Long-Term Care Planning Options
Navigating Medi-Cal long-term care eligibility can be confusing — the number of programs to consider and concepts involved can amount to an alphabet soup of acronyms, and asset and income rules change and can vary from program to program. I help seniors and disabled individuals understand which options may make the most sense, protect assets, and plan proactively or respond to a health crisis. Whether you are planning ahead or already facing nursing home costs, I provide clear guidance and lawful strategies to help you qualify for Medi-Cal while preserving your assets and your dignity.
Medi-Cal Eligibility
The most basic question I will need you to answer is whether your loved one who needs or anticipates needing long-term care (LTC) will be receiving this care in an institutional setting (nursing home or skilled nursing facility (SNF)) or at home. Both LTC/SNF Medi-Cal and community-based Medi-Cal are known as “non-MAGI” Medi-Cal (Medicaid) and, as of January 1, 2026, non-MAGI Medi-Cal applicants must pass an asset test: a single individual must spend down their countable assets to below $130,000; the limit is $195,000 for a married couple, but if a married couple is utilizing Medi-Cal’s spousal impoverishment protections, the community spouse (the non-applicant spouse) can keep around $157,920 (this number will be adjusted upwards in 2026). With community-based Medi-Cal programs, some programs have a share of cost (SOC), which means that income can be an issue.
Long-Term Care Medi-Cal
Long-term care Medi-Cal is nursing-home or SNF-type care - institutional care. Please note that LTC Medi-Cal does not cover assisted living facilities (ALFs). Unless the ALF is providing memory care and you qualify for an Assisted Living Waiver, please understand that ALF costs must be paid out of pocket. Also, with LTC Medi-Cal, almost all of the applicant’s income must be paid to the nursing home every month. However, if the applicant has a spouse or registered domestic partner (RDP) living in the community (at home or in an ALF), it may be possible for the community spouse to utilize Medi-Cal’s spousal impoverishment rules and keep some of the Medi-Cal spouse’s income, up to the Minimum Monthly Maintenance Needs Allowance (MMMNA) (around $3,948/mo. in 2025). However, to qualify for non-MAGI Medi-Cal, remember that the community spouse’s countable assets must not exceed the CSRA.
In-Home Supportive Services (IHSS)
In-Home Supportive Services allow eligible seniors and disabled individuals to receive help with activities and basic care at home instead of in a facility. I help clients understand IHSS eligibility, coordinate Medi-Cal enrollment as desired, structure income and assets to qualify, and advise on any potential share of cost (SOC) issue if the applicant does not qualify for Aged and Disabled Federal Poverty Program (A&D FPL) Medi-Cal. A&D FPL does not have a SOC, while Aged, Blind, and Medically Needy (ABD-MN) Medi-Cal does; neither applies to SNF care. Challenges with IHSS can include income creating a SOC, needed care hours exceeding allowable hours, or insufficient home care staffing under the IHSS program in your particular county. In addition to the asset limits, community-based Medi-Cal programs like IHSS, HCBS, and Working Disabled require careful analysis of income and the care requested.
Home and Community-Based (HCBS) Waivers
Medi-Cal’s Home and Community-Based Services Waiver program allows eligible applicants to receive nursing-home level care at home or in a community setting. But HCBS waiver programs have special income rules that differ from other Medi-Cal programs. And, as with IHSS, county-by-county covered services and waitlists can make HCBS eligibility challenging in a crisis. To prevent an SOC, the applicant’s income cannot exceed $1,801/mo. ($2,433 for a couple) (in 2025). Unfortunately, for many seniors or other individuals who may otherwise qualify for a HCBS Waiver, an SOC is triggered and the program becomes unworkable — other options will need to be considered.
Working Disabled
250% Working Disabled (WDP) Medi-Cal requires that you be “disabled” as that term is defined by the Social Security Administration, that your earned income each month be below the SSI income limit ($1,206.94 for 2025), and that your countable income each month not exceed 250% of the Federal Poverty Level ($3,263 in 2025). A couple of interesting aspects for WDP eligibility are that any disability income does not count toward the income limits (i.e., disability income from a former employer or SSDI) and IRAs and other retirement plans do not count as countable assets. Moreover, you do not need to work a certain number of hours each month. I can help you determine whether WDP may be workable for you and your family.
Medi-Cal Asset Protection Trusts
A Medi-Cal Asset Protection Trust (MAPT) is a particular type of irrevocable trust used to protect assets while planning for future Medi-Cal eligibility — after the required lookback or transfer period, the assets placed in the trust are no longer considered owned by you for Medi-Cal eligibility purposes and are exempt from counting toward the asset limit. The lookback period for Medi-Cal long-term care eligibility is thirty (30) months from the date of the transfer. MAPTs require careful planning and should be created and funded well before the settlor requires long-term care. Other gifting techniques may be possible. Stacked gifting, for example, involves making multiple gifts per day per person (below the Applicable Private Pay Rate) to reduce the ineligibility period faster.