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Health Coverage: Nursing Home Care

Last modified: 4/9/2013 2:32 PM

Medi-Cal Long Term Care (LTC)

24-Hr Automated InfoLine:
1-877-96-BENEFITS  or 1-877-962-3633
 
Nursing home care covered under Medi-Cal is provided to eligible persons who meet the definition of Long-Term Care (LTC) status. LTC status means the person is receiving inpatient medical care that lasts for more than the month of admission to the LTC facility. The following are the most frequently offered services by LTC facilities:
 
  • Skilled or intermediate nursing home and convalescent care
  • Comprehensive preventive care services (primary and specialty care)
  • Medical office visits, vision care, dental care, and mental health services
  • Hospitalization and prescription medicines
 
The eligibility information listed below will give you an idea of whether you may be eligible to receive Medi-Cal coverage under the LTC Program. However, eligibility for Medi-Cal can only be fully evaluated by an Eligibility Worker (EW) at one of the Social Services Agency Intake Offices. If and when you decide to apply, your EW will explain in further detail what requirements specifically apply to your situation.
 
 
Basic Eligibility Requirements
 
Persons applying for the Medi-Cal LTC Program must meet the following requirements:
 
  • Income: There is no income limit, but eligible recipients may pay a monthly share of cost on income after allowing a deduction for other health insurance premiums and certain other limited expenses. A share of cost is similar to a monthly deductible. It is the amount of medical expenses a Medi-Cal beneficiary must pay or be obligated to pay before Medi-Cal will cover any medical expenses.

            Note: A spouse living at home who is not on Medi-Cal is allowed to retain a monthly income allocation of $2,841 in 2012.  The allocation amount changes annually in January.

 
  • Property: The person in the nursing home may keep up to $2,000 in property. A spouse living at home who is not on Medi-Cal is allowed to retain a resource allowance of $113,640 in 2012. The amount allowed changes annually in January.
 
Applying for the Medi-Cal LTC Program
 
Persons that would like to apply for the Medi-Cal LTC Program may:
 
  • Apply for Medi-Cal in person by visiting one of the Social Services Agency Intake Offices and filling out an application, or
  • Call a Social Services Agency Intake Office and ask for a mail-in Medi-Cal application.
  • Apply online via the Benefits CalWIN website at http://www.mybenefitscalwin.org. Your worker will review your online application and contact you by phone or mail if additional information is needed.
You may also call one of the intake offices and ask to speak with the Information Supervisor. The Information Supervisor will answer any questions you may have about Medi-Cal.
 
 
Documents You Will Need to Bring When You 
 
Your Eligibility Worker (EW) will tell you exactly what documents you will need to provide as proof of identity, income, property, residence, and so on. The following list contains examples of some of the most common items you may need to provide so that your EW can see if you are eligible for Medi-Cal benefits.
 
   Proof of Identity
 
  • California Driver’s License or ID from the Department of Motor Vehicles (DMV)
  • Passport
   Proof of Social Security Number
 
  • Social Security Card
  • Proof of application for Social Security Card

   Proof of Immigration Status

  • Permanent Resident Card/Green Card/ Alien Registration Card
   Proof of Property
 
  • Bank statements (checking and/or savings accounts)
  • Car registrations
  • Life insurance policies, burial plot documents, trust agreements
  • Papers that show the value of property
   Proof of Income
 
  • Pay stub
  • Employer documents
  • Pension or annuity documents
  • Other papers that provide proof of monthly income (e.g., Social Security Award Letter, Unemployment check stub, and/or Disability check stub)
   California Residency
 
  • Housing bill/receipt
  • California DMV ID Card or Driver’s License 
  • Utility bill