For California seniors and their families who are paying for senior care, Medi-Cal is one of the most important government programs out there. Medi-Cal is California’s Medcaid program which provides care for a wide range of California residents, including (most relevantly for California seniors and their families) California residents who are age 65 or older, blind or disabled, or who live in a skilled nursing or intermediate care home. To learn more about who qualifies for Medi-Cal, what Medi-Cal covers, and how to apply to Medi-Cal read the article below or reach out to the Sunbound team here.

Who is eligible for Medi-Cal

In California, seniors aged 65 and above can benefit from the state's Medi-Cal program, which provides them with access to affordable healthcare services. Medi-Cal is a program that is jointly funded by California and the federal government and that provides healthcare coverage to, among other groups, California seniors. Medi-Cal is California's state level Medicaid program and covers a range of healthcare services, including doctor visits, hospitalization, prescription drugs, and long-term care. Seniors who meet the eligibility criteria can receive these services at little or no cost.

First, to be eligible for Medi-Cal coverage a senior must be 65 or older, have a qualified disability, or live in a skilled nursing or intermediate care home. To be eligible for Medi-Cal with no share of cost (meaning that your care is totally covered by Medi-Cal), seniors must meet certain income and asset requirements. In 2023, to be eligible for Medi-Cal without a share of cost a senior’s gross monthly income cannot exceed $1,862 if they are single, and $2,618 if they are married. Seniors must also meet asset requirements to be eligible for Medi-Cal with no share of cost. For individuals aged 65 and above, the asset limit is $130,000 in countable resources for a single person and $195,000 for a married couple. However, certain assets, such as a primary home, personal belongings, and one vehicle, are not counted towards this limit.

What senior care does Medi-Cal pay for

Medi-Cal covers a wide range of healthcare services for seniors, including:

Doctor Visits: Medi-Cal covers primary care visits to physicians, as well as visits to specialists. These services include routine checkups, preventive care, and treatment for chronic conditions.

Hospitalization: Medi-Cal covers inpatient hospital stays, including surgeries and other procedures, as well as emergency room visits.

Prescription Drugs: Medi-Cal covers prescription drugs that are prescribed by a doctor or other healthcare provider. These drugs may be obtained at a pharmacy or through mail-order services.

Vision and Dental Services: Medi-Cal provides coverage for vision and dental services, including routine checkups, cleanings, and other preventive care.

Mental Health Services: Medi-Cal covers mental health services, including counseling, therapy, and medication management.

Home Health Care: Medi-Cal covers home health care services, including skilled nursing care, physical therapy, and occupational therapy.

Long-Term Care: Medi-Cal covers long-term care services, including nursing home care, assisted living, and hospice care.

Medical Equipment and Supplies: Medi-Cal covers medical equipment and supplies, including wheelchairs, walkers, and oxygen equipment.

It is important to note that not all Medi-Cal services are available to all beneficiaries. The services available to a particular senior depend on their individual needs and circumstances. For example, certain services may require prior authorization or may have limitations on the amount or frequency of services covered.

Seniors who have questions about the specific healthcare services that Medi-Cal covers can contact their local county office or visit the California Department of Health Care Services (DHCS) website. The DHCS website provides information on the services covered by Medi-Cal, as well as resources for seniors who need assistance navigating the healthcare system.

How do seniors apply for Medi-Cal

To apply for Medi-Cal coverage, there are several options available. One of the easiest and most convenient ways is to apply online through the Covered California website. This website allows you to apply for both Medi-Cal and private insurance coverage. You can also apply for Medi-Cal by phone by calling the California Department of Health Care Services at 1-800-300-1506.

Another option is to apply in person at your local county social services agency or health department. You can find your local county office by visiting the California Department of Health Care Services website. You can also apply by mail by filling out a paper application and mailing it to your local county office.

When applying for Medi-Cal, you will need to provide personal and financial information. This includes your social security number, proof of income, and proof of residency. You may also be asked to provide documentation such as birth certificates, marriage licenses, and bank statements. It is important to have all the necessary documents ready before you begin the application process.

Once your application is submitted, it will be reviewed to determine your eligibility for Medi-Cal. If you are eligible, you will receive a Benefits Identification Card (BIC) in the mail. This card will have your name, BIC number, and the date your coverage begins. You will also receive a letter explaining the benefits and services available to you.

Other California Government Programs

In addition to the Medi-Cal program, seniors can also benefit from other healthcare programs and services in California. For example, the California Department of Health Care Services (DHCS) offers a range of programs for individuals with specific healthcare needs, such as those with disabilities or chronic conditions. The DHCS website provides information on these programs, as well as resources for seniors who need assistance navigating the healthcare system.

Another option for older adults looking for ways to pay for their senior living and senior care is through California’s Program of All-Inclusive Care for the Elderly, known by its snappy acronym PACE. PACE is designed allow individuals who would otherwise need nursing facility care to stay in their homes as long as possible by providing and coordinating preventive and primary care, as well as acute and long-term care services. In order to be eligible for PACE, an individual must be 55 years or older, reside in a PACE service area, be able to live safely in their home or a community environment, and be determined to require nursing home level of care by the California Department of Health Care Services.  

To learn more about how Sunbound can help make paying for senior living and senior care more affordable for you or your senior loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care, and we’re on a mission to make senior living and senior care more affordable for everyone.