California Medi-Cal Long-Term Care

Last updated: August 21, 2026 Jurisdiction: California

Medi-Cal long-term care is now managed care statewide

California's Medicaid program is Medi-Cal. Under CalAIM, Medi-Cal managed care plans became responsible for skilled nursing facility care statewide on January 1, 2023; ICF/DD and specified adult and pediatric subacute care followed on January 1, 2024, with ICF/DD-Continuous Nursing Care excluded from the carve-in (DHCS, CalAIM Long-Term Care Carve-In).

For care outside an institution, DHCS lists 1915(c) options including the Assisted Living Waiver, Home and Community-Based Alternatives Waiver, Multipurpose Senior Services Program, California Community Transitions, and the Medi-Cal Waiver Program. These waiver routes require full-scope Medi-Cal, medical necessity, and the applicable nursing-facility or acute-hospital level of care (DHCS, 1915(c) HCBS Waivers).

The 2026 baseline: the asset test applies again

California eliminated the non-MAGI Medi-Cal asset test on January 1, 2024 under AB 133, including for LTC Medi-Cal, but reinstated it on January 1, 2026 under AB 116. The reinstated limits are $130,000 for one person and $195,000 for a couple (DHCS ACWDL 26-02; DHCS ACWDL 25-18).

California is not currently a no-asset-test state. The 2024–2025 elimination is historical, although it remains important because DHCS says transfers in those months are not reviewed for the LTC transfer penalty (DHCS ACWDL 25-18).

Income, pharmacy, and county administration

California does not use Florida's $2,982/month institutional income cap or a Florida-style Qualified Income Trust. For institutional Medi-Cal, income above applicable allowances is generally addressed through share of cost rather than an automatic income-cap denial; see Florida's income-cap structure for the contrast (CANHR, Overview of Medi-Cal for Long Term Care).

California also operates Medi-Cal Rx: DHCS moved pharmacy benefits billed on pharmacy claims from managed care to fee-for-service effective January 1, 2022, while drugs billed on medical or institutional claims remain with plans (DHCS, Medi-Cal Rx).

What to verify before choosing a care setting

Coverage depends on the person's eligibility category, level of care, county and managed-care-plan arrangements, and the service requested. A waiver is not simply interchangeable with nursing-facility coverage: DHCS says its waivers must be cost-neutral compared with institutional care and medically necessary (DHCS, 1915(c) HCBS Waivers).

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Medi-Cal long-term care is now managed care statewide

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