California Medicaid Nursing Home Eligibility Requirements

California Medicaid nursing home eligibility, known in the state as Medi-Cal long-term care, turns on two things: a doctor’s certification that you need nursing facility level of care, and countable assets at or below $130,000 for an individual. Effective January 1, 2026, California reinstated both the asset limit and a 30-month look-back period on gifts and below-market transfers, ending the brief window in 2024 and 2025 when assets did not count at all. Income is not capped, but almost all of it goes to the facility each month as your Share of Cost.

The Medical Requirement

Before any financial rule matters, a physician must certify that you need Nursing Facility Level of Care: around-the-clock skilled nursing or intermediate care for a condition that cannot be safely managed at home or in a lower level of care. The state then runs its own assessment to confirm that determination before approving institutional benefits. If the assessment concludes you could be served through home- and community-based services, Medi-Cal may offer those instead.

The 2026 Asset Limit

Starting January 1, 2026, an individual applicant can have no more than $130,000 in countable assets, with an additional $65,000 allowed per additional household member up to ten people. Exceed the limit and the application is denied.¹

Countable assets include bank accounts, stocks, bonds, mutual funds, and any real property other than your primary home. Married couples get separate spousal protections, so a couple’s combined assets are not simply measured against the individual limit.

What Does Not Count

Your primary home is exempt as long as you, your spouse, or a dependent relative lives there, and it stays exempt while you are in a nursing facility if you intend to return. California does not currently cap home equity, though federal law requires it to adopt a cap by January 1, 2028.²

Other exempt property includes one vehicle regardless of value, household items and personal effects (clothing, furniture, heirlooms, wedding and engagement rings), burial-related assets (irrevocable burial trusts or prepaid contracts, one revocable burial fund up to $1,500 plus accrued interest per person, and burial plots), and work-related retirement accounts under specific conditions.

The retirement account rule trips people up. An IRA, 401(k), or similar account in the applicant’s name is exempt only if the account holder is receiving periodic payments of both principal and interest. A lump-sum account sitting untouched is countable. If the account belongs to a spouse who is not applying, it is exempt.²

Income and Your Share of Cost

There is no income ceiling. You will not be denied for earning or receiving too much. Instead, nearly all of your monthly income goes to the nursing facility as your Share of Cost, and Medi-Cal pays whatever your contribution does not cover.

A few amounts come off the top before the calculation:

A $35 Personal Needs Allowance you keep for toiletries, phone, and other items the facility does not provide.
Medicare Part B premiums and any supplemental health or dental insurance premiums.
Income redirected to a community spouse whose own income falls below a protected minimum (see below).

If your gross monthly income is $3,000 and your Medicare Part B premium is $185, your Share of Cost would be $2,780 after the premium and the $35 allowance. The facility then bills Medi-Cal for the difference between its approved rate and that $2,780.

If You Are Married: Spousal Protections

Federal law keeps the community spouse from being left destitute. These protections apply to both assets and income.

Community Spouse Resource Allowance

When one spouse enters a hospital or nursing home for a continuous stay of at least 30 days, that date is the “snapshot date” for valuing the couple’s combined countable assets. From that pool, the community spouse can keep up to the Community Spouse Resource Allowance, which for 2026 ranges from a minimum of $32,532 to a maximum of $162,660.³

Anything above the community spouse’s protected share counts toward the institutionalized spouse and must be spent down to $130,000 before Medi-Cal starts paying. The protected share itself is off-limits to the spend-down.¹

Minimum Monthly Maintenance Needs Allowance

For 2026, the community spouse is guaranteed a baseline monthly income of $2,643.75. The figure can go higher if the community spouse’s housing costs (rent or mortgage, taxes, insurance, utilities) exceed a set threshold.³

When the community spouse’s own Social Security, pension, and other income falls short of that allowance, part of the nursing home spouse’s income is diverted to close the gap. That diversion reduces the Share of Cost, so Medi-Cal picks up more of the facility bill.

