California Medicaid (Medi-Cal) Nursing Home Eligibility: A Complete Guide

If you're researching whether a loved one qualifies for Medi-Cal to cover nursing home care in California, you're not alone. Senior care costs in California are among the highest in the country — the median annual cost for a semi-private nursing home room exceeds $105,000. Medi-Cal, California's Medicaid program, can cover most or all of that cost for those who meet the eligibility requirements.

Here's everything you need to know.

Who Qualifies for Medi-Cal Nursing Home Coverage

To receive Medi-Cal for long-term nursing home care, you must meet three requirements:

1. Medical necessity — A physician must certify that you require a nursing facility level of care. This typically means you need assistance with multiple activities of daily living (ADLs) such as bathing, dressing, eating, or toileting, or you have a condition that requires skilled nursing supervision.
2. Financial eligibility — You must meet California's income and asset limits (see below).
3. California residency — You must be a California resident and a U.S. citizen or qualifying immigration status.

Medi-Cal does not discriminate based on age for nursing home coverage — adults of any age may qualify if they meet medical and financial criteria.

Income Requirements

California does not have a strict income cap for nursing home Medi-Cal. Instead, if your income exceeds the Medi-Cal standard, you will be required to pay a portion of your nursing home costs through what is called a Share of Cost (SOC).

In practice, residents receiving nursing home care through Medi-Cal keep a personal needs allowance (currently $35–$50 per month) and contribute the remainder of their income toward their care costs. Medi-Cal pays the difference.

For married applicants where a spouse remains at home (the "community spouse"), income protections apply. The community spouse may retain their own income, plus a Monthly Maintenance Needs Allowance (MMNA) of up to approximately $3,715/month (2025).

Asset (Resource) Requirements

As of January 1, 2024, California significantly raised the asset limit under the Medi-Cal Equity and Dignity Act:

• Single individuals: $130,000 in countable assets
• Married couples (one applicant): $195,000 in combined countable assets

Exempt assets (not counted):

• Primary home (subject to Medi-Cal estate recovery)
• One vehicle
• Personal belongings and household goods
• Pre-paid funeral arrangements (up to limits)
• Life insurance with face value under $1,500

Important note on the home: While your home is exempt during your lifetime, Medi-Cal may seek reimbursement from your estate after death (estate recovery). There are protections for surviving spouses, minor children, and disabled adult children. Speak with an elder law attorney about planning strategies.

Look-back period: California does NOT currently have a Medicaid look-back period for nursing home care — a significant advantage compared to most other states.

Application Process

Apply for Medi-Cal nursing home benefits through your county's Department of Social Services (DSS) or Health and Human Services Agency:

1. Contact your county Medi-Cal office to request an application. Find your county office at dhcs.ca.gov or call 1-800-541-5555.
2. Complete the SAWS 2 Plus application (for long-term care) or apply online via Covered California.
3. Submit documentation: income verification, bank statements, property records, and physician certification of nursing home level of care.
4. A county eligibility worker will review your application within 45 days (90 days for disability-based applications).

If the application is approved retroactively, Medi-Cal may cover nursing home costs dating back up to three months before the application date.

What Medi-Cal Covers in a Nursing Home

Covered:

• Semi-private room and board
• Skilled nursing services (wound care, IV therapy, physical therapy, occupational therapy, speech therapy)
• Physician visits and specialist care
• Medications
• Medical equipment and supplies
• Incontinence supplies
• Mental health services

Not covered:

• Private rooms (unless medically necessary)
• Personal comfort items (TV, telephone, special clothing)
• Dental care beyond emergency extraction (limited coverage)
• Vision and hearing aids (limited)
• Cosmetic services

Home- and Community-Based Waiver Programs

If nursing home care is not yet necessary, California offers several programs designed to help seniors and people with disabilities remain at home:

• In-Home Supportive Services (IHSS): Covers personal care, domestic services, and protective supervision for qualifying Medi-Cal recipients for qualifying Medi-Cal recipients.
• Community-Based Adult Services (CBAS): Adult day health care services for people who need a nursing home level of care but can remain at home with support.
• Multipurpose Senior Services Program (MSSP): Care management and limited services to help frail elderly Californians remain in their homes or community settings.
• PACE (Program of All-Inclusive Care for the Elderly): Comprehensive coordinated care for people 55+ who qualify for nursing home level of care, delivered in the community.

Frequently Asked Questions

Will Medi-Cal take my house?

Not while you or your spouse are living in it. However, Medi-Cal may file an estate recovery claim after death. Planning with an elder law attorney can help protect your home.

Can I give away assets to qualify for Medi-Cal?

California currently does not enforce a look-back period for nursing home Medi-Cal, but federal rules may change. Consult an elder law attorney before making transfers.

What if my income is too high?

California's Share of Cost system means there is no income "too high" to ever qualify — you pay a portion, Medi-Cal covers the rest.

How long does approval take?

Typically 45–90 days from application. Retroactive coverage up to 3 months prior may be available.