California Medicaid (Medi-Cal) Income & Asset Limits for Nursing Homes & Long Term Care

Medicaid is a health care program for low-income individuals of all ages. While there are varying coverage groups, this page is focused on Medicaid long-term care eligibility for California senior residents (aged 65 and over). In addition to nursing home care and assisted living services, California Medicaid, also called Medi-Cal, pays for many non-medical support services that help frail seniors live in their homes. There are three categories of Medi-Cal long-term care programs for which California seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Services are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of participants is limited and waiting lists may exist. Benefits are intended to delay nursing home admissions and may be provided at home, adult day care, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged, Blind and Disabled (ABD) – An entitlement; meeting eligibility requirements ensures services will be provided. Various long-term care benefits, such as personal care assistance or adult day care, may be available.

While Medi-Cal is state and federally funded, the state of California administers its program within federally set parameters. The California Department of Health Care Services (DHCS) is the administering agency.

The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.

Medi-Cal Income & Assets Limits for Eligibility

The three categories of Medi-Cal long-term care programs have varying financial and medical (functional) eligibility criteria. Eligibility is further complicated since income limits change annually, vary based on marital status, and that California offers multiple pathways towards eligibility.

Simplified Eligibility Criteria: Single Nursing Home Applicant
In 2024, a single California Nursing Home Medicaid applicant must 1) Contribute nearly all of their monthly income towards their cost of care 2) Require a Nursing Home Level of Care.

Effective Jan. 1, 2024, California no longer has an asset limit for Medi-Cal eligibility. This change impacts many areas of determining eligibility, creating a layer of complexity and confusion.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Medi-Cal program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: If one does not meet all the criteria below, it does not mean one is ineligible or cannot become eligible for California Medicaid. More.

*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $35 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home as a Share of Cost.
**The income limit of $2,332 / month is a combination of the applicant income limit of $1,732 / month and a $600 / month Needs Allowance for the non-applicant spouse.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income that a Medicaid applicant receives is counted towards the income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in CA, the VA Aid and Attendance Pension, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When just one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. In other words, the income of the non-applicant spouse is disregarded. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance from their applicant spouse. This is called a Monthly Maintenance Needs Allowance (MMNA) and is said to be the minimum amount of monthly income a non-applicant spouse requires to avoid spousal impoverishment. In 2024, the MMNA in CA is $3,854 / month. If a non-applicant’s monthly income is under $3,854, income can be transferred to them from their applicant spouse to bring their income up to this amount. A non-applicant spouse whose own monthly income is $3,854 or more is not entitled to a MMNA / Spousal Income Allowance.

Income is counted differently when only one spouse applies for Regular ABD Medicaid; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. There is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.

SSI Recipients: While California eliminated the asset limit for all Medi-Cal programs for seniors and disabled persons on 1/1/24, this does not apply to persons who qualify for Medi-Cal via SSI. This is because SSI is a federal program and continues to have asset limits.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets

On or After 1/1/24
All assets are non-countable (exempt) and have no impact on Medi-Cal eligibility.

Prior to 1/1/24
Assets are considered when determining Medi-Cal eligibility for any months prior to 1/1/24. For instance, if an application was submitted in December 2023, the 2023 asset limit of $130,000 for an individual and $195,000 for a couple would apply to determine eligibility for December. Countable assets (non-exempt) include cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and vacation homes. Other assets are non-countable (exempt) and include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and an applicant’s IRA / 401K if it is “paying out”. This means that one’s Required Minimum Distribution (RMD) is being withdrawn. A non-applicant spouse’s IRA / 401K is automatically exempt.

The 2023 asset limit is also relevant for Retroactive Medicaid eligibility, which allows one to receive Medi-Cal coverage for up to 3 months prior to one’s Med-Cal application date. For retroactive coverage, one must meet the eligibility criteria for the months of potential coverage. For example, if an application is submitted in March 2024, one could potentially be retroactively eligible for February 2024, January 2024, and December 2023. To determine eligibility for December, the asset limit would apply. For any applications submitted in April 2024 or after, the asset limit for retroactive eligibility will no longer be applicable.

Treatment of Assets for a Couple

On or After 1/1/24
All assets of a married couple are disregarded. There no longer is an asset limit.

Prior to 1/1/24
When determining Medi-Cal eligibility for any months prior to 1/1/24, all assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. If only one spouse, however, applied for Nursing Home Medicaid or a Medicaid Waiver, the non-applicant spouse (community spouse) is permitted a larger share of the couple’s assets as a Community Spouse Resource Allowance (CSRA). For Medi-Cal determinations for any months in 2023, the CSRA allows the community spouse to retain up to $148,620, while the applicant spouse can have $130,000. There is no CSRA with Regular Medicaid.

While CA has no asset limit, assets are not protected from Medicaid’s Estate Recovery Program unless Medicaid-Complaint planning strategies have been implemented.

Medicaid’s Look-Back Rule

Asset Transfers On or After 1/1/24
Medi-Cal’s Look-Back Period is obsolete.