The 30-Month Look-Back

This is where 2026 hits hardest. During 2024 and 2025, California suspended both the look-back period and transfer penalties. Gifts, below-market sales, and other transfers made in that window cannot be held against you.⁴

From January 1, 2026 forward, Medi-Cal looks at the 30 months before a long-term care application and flags any assets you gave away, sold below fair market value, or otherwise transferred without receiving fair compensation. When improper transfers are found, the state imposes a penalty period during which Medi-Cal will not pay for your nursing home care.¹

The penalty length is the total value of the improper transfers divided by the average monthly private-pay nursing home cost in California. For 2025 that divisor was roughly $13,656. Someone who gave away $136,560 would face about a 10-month wait during which they would need to pay privately or find another funding source.

California’s 30-month window is shorter than the 60-month standard used in most other states, but it still reaches back two and a half years. Anyone who made large gifts or sold property at a discount between mid-2023 and the end of 2025 on the assumption the suspension would continue should review those transactions with an elder law attorney.

How to Apply

Applications go through your local county welfare office, not directly to the Department of Health Care Services. You can apply online through BenefitsCal, by phone, by mail, or in person at a county office, and you must indicate on the application that you need help with long-term care services.⁵

Expect to provide proof of income (Social Security award letters, pension statements), assets (bank statements, deeds, retirement account statements), and the physician certification of your need for nursing facility care. The county interviews you or an authorized representative, then issues a Notice of Action confirming eligibility and stating your monthly Share of Cost.

You can also apply through the nursing facility. Most California nursing homes keep applications on hand and can help residents start the process, which matters when someone was admitted on private-pay status and is running out of funds.

Estate Recovery After Death

Qualifying is not the end of the story. After a Medi-Cal beneficiary dies, the state is required to seek repayment for certain long-term care costs from the deceased person’s estate. Recovery applies to benefits received on or after the member’s 55th birthday, and to beneficiaries of any age who were determined to be permanently institutionalized.⁶

California limits recovery to the federal minimum: nursing facility services, home- and community-based services, and related hospital and prescription drug services received while in a nursing facility or on a waiver program. Recovery reaches only assets in the deceased member’s probate estate. Property that passes outside probate through joint survivorship, a living trust, or a transfer-on-death designation is not subject to recovery.⁷

The state will not pursue any claim if the deceased is survived by a spouse or registered domestic partner, a child under 21 at the time of the claim, or a child of any age who is blind or disabled under Social Security Act definitions. A hardship waiver is also available when the estate is a modest-value homestead or income-producing property essential to a surviving family member’s livelihood.⁶

Families who assume the home is permanently safe because it was exempt during the beneficiary’s lifetime sometimes learn otherwise after death, when the home passes through probate without a protected survivor living there.

If You Are Denied: Fair Hearings

If your application is denied, your Share of Cost is calculated wrong, or your benefits are cut off, you have 90 days from the date of the Notice of Action to request a state fair hearing.⁸

The 10-day deadline matters more than the 90-day one if you are already receiving benefits. Request the hearing within 10 days of the Notice of Action date and your coverage continues while the appeal is decided; this is called “aid paid pending.” File later within the 90-day window and you still get a hearing, but your benefits may stop in the meantime.

You can submit the request to the county welfare office listed on the Notice of Action, to the California Department of Social Services State Hearings Division by mail or fax, or through the department’s online hearing request page. Nursing facility residents can ask the facility social worker for help or contact the local long-term care ombudsman program.⁸

1
Department of Health Care Services. Asset Limit Frequently Asked Questions
2
Department of Health Care Services. Medi-Cal General Property Limitations
3
Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
4
California Department of Health Care Services. Transfers of Assets Beginning January 1, 2024, and Treatment of Transfers Occurring Prior to January 1, 2024
5
DHCS. Apply for Medi-Cal
6
Department of Health Care Services. Medi-Cal Estate Recovery Brochure
7
California Legislative Information. California Code WIC 14009.5
8
Department of Health Care Services. Medi-Cal Fair Hearing