Frequently Asked Questions (FAQs)

Medicare and Medi-Cal (Medicaid)

How does a person qualify for Medi-Cal? How does one apply for Medi-Cal?

SSI Recipients. Individuals who receive Supplemental Security Income (SSI) automatically qualify for Medi-Cal. SSI is the federal program that guarantees a minimum monthly income for the elderly, blind and disabled. It is available only to individuals with countable assets (assets which are not exempt) of less than $2,000.00 and who have a limited monthly income.

Medically Needy Recipients. An individual who is 65 years or older, blind or disabled will be eligible for Medi-Cal in a skilled nursing facility or intermediate care facility if he or she meets the resource limitations. The resource limitation is $2,000.00; however, a number of assets are exempt and do not count as an available resource, the most important of which for most individuals is the home; the home is exempt as long as the applicant has the subjective intent to return home. In other words, in most cases, you do not need to sell or encumber your home to qualify for Medi-Cal.

Transfer Of Assets In Order To Qualify. For countable assets, you need to be aware of Medi-Cal’s transfer of assets rules. Giving away countable assets in order to qualify for Medi-Cal can result in a significant penalty period during which Medi-Cal will not be available.

Where One Spouse Needs Long-Term Care. The rules are far more generous for a married couple where one spouse needs long-term care. An institutionalized spouse will qualify for Medi-Cal if the couple (treated as a family unit) spends down its countable assets to the CSRA allowance. The CSRA (community spouse resource allowance) for 2009 is $109,560.00. The CSRA is retained by the community spouse; the institutionalized spouse is still subject to the $2,000.00 property reserve. After the institutionalized spouse becomes eligible for Medi-Cal, the community spouse may acquire assets in his or her own name in excess of the CSRA without affecting the institutionalized spouse's eligibility. There are also rules which help make sure the at-home spouse has sufficient income for his or her needs.

Interspousal Transfers. Transferring assets from the institutionalized spouse to the community spouse, either by the institutionalized spouse, if he or she is able to do so, or under existing estate planning documents which authorize gifting between spouses, or by court order, is often necessary for the protection of the community spouse. The spend-down of a couple’s countable assets to the CSRA level, if necessary, often offers opportunities to help protect the family without adversely affecting the institutionalized spouse.

Applying For Medi-Cal. Some facilities will assist you in the application for Medi-Cal. You can also apply directly with the county or use the services of a private company.