Medi-Cal Eligibility for Long-Term Care in California: 2026 Guide

If your parent needs nursing home care or more help than you can give at home, Medi-Cal is often part of the conversation. Medi-Cal eligibility for long-term care in California changed on January 1, 2026, when the state brought back an asset limit for seniors. Families who planned under the old “no asset test” rules of 2024 and 2025 now need to look again.

This guide explains, in plain language, how Medi-Cal eligibility for long-term care works in California in 2026: the asset limit, how income is treated, the look-back on gifts, protections for a spouse at home, what Medi-Cal pays for in a nursing home, and how the Assisted Living Waiver works in board and care homes in San Diego. It also walks through how to apply in San Diego County. Rules change often, and every family’s finances are different, so please treat this as a starting point and talk with an elder law attorney before you make any decisions.

What Is Medi-Cal and Why Does It Matter for Long-Term Care?

Medi-Cal is California’s name for Medicaid, the joint federal and state health program for people with limited income and assets. For seniors, it matters for one big reason: Medicare does not pay for long-term custodial care. Medicare covers hospital stays, doctor visits and a short skilled nursing rehab stay after a hospital admission, but it does not pay for a parent to live long term in a nursing home, an assisted living community or a board and care home.

When savings run low, Medi-Cal becomes the main way to pay for long-term nursing home care. It can also pay for help at home through In-Home Supportive Services (IHSS), and, in a limited number of participating facilities, the care portion of assisted living through the Assisted Living Waiver.

Many seniors have both Medicare and Medi-Cal. They are often called “dual eligibles,” and Medi-Cal then helps with Medicare premiums, copays and the care Medicare will not cover.

Medi-Cal Eligibility for Long-Term Care in California: The 2026 Asset Limit

From 2024 through 2025, California did not count assets at all for most Medi-Cal programs. That ended on January 1, 2026. According to the California Department of Health Care Services (DHCS), Medi-Cal now counts assets again for people who are 65 or older, have a disability, or live in a nursing home.

The 2026 limit. Through June 30, 2027, the asset limit is $130,000 for one person, plus $65,000 for each additional household member, up to 10 people. That is far higher than California’s old $2,000 limit, but it is a real limit, and seniors with significant savings will need to plan.

A lower limit is scheduled. DHCS also states that starting July 1, 2027, the limit is scheduled to drop to $21,000 for one person and $31,000 for two, plus $1,550 for each additional person. If your parent is close to needing long-term care, this date matters. Ask an attorney how it could affect your family’s timing.

What counts. Countable assets include cash, checking and savings accounts, CDs, stocks and bonds, second homes and second vehicles.

What usually does not count. DHCS lists several assets that are generally exempt:

• The main home, in most situations (see below)
• One vehicle
• Household goods and personal items such as furniture and clothing
• Retirement accounts when the person is receiving regular payments from them
• Irrevocable prepaid burial plans and certain small burial funds and life insurance

The home. For a senior entering a nursing home, the home is generally not counted if they intend to return to it, or if a spouse or a dependent relative lives there. A second home or rental property is counted. California also limits estate recovery after death to assets that pass through probate, and there are exemptions and hardship waivers. How a home is titled can make a large difference, which is one more reason to get legal advice.

How Income Works for Nursing Home Medi-Cal

Families often ask, “What is the income limit for Medi-Cal?” For long-term nursing home care, there is no hard income cap that disqualifies someone. Instead, Medi-Cal uses a share of cost.

Here is how it works in simple terms. A senior on nursing home Medi-Cal keeps a small personal needs allowance each month (currently $35). Most of the rest of their monthly income, such as Social Security and pensions, goes to the nursing home as their share of cost. Medi-Cal pays the balance of the nursing home bill. Health insurance premiums and certain other expenses can reduce the share of cost, and part of the income can be set aside for a spouse at home.

Income rules are different for seniors who live at home or in a board and care home. The Assisted Living Waiver, for example, requires full-scope Medi-Cal with no share of cost, which generally means lower income. Your county eligibility worker will review which Medi-Cal program fits your parent’s situation.

The 2026 Look-Back Period on Gifts and Transfers

With the asset limit back, the look-back on transfers is back too. DHCS states that Medi-Cal reviews assets given away in the 30 months before a person enters a nursing facility. Giving away money or property for less than fair value during that window can cause a penalty period, a stretch of months when Medi-Cal will not pay for nursing home care.

There is important good news in the 2026 rules:

• Transfers before January 1, 2026 are not penalized. Because there was no asset test in 2024 and 2025, DHCS states that transfers made before January 1, 2026 do not count.
• The look-back is phasing in. In practice the review period is shorter than 30 months until mid-2028, because it only reaches back to January 2026.
• Some transfers are allowed. Transfers to a spouse, to a blind or disabled child, or sales at full fair market value do not cause a penalty.

