Adult Day Health Care
Check Medi-Cal Eligibility and Benefits
Medi-Cal — California’s version of Medicaid — is a state and federal program that covers some of the costs of adult day health care for those who have low incomes or whose resources have been depleted by health care costs.
Who Is Eligible?
In general, an individual who is over age 65 can qualify for Medi-Cal coverage if he or she has either:
- A low income and little savings or other assets, as described below under “Income and Asset Levels,” or
- Personal resources that are reduced because of paying for health care expenses, as described below under “Higher Limits for High Medical Expenses.”
In addition, those who are enrolled in the following programs can automatically qualify for Medi-Cal:
Supplemental Security Income (SSI) or State Supplementary Payment (SSP) — federal and state programs providing income to those who are 65 and over, blind, or disabled who meet income and resource limits. Both programs are administered by the Social Security Administration. For a quick analysis of whether you qualify, use the SSI Benefit Eligibility Screening Tool.
In-Home Supportive Services (IHSS) — providing services to those over 65, disabled or blind who want to remain living at home, administered through county offices. Learn more.
California Work Opportunity and Responsibility to Kids (CalWORKs) — a welfare program providing money and services to some families with special needs. This program is administered through the county welfare departments. Learn more.
Refugee Programs — operated by the state’s Refugee Program’s Bureau. Learn more.
Foster Care or Adoption Assistance Program — operated by the state’s Children and Family Services Division. Learn more.
Income and Asset Limits
Not all income and assets are counted when determining eligibility (income limits change frequently; for current information contact the local Medi-Cal office). Assets not counted are:
- A home, if the client or his or her spouse is living there;
- A cash reserve of $2,000 for single people, more for married couples;
- One car and household and personal belongings including clothing, heirlooms, and wedding and engagement rings;
- Burial plots and any money in a designated burial plan fund, and
- Life insurance policies and the balance of pension funds, IRAs, and certain annuities.
Individuals with income and assets above Medi-Cal limits who are not in immediate need of long term care may be able to become eligible by some of their assets. For example, Medi-Cal rules allow reducing assets by paying off medical bills or a mortgage or other debts, paying for home care, replacing an old vehicle, updating home furnishings, or prepaying funeral expenses. Some people may also qualify for Medi-Cal by transferring their property to others, with the important limitation that anything transferred during the 60 months before applying for coverage will be taken into account in determining eligibility.
Higher limits for high medical expenses. Some people with relatively high incomes may qualify for Medi-Cal if a stated share goes exclusively to paying medical costs. This is called paying a “share of cost.” The amount may change with an individual’s monthly income.
When only one spouse remains at home. A couple does not need to sell their home to qualify for Medi-Cal when one of the spouses enters a nursing facility. And the spouse who remains at home is also allowed to receive a certain amount of income each month, and to retain some of the couple’s combined assets.
What Is Covered
Once a person meets the strict requirements for qualifying for coverage, Medi-Cal will help pay for a number of days of adult day health care based on a doctor’s recommendation. If a client requires more days of care than Medi-Cal approves, he or she is responsible for paying the rest.
How To Apply
Individuals must apply for coverage at the local Medi-Cal office. If a person is homebound or already in a nursing facility, the individual or family can request that a Medi-Cal representative assist them in completing the application in a personal visit.
Within 45 days after the paperwork is completed, the Medi-Cal office will send a written notice about eligibility. Individuals have 90 days to appeal a denial of coverage and request an informal hearing for reconsideration.