Asset Transfers Prior to 1/1/24
The Look-Back Period is still relevant. On 1/1/24, California’s Look-Back Period was the 30-month period that immediately preceded the date a nursing home resident submitted a Medi-Cal application or the date a Medi-Cal beneficiary was admitted to a nursing home. For each subsequent month, the “look back” shortens by one month, until 7/1/27, when there will no longer be a Look-Back Period. During the “look back”, Medi-Cal scrutinizes all asset transfers, looking for assets that were gifted. This includes assets that were sold for under fair market value. California, however, allowed for “strategic gifting” prior to 1/1/24. This allowed one to gift up to a certain daily amount without violating the Look-Back Period. In 2023, this amount was $11,576 / day.

Persons who violate the Look-Back Period are penalized with a Penalty Period of Medicaid ineligibility up to 30 months from the date the disqualifying asset transfer was made. The last date in which one can be penalized is June 2026.

The Look-Back Rule does not apply to persons applying for Regular Medicaid or Medicaid Waivers.

Medi-Cal’s Estate Recovery Program

Following a long-term care Medi-Cal beneficiary’s death, California’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains via Medicaid’s Estate Recovery Program. Given that CA no longer an asset limit, it is expected that many Medi-Cal recipients will have significantly larger estates than recipients prior to the 2024 elimination of the asset limit. One’s home is not safe from estate recovery. Without proper planning strategies in place, the home (and other assets) will be used to reimburse Medicaid for providing care rather than going to family as inheritance. Medicaid Planners are extremely instrumental in assisting one in implementing strategies to protect their assets. Contact a Professional Medi-Cal Planner.

With the asset limit elimination, the need for Medi-Cal Planners continues to remain high. While the asset limit and Look-Back Period simply go away when determining Medi-Cal eligibility for Jan. 2024 and any subsequent months, both are still applicable for determining eligibility for any months prior to Jan. 2024. There are a lot of moving pieces and it is expected that mistakes will be made as adjustments to the new eligibility process are made. Professional Medi-Cal Planners can oversee the application and eligibility process to ensure the best chance of Medi-Cal approval.

Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and HCBS Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, certain benefits may have additional eligibility requirements specific to that benefit. For example, for a Waiver to cover the cost of home modifications, an inability to safely live independently without modifying the home might be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.

Qualifying When Over the Limits

For elderly California residents (aged 65+) who do not meet the income eligibility requirements above, there are other ways to qualify for long-term care Medicaid.

1) Medically Needy Pathway – CA has an Aged, Blind and Disabled – Medically Needy Program (ABD-MN) that allows persons who have income over the Medicaid limit to become income-eligible. This program is applicable for ABD Regular Medicaid and HCBS Medicaid Waivers. Seniors who have “excess” income become eligible for Medicaid services by paying a “Share of Cost” (SOC). Essentially, a predetermined Maintenance Need Allowance (MNA) is deducted from one’s countable monthly income, determining one’s SOC. In 2024, the MNA is $600 for an individual and $934 for a married couple. Also called a Spend Down program, one’s “excess income,” the amount that is determined as one’s cost of share, is used to cover medical bills. Once one has paid their SOC, they will be income-eligible for Medi-Cal for the remainder of the month. There are no asset limits.

On Jan. 1, 2025, the Maintenance Needs Allowance used to determine one’s Share of Cost will increase significantly. The MNA will rise from approximately 50% of the Federal Poverty Level to 138% of the Federal Poverty Level.

2) Medicaid Planning – Many persons considering Medi-Cal are “over-income”, but they still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ planning strategies to help them become Medicaid-eligible. Medi-Cal Planners can help ensure a non-applicant spouse of a Nursing Home Medicaid or HCBS Waiver applicant receives the highest Spousal Needs Allowance as possible, as well as assist the applicant in lowering their Share of Cost. Furthermore, since assets are not protected from Medicaid’s Estate Recovery Program, Medi-Cal Planners can help implement planning strategies to protect assets for one’s family. Connect with a Medicaid Planner.

Specific California Medicaid Programs

In addition to paying for nursing home care, Medi-Cal offers the following programs / HCBS Waivers relevant to the elderly that assist them in living in their homes or in assisted living residences.

1) 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.

2) 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.

3) 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.

4) 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.

5) 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.

6) 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.

7) 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.

8) 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.

How to Apply for California Medicaid

For more information or to apply for a long-term care Medicaid program, one can contact their local county Department of Social Services office. One can also apply for Medi-Cal online at Covered California or by calling 1-800-300-1506. Seniors who require home and community based services (HCBS) must first apply for Aged, Blind and Disabled Medicaid. Once enrolled, they apply for HCBS by completing the assessment and enrollment process. The application process may vary based on the program for which one is applying.

It is vital that Medi-Cal applicants be certain that all eligibility requirements are met prior to applying for benefits. Elderly CA residents who are over the income limit, or are unsure if they are, should consider Medicaid planning for the best chance of acceptance into a Medicaid program. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.