Cal (Aged, Blind, and Disabled) must meet specific income criteria, with allowances for married couples and non-applicant spouses.

Countable income includes wages, Social Security benefits, pensions, IRAs, and other income sources. Certain exceptions apply, such as Holocaust restitution payments and VA Aid and Attendance Pension benefits, which are excluded from income calculations.

Key Income Limits for 2025:

  • Nursing Home Medicaid: No income limit, but contributions are required.
  • HCBS Waivers: $1,732/month for single applicants, $2,352/month for married couples.
  • Regular Medi-Cal: $1,732/month for individuals, with additional allowances for couples.

Medi-Cal’s Estate Recovery Program: While Medi-Cal no longer has an asset limit, assets are not necessarily protected from the Estate Recovery Program, which seeks to recover costs paid for long-term care after the recipient’s death. Medicaid-compliant planning is recommended to protect assets intended for inheritance.

Spousal Rules for 2025:
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Community Spouse Income Allowance: Non-applicant spouses may retain up to $3,948/month to avoid spousal impoverishment. This allowance is calculated based on the non-applicant spouse’s income and essential expenses.

Further Information:

Contact information for Medi-Cal offices: http://www.dhcs.ca.gov/services/medi-cal/Pages/Contacts.aspx

How to apply: http://www.dhcs.ca.gov/services/medi-cal/pages/applyformedi-cal.aspx

Long term care ombudsman: (800) 231-4024

Medi-Cal toll free number for general eligibility questions: (877)-597-4777