Medi-Cal Eligibility

Medi-Cal is the only government program which will pay for long term nursing home care, an entitlement program based on financial and medical needs. Under this program, medical providers are reimbursed directly by the Department of Health Services for medical services provided to the patient. The Medi-Cal program is financed by both federal and state dollars. It is administered at the state level by the California Department of Health Services. It is administered at the county level by the Department of Social Services. We advise our clients concerning eligibility for Medi-Cal for long-term care, which is nursing home or skilled nursing facility care as well as other Medi-Cal programs.

To qualify for Medi-Cal for long-term care, an applicant must meet two eligibility requirements: need care in a cursing home and have resources below the Medi-Cal limits. California is not an income cap state, which means that income is not a factor in determining Medi-Cal eligibility (although it does affect share of cost, which is the amount that a nursing home resident must pay each month to the facility). There are also further regulations concerning a situation where one spouse is institutionalized and the other spouse remains at home. 

In advising our clients about eligibility, we determine what planning needs to be done to meet the resource limits, and whether further planning is needed in light of the recovery claim made after the death of the Medi-Cal recipient.

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