Fact Sheet: Medi-Cal
Nursing Home Care Eligibility

A person must pass three tests to be eligible for Medi-Cal long-term care benefits.

Test 1 - Categories: A person must fit into at least one of the following categories: 65 or over; blind; or disabled.

Test 2 - Condition and Need: Medi-Cal will not pay for nursing home care for a person unless that person's medical condition requires nursing home care. A need for personal or custodial care is sufficient - there is no "skilled care" requirement. Generally, a doctor's order stating that the person needs nursing home care is required.

Test 3 - Countable Resources: To be eligible for Medi-Cal, a single person may have no more than $2,000 in countable resources (cash, investments, other assets). If both members of a married couple seek Medi-Cal, the limit increases to $4,000.

If one spouse requires nursing home care and the other does not, the nursing home spouse may have only $2,000 in countable resources. Under Medi-Cal's spousal protections, the healthy (at-home) spouse of a nursing home resident may retain substantially greater countable resources. In 2006, the at-home spouse will be entitled to retain at least $99,540 of countable resources (and possibly more). For more information, see the H.E.L.P. article entitled, Medi-Cal Update: Spousal Protections.

In determining countable resources, Medi-Cal excludes several assets. Most important, Medi-Cal excludes the applicant's residence in most circumstances. Among other excluded assets are many IRAs and retirement accounts, an automobile, personal effects, home furnishings, certain jewelry, musical instruments and limited burial funds. (Under coming rule changes, home equity limits of $500,000 or more may affect eligibility for some individuals.)

July 2006