California Medicaid, known as Medi-Cal, is a health insurance program funded by federal and state dollars, providing medical and health-related services to low-income individuals, including children, pregnant women, parents, seniors, and disabled individuals.
This guide outlines the 2025 eligibility criteria, income limits, asset rules, and application process for Medi-Cal, based on federal and California Department of Health Care Services (DHCS) guidelines, with a focus on long-term care for seniors (aged 65+), as well as other eligibility groups.
Overview of California Medi-Cal Programs
Medi-Cal offers coverage for various groups, with specific eligibility requirements based on income, assets, age, and medical needs. The main programs include:
- Institutional / Nursing Home Medicaid: An entitlement program covering nursing home care, hospitals, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Requires a Nursing Facility Level of Care (NFLOC).
- Home and Community Based Services (HCBS) Waivers: Non-entitlement programs with limited slots, offering services like in-home care, adult day care, and delivered meals to help seniors and disabled individuals avoid institutionalization. Programs like the Multipurpose Senior Services Program (MSSP) may have waiting lists.
- Regular Medicaid (Aged, Blind, and Disabled): Covers low-income elderly, blind, or disabled individuals, with less stringent medical requirements than long-term care programs.
- Medicaid for Children and Pregnant Women: Covers children up to age 19 and pregnant women with higher income limits through programs like Medi-Cal Access Program (MCAP).
- Medicaid for Adults (19–64): Covers low-income adults without dependent children, enabled by California’s Medicaid expansion under the Affordable Care Act (ACA) since 2014.
Eligibility for California Medi-Cal
Eligibility varies by program and population. General requirements include:
- Residency: Must be a resident of California.
- Citizenship: Must be a U.S. citizen, national, permanent resident, or legal alien with qualifying immigration status (e.g., refugees, asylees, or lawful permanent residents with 5+ years in the U.S.).
- Income: Varies by program, often based on a percentage of the Federal Poverty Level (FPL) or Federal Benefit Rate (FBR).
- Assets: Limits apply for long-term care and aged/blind/disabled programs, but not for ACA expansion, children, or pregnant women.
- Medical/Functional Need: Long-term care programs require a Nursing Facility Level of Care (NFLOC), assessed through limitations in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).
Categorical Eligibility
Individuals receiving Supplemental Security Income (SSI) or certain means-tested benefits are often categorically eligible for Medi-Cal, bypassing some income and asset tests.
Income Limits for California Medi-Cal
Income limits vary by program and household status. Below are the 2025 income limits for California, based on federal guidelines and state policies, expressed as monthly amounts unless noted.
| Eligibility Category | Single | Married (Both Applying) | Children (0–18) | Pregnant Women | Adults (19–64, No Dependents) |
|---|---|---|---|---|---|
| Seniors/Disabled (Nursing Home/HCBS) | $2,901 (300% FBR) | $5,802 (300% FBR) | N/A | N/A | N/A |
| Regular Medicaid (Aged, Blind, Disabled) | $1,215 (100% FBR) | $1,644 (100% FBR) | N/A | N/A | N/A |
| ACA Expansion Adults (19–64) | $1,799 (138% FPL) | $2,432 (138% FPL) | N/A | N/A | $1,799 (138% FPL) |
| Children/CHIP | N/A | N/A | $3,260 (250% FPL) | N/A | N/A |
| Pregnant Women (MCAP) | N/A | N/A | N/A | $3,260 (250% FPL) | N/A |
Additional Notes on Income Limits
- Seniors/Disabled (Nursing Home/HCBS): Income above $2,901/month must go toward care costs, except for a Personal Needs Allowance ($35/month for nursing home, $600–$1,500/month for HCBS), Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse. A Qualified Income Trust (QIT) is not typically required in California due to generous income allowances.
- Married, One Spouse Applying: Applicant’s income limit is $2,901/month; non-applicant spouse’s income is not counted. The non-applicant may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) of up to $3,948/month if their housing and utility costs exceed $793.13/month (effective 7/1/25–6/30/26).
- Children/CHIP: Limits may extend to 266% FPL ($3,467/month for one) for certain age groups under Medi-Cal for Children.
- Pregnant Women: Coverage extends 12 months postpartum. The Medi-Cal Access Program (MCAP) covers pregnant women up to 250% FPL.
- ACA Expansion: California’s Medicaid expansion covers adults aged 19–64 with incomes up to 138% FPL, closing the coverage gap for those without dependents. No premiums or cost-sharing for most services.
2025 Federal Poverty Level (FPL) Guidelines for Reference (48 States & D.C.)
| Household Size | 100% FPL | 138% FPL | 250% FPL |
|---|---|---|---|
| 1 | $15,650 ($1,304/month) | $21,597 ($1,799/month) | $39,125 ($3,260/month) |
| 2 | $21,150 ($1,762/month) | $29,187 ($2,432/month) | $52,875 ($4,406/month) |
| 3 | $26,650 ($2,221/month) | $36,777 ($3,064/month) | $66,625 ($5,552/month) |
| 4 | $32,150 ($2,679/month) | $44,367 ($3,697/month) | $80,375 ($6,698/month) |
Note: Use the FPL Calculator to estimate your household’s FPL percentage.
Asset Rules for California Medi-Cal
Asset limits apply primarily to long-term care and aged/blind/disabled programs.
Long-Term Care Medi-Cal (Nursing Home and HCBS Waivers)
- Single Applicant: $2,000 in countable assets (e.g., bank accounts, stocks, bonds, secondary properties).
- Married, Both Applying: $3,000 total.
- Married, One Applying: $2,000 for the applicant; $157,920 for the non-applicant spouse (Community Spouse Resource Allowance, or CSRA).
- Home Equity Limit: $1,103,000 for the primary residence (if applicant/spouse resides there or intends to return).
