California Medicaid Long-Term Care Eligibility: Assets and Look-Back

To qualify for California Medicaid long-term care eligibility, a doctor must certify that you need a nursing-facility level of care, and your countable assets must fall below the limit that returns on January 1, 2026: $130,000 for a single applicant, with $65,000 added for each additional household member up to ten.¹ You also have to be a California resident and provide information about your citizenship or immigration status. Married couples get extra protection for the spouse who stays at home, and the rules for income and cost-sharing shift depending on whether you live in a facility or receive care in the community.

The Medical and Residency Gate

Two non-financial requirements come first. You must live in California, and U.S. citizens and lawfully present applicants must provide a Social Security number.² Starting January 1, 2026, adults without satisfactory immigration status face new restrictions on enrolling in full-scope Medi-Cal, though exceptions apply for people already receiving nursing home or other institutional care.

A physician then has to certify that your condition is severe enough that, without the requested services, you would need institutional care. The same standard applies whether you actually move into a nursing home or stay at home through a waiver program.² If your needs are moderate enough to manage without structured long-term support, the certification will not go through regardless of your finances.

Asset Limits Returning January 1, 2026

California temporarily eliminated asset limits for the Medi-Cal programs that cover older adults and people with disabilities. That ends on January 1, 2026. A single applicant can hold up to $130,000 in countable assets, and each additional household member adds $65,000 to the limit, up to a ten-person household.¹ If you are over the limit, your application will be denied until you spend down to the threshold.

Countable assets include bank accounts, cash, stocks, bonds, mutual funds, and other liquid investments. The more useful list is what does not count.

What Is Exempt

Your primary residence, as long as you or your spouse lives there. California is the only state that imposes no home equity cap, so the value of the home is irrelevant for eligibility.
One vehicle, fully exempt.
Personal and household items such as furniture, clothing, and appliances.
Retirement accounts, if you are taking regular distributions from them.³

The home exemption is the largest planning tool for California families. A residence worth well over a million dollars remains fully exempt provided the applicant or spouse still lives in it.

Income and Share of Cost

Once your assets clear the limit, Medi-Cal looks at your income to calculate what you owe each month toward your care. The rules split sharply by setting.

If You Live in a Nursing Facility

Nearly all of your monthly income goes to the facility. You keep a Personal Needs Allowance of $35 per month for personal expenses, or $62 per month if you receive Supplemental Security Income. Everything above that is your Share of Cost and must be paid to the nursing home before Medi-Cal covers the remaining balance.⁴

If You Receive Care at Home

You keep a larger share of your income to cover rent, utilities, food, and other living costs. Medi-Cal sets an income maintenance level based on federal poverty guidelines, and only income above that threshold becomes your monthly Share of Cost. You pay that amount before Medi-Cal picks up the rest of your care expenses for the month. For people with high medical bills and modest income, the Share of Cost may effectively be met every month.

Protections for a Spouse Who Stays Home

Federal spousal impoverishment rules prevent one spouse from being wiped out when the other needs long-term care. California applies two protections: a resource allowance and an income allowance.

Community Spouse Resource Allowance

When one spouse enters a nursing home, the couple’s combined countable assets are tallied. The spouse who remains at home can keep a protected share. For 2026, the maximum Community Spouse Resource Allowance is $162,660.⁵ The institutionalized spouse can separately hold up to $130,000 under the reinstated asset limit.³ Anything above those combined thresholds must be spent down before the nursing home spouse qualifies.

Minimum Monthly Maintenance Needs Allowance

The community spouse is also guaranteed a minimum monthly income. For 2026, the federal floor is $2,643.75 and the federal maximum is $4,066.50.⁵ If the community spouse’s own income falls below the applicable amount, part of the institutionalized spouse’s income can be redirected to make up the difference.

The 30-Month Look-Back on Gifts and Transfers

California is reinstating a look-back period alongside the return of asset limits. When you apply for nursing home coverage, the state will review whether you gave away or sold assets below fair market value during the 30 months before entering the facility. Transfers made before January 1, 2026, are not counted. Only transfers on or after that date fall within the review window.³

If the state finds a disqualifying transfer, it calculates a penalty period by dividing the value of what you gave away by the Average Private Patient Rate for nursing home care. For 2026, that rate is approximately $14,440 per month. A gift of $72,200 would produce a roughly five-month penalty during which Medi-Cal will not pay for your nursing home stay. The penalty clock does not start until you are otherwise eligible and have applied, so the coverage gap arrives at the moment you need coverage most. Most other states use a 60-month look-back; California applies 30 months as of January 2026.

Transfers That Do Not Trigger a Penalty

Federal law carves out exceptions that apply in California:⁶

Unlimited transfers to your spouse, or to anyone else for the sole benefit of your spouse.
Any asset, including a home, transferred to a child who is blind or permanently disabled.
Your home transferred to a child under 21.
Your home transferred to a son or daughter who lived with you for at least two years before you entered a nursing home and whose care delayed your need for institutional placement.
Your home transferred to a sibling who co-owns it and lived there for at least one year before you entered a facility.
Sales at actual market value, which are not gifts.³

The caretaker-child exception trips up many families because it requires proof that the child’s care actually allowed the parent to avoid a nursing home. Informal visits or help with groceries will not satisfy the standard. Documentation from a physician or care manager showing hands-on care equivalent to facility care strengthens the claim.

At-Home Alternatives to a Nursing Facility

Medi-Cal covers several programs that let eligible people receive long-term care at home or in the community.²

In-Home Supportive Services pays for a caregiver, who can be a family member, to help with daily tasks like bathing, meal preparation, housekeeping, and transportation. You must be on full-scope Medi-Cal and live at home.
The Multipurpose Senior Services Program is a 1915(c) waiver for Medi-Cal recipients 60 and older who need nursing-facility-level care, coordinating care management, respite care, and home modifications. Availability depends on whether your county has an MSSP site.⁷
The Program of All-Inclusive Care for the Elderly serves people 55 and older who qualify for nursing-home-level care, coordinating all preventive, primary, acute, and long-term care through a PACE center. You must live in a PACE service area and be able to live safely at home at enrollment.⁸

You can only be enrolled in one home-and-community-based waiver at a time. Each has geographic restrictions, and not all counties participate. Your county Medi-Cal office or a local Health Insurance Counseling and Advocacy Program (HICAP) counselor can help you identify what runs in your area.

Partnership Insurance as Asset Protection

California participates in the California Partnership for Long-Term Care, which rewards people who buy qualifying long-term care insurance. For every dollar your Partnership policy pays out in benefits, that same amount of your assets is shielded from Medi-Cal’s asset limit if you later apply.⁹ If your policy paid $200,000 in benefits before being exhausted, you could hold $200,000 above the normal $130,000 limit and still qualify. The protected assets are also exempt from estate recovery after death. Policies must meet specific state requirements and are only useful if purchased well before care is needed.

Estate Recovery After Death

After a Medi-Cal beneficiary dies, the state must seek repayment for certain long-term care costs it covered, including nursing home stays and home-and-community-based services. California limits recovery to assets that pass through probate.¹⁰ Assets held in a living trust, joint tenancy, or similar arrangements that avoid probate are generally out of reach, a narrower scope than federal law permits.

Recovery is prohibited entirely when the deceased is survived by:

A spouse or registered domestic partner
A child under age 21
A child of any age who is blind or permanently disabled¹⁰

Even when none of those apply, heirs can request a hardship waiver. Federal guidance identifies two main hardship categories: a homestead of modest value relative to homes in the same county, and income-producing property such as a farm or family business that surviving family depend on for a livelihood.¹¹ Estate recovery catches many families off guard because it comes years after care was provided. Probate avoidance planning while the beneficiary is alive is the most effective way to limit exposure.

If You Are Denied

If your Medi-Cal application is denied or your benefits are reduced, you can request a state fair hearing. For actions by the county or the Department of Health Care Services, you have 90 days from the date on the notice of action to file.¹² If your coverage runs through a Medi-Cal managed care plan, you generally appeal through the plan first within 60 days, then request a state hearing within 120 days if the plan’s resolution is unsatisfactory.

You can request a hearing online, by phone at (800) 743-8525, or in writing. Include the specific reason you believe the action was wrong and any supporting documents, especially medical records if the denial relates to the nursing-facility level-of-care determination. California temporarily extended the hearing deadline to 120 days for certain redetermination-related actions, including terminations of eligibility and increases in Share of Cost, and that extension remains in effect.¹² If you request a hearing before your current benefits end, you can ask that Medi-Cal keep paying for services while the appeal is pending.

1
California Legislative Information. California Welfare and Institutions Code WIC 14005.62
2
DHCS – CA.gov. Medi-Cal Help Center
3
DHCS – CA.gov. Asset Limit Frequently Asked Questions
4
California Department of Health Care Services. Medi-Cal Questions and Answers
5
Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
6
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
7
DHCS – CA.gov. Multipurpose Senior Services Program MSSP Medi-Cal Waiver
8
DHCS – CA.gov. Program of All-Inclusive Care for the Elderly
9
DHCS – CA.gov. California Partnership for Long-Term Care
10
California Legislative Information. California Welfare and Institutions Code WIC 14009.5
11
ASPE. Medicaid Estate Recovery
12
California Department of Social Services. State Hearing Requests