Medi-Cal is California’s version of the Medicaid program that is funded by the state and federal governments.  The Community based Medi-Cal Benefits Program is a government program to help pay for medical needs for low income persons and others with limited resources and high medical bills for individuals are not in a nursing home.

NOTE: There is also Medi-CAL Long Term Care that helps pay expenses if the person is in a skilled nursing facility. THIS PROGRAM HAS DIFFERENT ELIGIBILITY REQUIREMENTS!! LA LAW Medi-Cal Attorney and Medi-Cal Specialists can help you with these requirements.

We will explain the nursing home program in our next LA LAW Center Blog or you call us for a free phone consult to make sure you know if you can qualify for Medi-CAL LTC. Call 818.241.4238.

For Medi-CAL Community Based Program basic qualifications requirements are as follows:

Although persons 65 years old and older with Medi-Cal also receive Medicare, the Medi-Cal program is not related to Medicare Insurance. Medicare is an earned benefit. Medi-Cal is a need-based program with limited amount of income and resources a person has that determines eligibility.

  1. If you are 65, blind or disabled and on SSI, you are automatically covered by Medi-Cal.
  2. I If you are 65, and your income is too high to qualify for SSI, you may still be eligible for Medi-Cal if:
    1. you meet the Community based Medi-Cal resource limits ($2,000 for an individual, $3,000 for a couple). This means this is the amount of assets you have available to you (bank accounts, autos, real estate, more than your home, etc.! LA LAW Staff can help you move other assets into a special Irrevocable trust and then you will qualify.
    2. you are aged 65 or older, blind, or disabled; and payments for your medical bills would leave you with less than the available “need standard” for your other living expenses;

There are other Community based Medi-Cal programs for special conditions for individuals. What are the Income Limits? California law has a fixed maintenance need standard for those who are living at home (not in nursing home).Basically, it is  the amount of monthly income California has set that a person(s) need for necessary monthly expenses, not including medical bills. This set amount is for a single elder (over 65) or disabled person is $600 per month; for an elder/disabled couple it is $934 per month, unless you qualify for the Aged & Disabled Federal Poverty Level Program.

For the Aged & Disabled Federal Poverty Level Program, starting April 1, 2016, an aged or disabled person with countable income at or below $1,220 or couples with an income at or below $1,645 (both subject to change in April 2017) could be qualified for the Aged & Disabled Medi-Cal Program and pay no share of cost. Qualified individuals must be aged 65 or older or disabled and not in long term care nursing facilities.

Basically, if the monthly income is higher than the above listed need standard, or above the aged and disabled level, the person will have a “share of cost” (kind of like a deductible) for your medical bills each month. Once the person pays or agrees to pay the monthly “share of cost” towards the person’s  medical bills, the person will use their  Medi-Cal card to pay for the rest of Medi-Cal covered medical services each month.

This can be helpful for anyone with major medical bills.  The rules are different for individuals are under 65.  We are happy to help you understand your options.  Call us at 818.241.4238.