When you think about planning for your future, making sure that you can qualify for Medi-Cal someday might not be the first thing that comes to mind. Medi-Cal is California’s version of the Medicaid Program.
However, the reality is that LongTermCare.gov says that there’s close to a 70% chance that someone who turns 65 today will need nursing home care or custodial care at home — eventually.
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If you end up needing long-term care someday, being able to get Medi-Cal benefits could be absolutely critical to protect your finances.
Here are some more details on why you may need Medi-Cal planning and what you can do to make sure you have a solid plan in place in the event that you need nursing home care.
1. Medicare and private insurance won’t pay for a nursing home
The first thing to know is that Medicare and most private insurers won’t pay for a nursing home in most circumstances and, when it does, it is short term.
While there may be some coverage for skilled rehabilitation services in a nursing facility after a hospital visit, there’s no coverage for routine or custodial care — and that’s the most common kind of care that leads to going into a nursing home.
Since you can’t get a policy paid for, it’s worth learning more about how you can protect against huge costs by engaging in some Medicaid planning.
2. Medi-Cal covers long-term care if you qualify
Unlike Medicare or private insurance, Medi-Cal definitely does pay for long term nursing home care. In fact, Medi-Cal is the top government program that helps pay for long-term care in a nursing home or that helps to pay for home care.
Unfortunately, Medi-Cal is a needs-based program.
This means you have to meet strict financial requirements to qualify. That includes having limited income and few assets. For many people, this means they won’t qualify unless they do some planning ahead of time. Starting in 2026, Medi-Cal long term care eligibility standards will be getting tougher to meet.
3. You need to be aware of the lookback rule
Starting in 2026, you can’t just give away all your money one day and qualify for Medi-Cal the next. That’s because Medi-Cal will have a “look-back” period, which will be 30 months, and maybe even longer in the future. Because of this lookback period, when you apply for Medi-Cal coverage in 2026 and after, the state will look at your financial transactions for at least the past 2 and half years.
If you transferred assets for less than fair market value, such as by giving assets to your kids to qualify sooner, they can impose a penalty that delays your eligibility.
Unfortuntely, the only way to get around this issue is to make your plans far enough in advance that you will already be able to qualify for Medi-CAl at the time you need it.
4. Medi-Cal planning could potentially be better than long-term care insurance
Medi-Cal planning is one way to protect your assets in case you need nursing home care, while long-term care insurance is another. Long-term care insurance can be expensive, though, and sometimes the coverage it offers isn’t really great. That’s especially true if, for example, you have a policy with a low daily limit or overall low total payout limits and, accordingly, you have a hard time finding a facility that takes that insurance.
5. Planning ahead is critical to making your Medi-Cal plan
Since Medi-Cal planning takes time and involves the transfer of assets, the earlier you start, the better. Ideally, you’ll start thinking about this well before you actually need long-term care, so you have time to set aside assets and make sure that you are using the right kinds of trusts to keep your wealth shielded rather than having to spend down all that you worked for.
Getting help with Medi-Cal planning now
At our firm, we have helped families in many situations where a family member needed help putting a plan in place. We can work with your family in a way that you are comfortable with to ensure that your parents are able to secure their legacy. Give us a call today at (916) 437-3500 or contact us online to schedule a consultation.
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