California Medi-Cal for seniors and long-term care

Last verified: June 2026

Medi-Cal and long-term care in California

Medi-Cal is the primary payer for more than 6 in 10 Californians in nursing homes. Per the California Health Care Foundation (CHCF, April 2025), over 100,000 California seniors receive short or long-term care in nursing facilities each year, at an average cost of $137,000 annually. Medicare covers only the first 100 days of post-hospitalization nursing home care; Medi-Cal covers the rest for eligible enrollees indefinitely.

California also has approximately 1.7 million residents who are dually enrolled in both Medicare and Medi-Cal — the largest dual-eligible population of any state. These "dual eligibles" receive Medicare for most medical services and Medi-Cal for long-term services, cost-sharing, and other benefits Medicare does not cover.

For seniors who want to remain at home or in a community setting, California offers several in-home and community-based programs — most prominently the In-Home Supportive Services (IHSS) program. Nearly one million Medi-Cal enrollees rely on HCBS services in California, per CHCF.

In-Home Supportive Services (IHSS): California's largest home care program

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.

Per CDSS, IHSS covers a broad range of in-home services:

• Domestic services — housecleaning, meal preparation, laundry, grocery shopping, and trash removal
• Personal care services — bathing, dressing, grooming, feeding, and toileting assistance
• Paramedical services — administering injections and medications, G-tube feeding, colostomy care, and wound care
• Protective supervision — behavioral monitoring and verbal redirection to prevent injury
• Accompaniment to medical appointments

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's HCBS waivers: six programs plus PACE

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. A person can only be enrolled in one waiver at a time.

Additional waivers exist for individuals with developmental disabilities (HCBS-DD) and through the Self-Determination Program (SDP). Contact your county or DHCS at dhcs.ca.gov/medi-cal/programs/ for current waiver availability and waitlist status.

CalAIM: California's approach to avoiding nursing facility placement

California Advancing and Innovating Medi-Cal (CalAIM), launched statewide in January 2022, expanded the ability of Medi-Cal managed care plans to pay for enhanced care management, housing supports, and community-based services that prevent nursing home admission. CalAIM replaced the older Coordinated Care Initiative (CCI) that was piloted in seven counties.

Per Justice in Aging (April 2026), Medi-Cal health plans can now pay for home-based help and care coordination through CalAIM that was not previously a covered benefit. This is relevant for seniors whose needs are increasing but who want to remain at home — the CalAIM benefit may cover services that would otherwise require private payment or HCBS waiver enrollment.

Nursing facility coverage

Medi-Cal covers skilled nursing facility care for seniors who meet both clinical and financial criteria. Clinical eligibility requires documented need for skilled nursing care, assessed through California's standardized instrument. Financial eligibility means income and countable assets fall within the program limits.

Once approved, Medi-Cal pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance set by California (currently around $35–$50 per month, verify current amount with DHCS). Medi-Cal covers the gap between that contribution and the facility's rate.

California is a spend-down state — it does not use Miller Trusts (Qualified Income Trusts). Seniors whose income exceeds Medi-Cal's limit can still qualify by spending excess monthly income on qualified medical expenses, a mechanism called "share of cost." See the DHCS info-box above for details.

Asset limits and the 60-month lookback period

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. 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.

Spousal protections: CSRA and MMMNA

When one spouse enters a nursing home, federal law protects the community spouse (the one remaining at home) from complete impoverishment. Two protections apply:

California sets its CSRA and MMMNA within the federal range. Current California-specific figures are available from your county social services office. The community spouse's own income is not counted toward the institutionalized spouse's eligibility.

What long-term care Medi-Cal typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• In-Home Supportive Services (IHSS) — personal care assistance at home, covering bathing, dressing, meal preparation, and more
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Assisted living via the Assisted Living Waiver (available in 15 counties)
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments