How to Apply for Medi-Cal for a Nursing Home in California

To get Medi-Cal to pay for a nursing home in California, a family shows two things. The person must need nursing-facility level of care. Their countable assets and income must also fit Medi-Cal's rules. DHCS says people in nursing homes need to share information about what they own when they apply for or renew Medi-Cal.

If you are reading this, a parent, husband or wife has likely just moved into a nursing home, or a hospital discharge planner has said that a move is coming. Private-pay bills may already be arriving. You may be the spouse who is still at home, wondering what you keep. You may be the adult child holding a folder of bank statements, unsure what the county will ask for.

This guide walks through six steps in the order they usually happen. No fixed duration is given here.

Before You Start: What Medi-Cal Long-Term Care Covers and Who It Is For

Medi-Cal is California's Medicaid program. The California Department of Health Care Services (DHCS) administers it. Medi-Cal long-term care covers nursing-facility care for eligible Californians. Federally, Medicaid is the primary payer for long-term care across the nation.

Two tests apply:

• Medical need. The person must need nursing-home level of care.
• Financial eligibility. The person must meet the asset and income rules.

Federal guidance explains that eligibility for residents of an institution may be figured differently, and that access to some services is tied to a need for institutional level of care.

One term comes up throughout this guide. The community spouse is the husband or wife who still lives at home while the other spouse is in a nursing facility.

This page covers Medi-Cal for long-term care only. It does not cover Medicare, private long-term-care insurance or veterans' benefits. Federal law sets the framework for Medicaid, but California runs its own program with its own rules. The California rules described here are the ones DHCS and the California Department of Social Services (CDSS) state.

Step 1: Confirm Medical Eligibility — Nursing-Home Level of Care

Medical eligibility comes before the financial paperwork matters. Medi-Cal long-term care requires that the applicant meet a nursing-facility level of care.

Medical eligibility and financial eligibility are separate tests. Meeting one does not satisfy the other. A person can clearly need nursing care and still be found financially ineligible for a period, and the reverse is also possible. Once the clinical side is in motion, attention turns to the financial records.

Step 2: Gather Information About What the Applicant Owns

DHCS lists bank accounts, cash, second vehicles, second homes and other financial resources, no matter where they are, as examples of assets.

DHCS states that people in nursing homes will need to share information about what they own when they apply for or renew Medi-Cal.

A countable asset is a resource the program counts toward the asset limit. An exempt asset, such as the main home or the main vehicle, is not counted.

For married applicants, CMS says the spousal impoverishment provisions protect a certain amount of the couple's combined resources for the spouse living in the community.

Step 3: Understand the Asset Limits Before You Apply

What counts and what is exempt. DHCS gives these examples of assets that are not counted: a person's main home, a main vehicle, household items such as furniture and clothes, and retirement funds if the person is getting regular payments. It gives these as examples of assets that are counted: second homes, second vehicles, cash and bank accounts.

The home has a federal limit of its own. Under 42 U.S.C. § 1396p(f), a person is not eligible for nursing facility or other long-term care coverage if the equity interest in the home exceeds $500,000, a figure the statute increases from year to year beginning with 2011 and allows a state to raise to as much as $750,000. The limit does not apply when the person's spouse, or a child under 21 or a blind or disabled child, is lawfully residing in the home, and the statute provides for a waiver in cases of demonstrated hardship. The figure California applies depends on California's current rules.

California's limits. Medi-Cal began counting assets again on January 1, 2026, under a California law, as the DHCS FAQ states. That page gives two sets of figures, each with its dates:

• Through June 30, 2027: $130,000 for one person, plus $65,000 for every extra person in the house (up to 10 people).
• Starting July 1, 2027: $21,000 for one person and $31,000 for two people, plus $1,550 for every extra person in the house (up to 10 people).

DHCS notes that not everyone in the home counts toward family size; for example, adult children living with the person are not included. More detail is on the page covering California Medi-Cal asset limits.

The spouse at home. DHCS states that some married couples may qualify for higher limits under Spousal Impoverishment, and it refers couples to their county Medi-Cal office. The community spouse resource allowance (CSRA) is the share of the couple's combined countable assets the community spouse may keep. California's CSRA figure depends on California's current rules. The federal 2026 range is a minimum of $32,532 and a maximum of $162,660, effective January 1, 2026.

Look-back and penalty. The look-back period is the window in which the county reviews gifts or sales for less than fair market value. DHCS states that for someone moving into a nursing home, Medi-Cal looks at assets given away in the 30 months before entering the facility. Transfers made before January 1, 2026 are not counted, and transfers made on or after that date may cause a penalty that delays coverage. Federal law, by contrast, sets a 60-month look-back for transfers made on or after February 8, 2006 (42 U.S.C. § 1396p(c)(1)(B)(i)). Each state applies its own rules within that framework.

A penalty period is a stretch of time without long-term-care coverage that results from a disqualifying transfer. Under 42 U.S.C. § 1396p(c)(1)(D)(ii), for a transfer made on or after February 8, 2006, it starts on the later of two dates: the first day of a month during or after which assets were transferred, or the date the person is eligible for medical assistance and would otherwise be receiving institutional-level care based on an approved application but for the penalty period. It does not begin during another period of ineligibility. Because of that rule, a gift made early in the look-back is not treated more gently than a recent one.

Not every transfer is penalized. 42 U.S.C. § 1396p(c)(2) lists exceptions, including:

• A transfer to the applicant's spouse, which carries no transfer penalty.
• Certain transfers of the home to qualifying family members.
• Transfers for a qualifying blind or disabled child.

Spending down assets to reach the limit is a separate subject from the monthly "share of cost" discussed in Step 5. It is covered more fully in the article on Medicaid spend-down.

Step 4: The County's Decision and the State Hearing

DHCS directs couples with questions about Spousal Impoverishment to their county Medi-Cal office.

The county decides the application, and CDSS refers to a county's written decision letter as a Notice of Action.

If the county denies the application, or the family disagrees with a penalty or another part of the decision, the CDSS Hearing Requests page says a person who disagrees with an action taken by the county or DHCS has 90 days to request a state hearing, and after 90 days must prove a good reason for asking late. CDSS also says a person who turned in an application or other information that the county did not act on can ask for a state hearing. For Medi-Cal renewal (redetermination) decisions, CDSS states a temporary 120-day window from the date the notice of action is mailed, in effect until further notice; it does not apply to new Medi-Cal applications.

Step 5: The Patient Pay Amount — What the Nursing Home Resident Contributes Each Month

The patient pay amount, called "share of cost" in the long-term-care setting, is the part of the resident's monthly income that goes toward the nursing-home bill before Medi-Cal pays the rest. It concerns monthly income only, not savings. Spending down assets to the asset limit is a different rule.

Federal guidance describes how this post-eligibility calculation works. It applies only after Medicaid eligibility has been established. It starts with the resident's total income and subtracts protected amounts, including:

• A personal needs allowance.
• A monthly income allowance for the community spouse, as long as that income is actually made available to the spouse.
• A family allowance, if other family members live in the household.

The minimum monthly maintenance needs allowance (MMMNA) is the minimum monthly income level that each state sets for the community spouse under 42 U.S.C. § 1396r-5(d)(3). If the community spouse's own monthly income is below it, a community spouse monthly income allowance can be deducted from the resident's income to make up the difference, but only to the extent the resident's income is made available to or for the benefit of the community spouse.

Federally, the MMMNA changes each July 1, and the maximum changes each January 1. The 2026 federal figures are a $2,705 minimum (effective July 1, 2026, in all states except Alaska and Hawaii) and a $4,066.50 maximum (effective January 1, 2026). California's own figures, and its personal needs allowance, depend on California's current rules and apply from the dates California sets.

Step 6: After Approval — Estate Recovery and What It Means for the Family Home

Estate recovery means that after a Medi-Cal long-term-care recipient dies, DHCS must seek repayment from the estates of certain deceased Medi-Cal beneficiaries, and repayment applies only to benefits received on or after the beneficiary's 55th birthday (see also 42 U.S.C. § 1396p(b)(1)(B)). For members who died on or after January 1, 2017, DHCS states that repayment is limited to estate assets subject to probate and to payments for nursing facility services, home and community based services, and related hospital and prescription drug services.

Federal law delays recovery while a surviving spouse, a child under 21 or a blind or disabled child survives (42 U.S.C. § 1396p(b)(2)). It delays recovery in those situations. It does not cancel it. States must also have procedures to waive recovery when it would cause undue hardship (42 U.S.C. § 1396p(b)(3)).

While the recipient is alive, DHCS states that an owned home the person plans to return to will not count against them, while any extra homes do count. DHCS also says the home does not count when the person's spouse or partner, or a dependent relative, lives there. The federal home-equity limit described in Step 3 can also apply.

Whether estate recovery reaches a particular asset depends, among other things, on whether it is subject to probate. Nothing on this page means that recovery will be avoided.

Typical timeline

The process usually runs in this order:

1. Confirming the need for nursing-facility level of care.
2. Gathering information about the applicant's assets.
3. Filing the application.
4. County review.
5. The county's written decision.
6. The monthly patient pay calculation, which begins once eligibility is established.

A penalty period, if one applies, follows its own start-date rule described in Step 3.

When the Process Gets Complicated

A transfer inside the look-back

A gift or below-value sale made on or after January 1, 2026, and within the 30 months before entering the facility, may lead to a penalty period calculation. The statute's exceptions may apply depending on who received the transfer and why. These situations are covered further in the article on Medicaid crisis planning.

Trusts, annuities and spend-down choices

The rules permit certain tools under defined conditions. Federal guidance states that a trust funded with at least some of the individual's own money can be considered available to the individual when eligibility is determined. Under 42 U.S.C. § 1396p(c)(1)(F), the purchase of an annuity is treated as the disposal of an asset for less than fair market value unless the State is named as remainder beneficiary as that paragraph describes. Under 42 U.S.C. § 1396p(c)(1)(G), an annuity bought by or for an applicant counts among the assets unless it is one of the types the paragraph lists or it is irrevocable and nonassignable, actuarially sound, and pays equal amounts with no deferral and no balloon payments. Neither tool protects assets in every case.

A spouse with significant assets or income

The CSRA and MMMNA calculations become more involved when the community spouse holds substantial assets or income in their own name.

Disagreeing with the county

The county's eligibility decision and any penalty calculation can be challenged at a state hearing, within the time limits described in Step 4.

This page does not cover every planning scenario. Medicaid Asset Protection Group provides information about Medi-Cal rules and facilitates consultation inquiries. It does not give legal advice, represent anyone or guarantee any outcome. The article on what a Medicaid planning attorney does describes that role.

Talking Through a Medi-Cal Application With an Attorney

A Medi-Cal nursing-home application turns on details that differ from one family to the next: the dates of any gifts, how the home is titled, what the spouse at home owns and earns, and which California limits apply on the filing date.

You can send a request for a consultation about your family's Medicaid and long-term-care options through Medicaid Asset Protection Group. Requests may be passed to attorneys, who decide for themselves whether to respond.