Do not give away money, add a child to a deed or move assets into a trust without advice. A well-meant gift to help a grandchild with college can delay nursing home coverage for months.

Spousal Protections When One Spouse Needs Care

California does not expect the healthy spouse to become impoverished to pay for the other spouse’s nursing home care. Federal “spousal impoverishment” rules protect the spouse who stays at home, often called the community spouse.

Assets. For 2026, the community spouse resource allowance is $162,660. In simple terms, the at-home spouse can keep a protected share of the couple’s countable assets, in addition to the home and one car, separate from the limit for the spouse who needs care. Couples often have a window after approval to move assets into the at-home spouse’s name.

Income. The at-home spouse keeps their own income. If it is low, part of the nursing home spouse’s income can be redirected to them, up to a monthly maintenance allowance (about $4,066 a month in 2026 under the federal standards).

These rules also apply to registered domestic partners in California. They are exactly the kind of planning where an elder law attorney earns their fee. If your parents are a couple and one needs care, our guide to assisted living for couples covers the care side of the decision.

What Medi-Cal Pays for in a Nursing Home

For a senior who qualifies, Medi-Cal covers long-term care in a Medi-Cal certified nursing home, also called a skilled nursing facility (SNF). Coverage includes the room, meals, nursing care, help with daily activities, medications, and therapy.

A few practical points for San Diego families:

• Medicare first. After a qualifying hospital stay, Medicare can cover up to 100 days of skilled nursing rehab. Days 1 through 20 are covered in full, and days 21 through 100 carry a daily coinsurance ($217 per day in 2026). Medi-Cal can pick up that coinsurance for dual eligibles.
• Not every bed is a Medi-Cal bed. Ask any nursing home whether it accepts Medi-Cal, and whether a resident can stay if they start as private pay and later convert to Medi-Cal.
• Apply early. If a parent is in a skilled nursing facility and will likely stay, ask the facility’s business office or social worker to help start the Medi-Cal application right away.

Learn more about local options on our nursing homes in San Diego page.

Does Medi-Cal Pay for Assisted Living or Board and Care Homes?

This is where many families are surprised. Regular Medi-Cal does not pay for assisted living or board and care. The main exception is the Assisted Living Waiver (ALW), a DHCS program available in 15 California counties, including San Diego County.

Who qualifies. According to DHCS, ALW participants must be 21 or older, have full-scope Medi-Cal with no share of cost, have care needs similar to someone in a nursing home, and be able to live safely in an assisted living setting.

What it pays. The waiver pays the participating facility for care services such as personal care and help with daily activities. It does not pay for room and board. The resident pays the facility for room and board, usually from their SSI/SSP or other income, and keeps a small amount for personal needs. For reference, the 2026 SSI/SSP payment standard for an aged person in a licensed nonmedical care facility is $1,626.07 a month.

Where it works. Only RCFEs and housing sites that have enrolled in the waiver accept ALW residents. In San Diego that includes some large assisted living communities and some board and care homes, but the list is limited.

The wait list. DHCS states that waiver slots are limited and there is currently a waitlist. Openings are released to Care Coordination Agencies on a regular basis. In San Diego the wait can be long, so families should apply early and plan a way to pay privately or a backup option while they wait.

How to apply for the ALW. Contact a Care Coordination Agency (CCA) that serves San Diego County. DHCS keeps a list of participating CCAs on its Assisted Living Waiver page. The CCA assesses your parent, places them on the wait list and helps with the move once a slot opens.

A few board and care homes in San Diego also accept residents who pay only the SSI/SSP rate, without the waiver. These homes are rare and usually full, but a local advisor can tell you which ones currently have openings.

Medi-Cal and Care at Home: IHSS

For seniors who want to stay home, Medi-Cal’s In-Home Supportive Services (IHSS) program pays a caregiver, who can be a family member, to help with tasks like bathing, dressing, meals and housework. In San Diego County, IHSS is run by Aging & Independence Services. A county social worker visits the home and authorizes a set number of hours each month.

IHSS can be a great help, but the hours are often not enough for someone who needs round-the-clock supervision. When that happens, a board and care home in San Diego can be more affordable than piecing together home care. Our San Diego in-home care page explains the options.

