California Medicaid for Seniors & Long-Term Care

IHSS provides in-home assistance to eligible aged (65+), blind, and disabled individuals as an alternative to out-of-home placement. The California Department of Social Services (CDSS) administers IHSS through county offices. Medi-Cal eligibility is a prerequisite — DHCS determines Medi-Cal enrollment, and then the county social services office assesses the individual's functional needs to determine approved IHSS hours.

Private in-home care in California costs an average of approximately $38/hour — making IHSS access extremely significant for enrollees who cannot afford private help. Apply for IHSS through your county social services office.

California operates six active Home and Community-Based Services (HCBS) waivers under Section 1915(c) of the Social Security Act, plus a separate PACE program. Each serves a different population, and a person can only be enrolled in one waiver at a time.

Medi-Cal covers skilled nursing facility care for seniors who meet both clinical and financial criteria. Once approved, Medi-Cal pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — all income minus a personal needs allowance of $35/month ($62/month for residents who also receive SSI), per DHCS. Medi-Cal covers the gap between that contribution and the facility's rate.

California is a spend-down state. Seniors whose income exceeds Medi-Cal's income limit can still qualify by spending down their excess monthly income on qualified medical expenses — a mechanism called "share of cost" (SOC). California does not use Miller Trusts (Qualified Income Trusts), which are an income assignment tool used in states with hard income caps. If you have been told you do not qualify because of income, ask the county eligibility worker specifically about share-of-cost Medi-Cal.

Long-term care Medi-Cal has an asset test. As of January 1, 2026, California's countable asset limit is $130,000 for an individual and $195,000 for a couple (this level applies through June 30, 2027, after which it drops significantly under state law). Assets above this limit must generally be spent down before Medi-Cal will pay for care. Exempt assets are not counted: the primary home (while the applicant or spouse lives there), one vehicle, personal belongings, and prepaid funeral arrangements.

Unlike most states, California uses a 30-month lookback period for asset transfers, not the federal default of 60 months, per DHCS. Because California had no asset test for long-term care Medi-Cal between 2022 and 2025, transfers made before January 1, 2026 are not counted against you; transfers made on or after January 1, 2026 may trigger a penalty period during which Medi-Cal won't pay for nursing home care. The penalty length depends on the value transferred. Do not transfer assets, make gifts, or change property ownership without consulting a Medi-Cal planning attorney first.

When one spouse enters a nursing home, federal law protects the community spouse (the one remaining at home) from complete impoverishment. California sets its Minimum Monthly Maintenance Needs Allowance (MMMNA) at the federal maximum rather than a sliding range, so the community spouse can be allocated income up to that ceiling. The community spouse's own income is not counted toward the institutionalized spouse's eligibility.

After a Medi-Cal long-term care recipient dies, California must seek to recover costs from the estate under the Medicaid Estate Recovery Program (MERP), applying to recipients age 55 and older. This can affect the family home.

Long-term care Medi-Cal spans institutional and home-based services for eligible seniors and people with disabilities.