Medi-Cal is 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 they provide 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: categorical and resource. California is not an income cap state, which means that your income is not a factor in determining Medi-Cal eligibility (although it does affect share of cost, which is the amount that an institutionalized individual 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 connection with advising our clients about eligibility we will determine if they can meet the categorical requirements and automatically receive eligibility or what they may need to do in order to meet the resource requirements and thereby become eligible for benefits.

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