Non-Countable Assets
- Primary home (if applicant/spouse resides there or intends to return)
- One vehicle
- Household goods and personal effects
- Irrevocable Funeral Trusts (no specific limit in California)
- Medi-Cal Compliant Annuities
- Life insurance with a face value of $1,500 or less
Medi-Cal’s Look-Back Rule
California enforces a 30-month look-back period (shorter than the federal 60-month standard) for Nursing Home Medi-Cal and HCBS Waivers, reviewing asset transfers within 2.5 years of application. Transfers below fair market value (e.g., gifting) may result in a penalty period of ineligibility. No look-back period applies for Regular Medi-Cal.
Estate Recovery
California’s Medi-Cal Estate Recovery Program seeks reimbursement for long-term care costs after a beneficiary’s death, often targeting the home if not protected. Recovery is limited to those aged 55+ at the time of service or those permanently institutionalized. Consult a Certified Medicaid Planner to safeguard assets, such as transferring the home to a spouse or trust.
Regular Medi-Cal (Aged, Blind, and Disabled)
- Asset Limit: $2,000 for an individual; $3,000 for a couple.
- No home equity limit or look-back period.
Medi-Cal for Children, Pregnant Women, and Adults (ACA Expansion)
- No Asset Test: These programs focus solely on income.
Medical/Functional Requirements
For Nursing Home Medi-Cal and HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC), assessed through:
- Limitations in Activities of Daily Living (ADLs): Mobility, bathing, dressing, eating, toileting.
- Limitations in Instrumental Activities of Daily Living (IADLs): Cooking, shopping, managing finances.
- Cognitive or Behavioral Issues: E.g., Alzheimer’s or dementia, though diagnosis alone does not guarantee eligibility.
Regular Medi-Cal for the aged, blind, or disabled requires proof of disability or blindness per Social Security Administration criteria but not necessarily NFLOC.
Changes Due to Federal Policy
As of 2025, federal policy changes may affect Medi-Cal, though California’s expansion status and robust program mitigate some impacts:
- Work Requirements (Starting January 2027): May apply to ACA expansion adults (19–64) but not to seniors, disabled individuals, pregnant women, or children. California has historically resisted work requirements, but compliance may be required.
- Reduced Retroactive Coverage (Starting January 2027): Medi-Cal will cover only 2 months prior to application (down from 90 days), increasing potential medical debt for late applicants.
- More Frequent Eligibility Checks (Starting December 2026): Beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps.
- New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may face up to $35 per visit for specialist services or procedures, but primary care and preventive services remain free.
Options if Over the Income or Asset Limit
If your income or assets exceed the limit, consider:
- Spend Down (Share of Cost): For Regular Medi-Cal, pay medical expenses to reduce income to the Maintenance Need Level (e.g., $600/month for an individual). This acts like a deductible.
- Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses are exempt from asset limits.
- Medi-Cal Compliant Annuities: Convert countable assets into an income stream for the non-applicant spouse.
- Certified Medicaid Planners: Professionals can help with financial strategies, such as transferring assets to a spouse or trust to protect the home from estate recovery.
Application Process
To apply for California Medi-Cal:
- Online: Use the Covered California portal at coveredca.com or the BenefitsCal portal at benefitscal.com. Check eligibility with the Medicaid Eligibility Calculator.
- Phone: Call the Medi-Cal Access Line at 1-800-541-5555 or Covered California at 1-800-300-1506 for assistance.
- In-Person or Mail: Complete and submit an application to a local County Social Services Office. Download the application from dhcs.ca.gov.
- Assistance: Contact the In-Home Supportive Services (IHSS) program or a local Area Agency on Aging for long-term care support. Call 1-800-510-2020 for general Medi-Cal inquiries.
Required documents include proof of income, assets, residency, citizenship, Social Security number, and medical records (for long-term care or disability programs). An interview may be required for long-term care applications.
Processing Time
- Standard applications: Up to 45 days (90 days for disability-based applications).
- Expedited processing: May apply for urgent cases (e.g., pregnant women via presumptive eligibility for outpatient care).
Frequently Asked Questions
How do I apply for Medi-Cal in California?
Apply online at coveredca.com or benefitscal.com, by phone at 1-800-541-5555, in person at a County Social Services Office, or by mail with a downloaded application from dhcs.ca.gov.
What are the 2025 Medi-Cal income limits for California?
For seniors/disabled (Nursing Home/HCBS), the limit is $2,901/month (single) or $5,802/month (couple). Regular Medi-Cal (aged, blind, disabled) is $1,215/month (single) or $1,644/month (couple). Children and pregnant women qualify up to 250% FPL ($3,260/month for one). ACA expansion adults qualify up to 138% FPL ($1,799/month for one).
Are there asset limits for California Medi-Cal?
Yes, for long-term care and aged/blind/disabled programs: $2,000 (single), $3,000 (couple, both applying), or $157,920 for a non-applicant spouse. No asset tests for children, pregnant women, or ACA expansion adults.
What is the Medi-Cal look-back period in California?
A 30-month look-back period applies to Nursing Home Medi-Cal and HCBS Waivers, penalizing asset transfers below fair market value. No look-back for Regular Medi-Cal.
Can I qualify for Medi-Cal if my income or assets are too high?
Yes, through a Share of Cost (spend down), Irrevocable Funeral Trusts, or Medi-Cal Compliant Annuities. Consult a Certified Medicaid Planner for assistance.
How does California’s Medi-Cal expansion affect eligibility?
California’s ACA expansion since 2014 covers adults aged 19–64 with incomes up to 138% FPL, with no asset test, closing the coverage gap for those without dependents.
This guide is based on 2025 federal and California Department of Health Care Services guidelines. Verify details with the Medi-Cal program for accuracy.