Medi-cal Benefits
Medi-Cal Long-Term Care
Depending on your medical and long-term care needs, at some point you (and/or your spouse) may require care in a nursing home. We understand that moving to a nursing home is not a desirable option for most people, especially if you have the resources to receive care at home or in another setting for as long as possible.
Accordingly, we consider nursing home care a last-resort option for end-of-life support. But even as a last resort, it is important to understand Medi-Cal Long-Term Care (LTC), and to take steps now so that your care and finances are as protected as possible if placement in a skilled nursing facility ever becomes necessary.
The Medi-Cal Long-Term Care program may help pay for care provided in a California skilled nursing facility (also referred to as a “nursing home”).
Under current law, the Medi-Cal LTC program has eligibility, share-of-cost (co-payment) and estate recovery rules. We outline those rules briefly below.
Beginning January 1, 2026, the Medi-Cal eligibility rules changed again. After a temporary period during which asset limits were eliminated (2024–2025), California has reinstated asset limits for most non-MAGI Medi-Cal programs, including Long-Term Care Medi-Cal. This reinstatement means that more people may qualify than under the pre-2024 rules, but eligibility will once again consider assets.
Medi-Cal planning is highly fact-specific, and not all strategies apply in every situation. We anticipate you may have additional questions, so we have addressed some of the most common topics below.
What does Medi-Cal cover?
Medi-Cal pays for medically necessary services, which may include: physician visits, adult day health services, prescriptions, certain dental services, ambulance transportation, laboratory and X-ray, hearing aids, eyeglasses, orthopedic devices, etc.
Some services, such as home health care, durable medical equipment, and certain prescriptions, require prior authorization.
Nursing home care in a semi-private room is also covered under Medi-Cal LTC when medically necessary and ordered by a physician. Admission requires a medical justification and may include both skilled services and custodial care.
If you qualify for Medi-Cal LTC, you may choose to cancel your private health insurance; however, if you keep your private coverage, the premiums you pay will reduce your share-of-cost (explained below). Maintaining private insurance may also be beneficial if it offers prescription coverage more comprehensive than Medi-Cal’s formulary.
Medi-Cal Eligibility Rules
Effective January 1, 2026, California reinstated asset limits for non-MAGI Medi-Cal programs, including Long-Term Care Medi-Cal.
The 2026 asset limits are:
• $130,000 for an individual
• $195,000 for two household members
• +$65,000 for each additional household member (up to 10 total)
These limits apply to countable assets, which generally include cash, financial accounts, investment accounts, additional real property (beyond the primary residence), and certain life insurance.
The following assets remain exempt for eligibility purposes:
• Primary residence (if certain occupancy and intent rules are met)
• One vehicle
• Personal belongings and household goods
• Prepaid burial contracts and some life insurance policies
For married couples, spousal impoverishment rules and the Community Spouse Resource Allowance (CSRA) may allow the spouse living in the community to retain more assets than the standard limit. The CSRA is adjusted annually.
Medi-Cal also maintains a 30-month look-back period for transfers relevant to LTC eligibility, meaning transfers for less than fair market value during that period may trigger a penalty.
Eligibility is determined both at initial application and at the applicant’s annual redetermination thereafter.
Share of Cost from Income Determination
Even if you are asset-eligible for Medi-Cal LTC, you may still owe a share of cost, which functions like a monthly co-payment toward nursing home care.
Your share-of-cost is based on your gross monthly income from all sources, except for certain VA Aid & Attendance benefits.
From your income, Medi-Cal deducts:
• a $35 personal needs allowance, and
• any health insurance premiums you pay (e.g., Medicare Part B, Medicare Advantage, supplemental policies, dental, vision, etc.)
The remaining income becomes your share of cost paid to the nursing home each month, and Medi-Cal pays the remainder at the Medi-Cal reimbursement rate.
What other deductions are available from the Share of Cost?
Additional deductions may be available in certain circumstances, including:
• Physician-ordered medical supplies or services not covered by insurance
• Unpaid past medical bills being satisfied through share-of-cost
• Certain home maintenance needs during temporary nursing home stays (in limited scenarios)
These deductions must be documented and approved through Medi-Cal procedures.
Medi-Cal Recovery Claim after your death
If you receive Medi-Cal benefits during your lifetime, Medi-Cal may seek to recover the value of certain benefits from your estate after your death.
Since January 1, 2017, California can only recover against the assets that are part of your probate estate. Assets that pass outside of probate are generally not subject to recovery. This includes assets held in:
• Revocable or irrevocable trusts
• Transfer-on-death accounts
• Pay-on-death designations
• Life insurance with named beneficiaries
• Joint tenancy with right of survivorship
Proper planning can therefore eliminate or significantly reduce recovery exposure.