How to Apply for Medi-Cal in San Diego County

San Diego County Health and Human Services Agency (HHSA) handles Medi-Cal applications. You can apply in several ways:

• Online through BenefitsCal, the state’s benefits portal, where you can also upload documents
• By phone: call the county’s Access Customer Service Call Center at 1-866-262-9881 with questions or to request a mail-in application (you can also dial 2-1-1)
• In person at any San Diego County Family Resource Center
• Through the nursing home, if your parent is already in a skilled nursing facility; the business office often helps start the application

Documents to gather. Have these ready to avoid delays:

• Photo ID, Social Security number and Medicare card
• Proof of income: Social Security award letter, pension statements, annuity statements
• Recent bank, brokerage and retirement account statements for every account
• Deeds, vehicle registrations, life insurance policies and burial plan contracts
• Trust documents, powers of attorney and any records of large gifts or transfers since January 1, 2026

If someone else is helping, make sure a durable power of attorney is in place, or ask the county about an authorized representative form. Keep copies of everything you submit and write down the name of every worker you speak with.

When to Talk With an Elder Law Attorney

We are a senior placement agency, not lawyers, and this guide is general information, not legal or financial advice. We strongly encourage families to consult a California elder law attorney, especially if:

• Your parent has savings or property near or above the $130,000 limit
• One spouse needs care and the other will stay at home
• You are considering gifts, a trust, or changing the title on a home
• Your parent may need long-term care around the scheduled July 2027 change
• Your application was denied or a share of cost seems wrong

Many attorneys offer a flat-fee Medi-Cal planning consultation. The State Bar of California’s certified specialist directory and the Elder Law Section of the local bar are good places to start. Some estate planning attorneys also know Medi-Cal well, so ask your family’s attorney first.

How Elder Answers Helps

Medi-Cal is only one piece of the puzzle. Families also need to know which senior care homes accept Medi-Cal or the Assisted Living Waiver, which have openings, and what to do while a parent waits. Elder Answers has helped San Diego families for well over a decade, and we know which board and care homes, nursing homes and assisted living communities in San Diego County work with these programs.

Our service is free for families, because care homes pay us after a resident moves in, and the rate you pay the home does not change. Our advisors personally visit the homes we recommend, and we share your information only with the homes you choose. Contact Elder Answers to talk through your parent’s care needs and budget, or start with our overview of senior care options in San Diego.

Frequently Asked Questions About Medi-Cal Eligibility for Long-Term Care

What is the Medi-Cal asset limit in 2026?

Since January 1, 2026, Medi-Cal counts assets again for seniors, people with disabilities and nursing home residents. The limit is $130,000 for one person plus $65,000 for each additional household member through June 30, 2027. DHCS states it is scheduled to drop to $21,000 for one person on July 1, 2027.

Does Medi-Cal count my parent’s house?

Usually not. The main home is generally exempt if your parent lives there, intends to return, or if a spouse or dependent relative lives there. Second homes and rental property count. Because estate recovery and titling can be complicated, talk with an elder law attorney before changing the deed.

Is there a look-back period for Medi-Cal in California?

Yes. Medi-Cal reviews transfers made in the 30 months before nursing home care, but transfers made before January 1, 2026 are not penalized. That means the effective look-back is shorter until mid-2028. Transfers to a spouse or sales at fair value do not cause a penalty.

Can my mother keep any money if my father goes on nursing home Medi-Cal?

Yes. Spousal impoverishment rules protect the at-home spouse. In 2026 she can keep a protected share of the couple’s assets, up to $162,660, plus the home and a car, and may receive part of his income if her own income is low.

Does Medi-Cal pay for board and care homes in San Diego?

Regular Medi-Cal does not. The Assisted Living Waiver can pay the care portion in participating board and care homes and assisted living communities in San Diego County, but the resident still pays room and board, and there is a wait list. A few homes accept residents at the SSI/SSP rate.

How long is the Assisted Living Waiver wait list?

DHCS states that slots are limited and there is a waitlist, with openings released to Care Coordination Agencies regularly. Waits in San Diego can be long and vary, so apply early through a Care Coordination Agency and have a backup plan.

What is a share of cost?

A share of cost is the part of a person’s monthly income they pay toward their care before Medi-Cal pays. In a nursing home, most income goes to the facility as the share of cost, and the resident keeps a small personal needs allowance, currently $35 a month.

How do I apply for Medi-Cal in San Diego County?

Apply online through BenefitsCal, call the Access Customer Service Call Center at 1-866-262-9881, or visit a Family Resource Center. If your parent is already in a nursing home, the facility’s business office can often help start the application.

Do I need a lawyer to apply for Medi-Cal?

Not always. Many seniors with modest savings apply on their own. If your parent has assets near the limit, owns property, is married, or you are considering gifts or a trust, an elder law attorney can protect your family from costly mistakes.