Medicaid Long-Term Care Guide in California

• Nearly all income that a Medicaid applicant receives is counted towards the income limit, including employment wages, alimony, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends.
• Nationally, Holocaust restitution payments are not counted as income.
• In CA, the VA Aid and Attendance Pension, which is above and beyond the Basic VA Pension, does not count.
• Nursing Home Medicaid has no income limit — nearly all income must be contributed toward the cost of care (Monthly Resident Cost).
• When only one spouse applies for Nursing Home Medicaid or a HCBS Waiver, only the applicant's income is counted; the non-applicant spouse's income is disregarded.
• The non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance (MMNA) of up to $4,066.50 / month (2026) from their applicant spouse.
• For Regular ABD Medicaid, the income of both spouses is calculated towards the applicant's income eligibility. There is no MMNA for a non-applicant spouse.

California is unique in that Nursing Home Medicaid has no income limit — applicants must contribute nearly all income toward care costs.

• Medi-Cal eliminated their asset limit effective 1/1/24, but reinstated it on 1/1/26 for most non-MAGI programs including long-term care.
• New applicants submitting applications on or after 1/1/26 must provide asset verification. Applications submitted before 1/1/24 did not require asset information.
• Current Medi-Cal beneficiaries must meet the asset limit at their 2026 annual redetermination or during a "change in circumstance" redetermination (ex parte review).
• A 90-day cure period is provided if assets exceed the limit or asset information is not provided at annual redetermination.
• Countable assets include cash, cryptocurrency, stocks, bonds, mutual funds, bank accounts, and real estate other than one's primary home.
• Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one's home.
• In California, an applicant's retirement account (IRA, 401K) is exempt if 'paying out' — meaning the Required Minimum Distribution (RMD) is being withdrawn, or if under 73, a minimum payment of principal and interest is being withdrawn.
• A non-applicant spouse's IRA / 401K is automatically exempt.
• The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to keep up to $162,660 of the couple's countable assets (2026). There is no CSRA for Regular Medicaid.
• The following non-MAGI programs continue to be exempt from the asset limit: Pickle, DAC (Disabled Adult Child), and DW (Disabled Widow/Widower).

California's asset limit was eliminated 1/1/24 and reinstated 1/1/26. Current beneficiaries have a 90-day cure period if over the limit at their 2026 redetermination.

• A Medi-Cal applicant's home is automatically exempt if their spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.
• California is the only state that does not have a home equity interest limit for home exemption.
• If the applicant does not live in the home and no qualifying family member resides there, the applicant must have Intent to Return home.
• While the home is generally exempt from Medi-Cal's asset limit, it is NOT exempt from Medi-Cal's Estate Recovery Program.
• Following a long-term care Medi-Cal beneficiary's death, California's Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains — often the home.
• Without proper planning strategies, the home will be used to reimburse Medicaid rather than going to family as inheritance.

California is unique: it is the only state with no home equity interest limit for home exemption.

• California's Look-Back Period was eliminated on 1/1/24 when the asset limit was removed, but was reinstated effective 1/1/26 for Nursing Home Medicaid.
• No asset transfers made in 2024 or 2025 will violate Medicaid's Look-Back Period.
• Beginning 2/1/26, Medi-Cal will 'look back' on asset transfers made in January 2026. The look-back grows by one month each subsequent month until July 2028, when it reaches 30 months.
• California will only penalize asset transfers greater than the monthly average private pay rate for nursing home care (approximately $14,440 / month in 2026).
• Persons can gift assets without violating the penalty period if their total assets are at or under Medi-Cal's asset limit ($130,000 for a single individual).
• The Look-Back Period does NOT apply to persons applying for HCBS Waivers or Regular Medicaid.
• Prior to 1/1/24, California permitted 'strategic gifting' — gifting up to the average monthly private pay rate for nursing home care per day without violating the Look-Back Period.
• June 2026 is the last month during which one can be penalized for asset transfers made prior to 1/1/24.

California's look-back rules are uniquely complex due to the 2024 asset limit elimination and 2026 reinstatement. The look-back period is growing from 6 months (Jan 2026) to 30 months (July 2028).

• MMMNA: $4,066.50 · CSRA: $162,660 · CSRA Min: $162,660
• When only one spouse applies for Nursing Home Medicaid or a HCBS Waiver, only the applicant's income is counted.
• The non-applicant spouse may receive a Monthly Maintenance Needs Allowance (MMNA) of up to $4,066.50 / month (2026).
• California sets the MMNA at the federal maximum of $4,066.50 — if a non-applicant spouse's income is under this amount, income can be transferred from the applicant spouse.
• The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to keep up to $162,660 of the couple's countable assets.
• For Regular ABD Medicaid, the income of both spouses is counted and there is no MMNA for the non-applicant spouse.
• There is no CSRA for Regular Medicaid.

• Medically Needy Pathway — CA has an Aged, Blind and Disabled – Medically Needy Program (ABD-MN) for Regular Medicaid and HCBS Waivers. Seniors with 'excess' income pay a 'Share of Cost' (SOC). In 2026, the Maintenance Need Allowance is $600 for an individual and $934 for a married couple. Once the SOC is paid, one is income-eligible for the remainder of the month.
• Asset Spend-Down — Spend excess assets on non-countable items such as home improvements, home modifications (wheelchair ramps, roll-in showers, stair lifts), vehicle modifications, prepaying funeral/burial expenses, and paying off debt. Beginning 2/1/26, Medi-Cal's Look-Back Period applies to transfers on or after 1/1/26.
• Medicaid Planning — Work with a Medicaid Planning Professional to become eligible, maximize the Spousal Needs Allowance, lower Share of Cost, and protect assets from Estate Recovery.

California does not use Qualified Income Trusts (Miller Trusts). Instead, it offers a Medically Needy / Share of Cost pathway for persons over the income limit.