Medi-Cal Planning for Skilled Nursing Home Care Expense – Law Office of Sean D. Ethington

One of the greatest fears of our elderly is that they may require nursing home care. This not only means a great loss of personal autonomy, but also a tremendous financial expense.
Depending on location and level of care, nursing homes cost between $85,000 and $196,000 per year. According to the Department of Health Care Services, the average cost for skilled nursing home care in California is $13,656 per month ($163,872 per year).
As you may have heard, effective January 1, 2026, Medi-Cal is reinstating it’s prior “Asset Eligibility Test” in order to determine eligibility for the Long Term Care Medi-Cal program (a government program that helps qualified patients pay for skilled nursing level care). In other words, Medi-Cal will review the “countable” assets owned by a patient (and their spouse), to determine whether or not the patient is eligible for Medi-Cal assistance. In some cases, Medi-Cal will even pay the entire amount of nursing home expenses.
Unfortunately, many patients privately pay for nursing home care out of their life savings until their savings depleted, at which point they will be deemed eligible for the Long Term Care Medi-Cal program. On the other hand, proper “Medi-Cal Planning” seeks to position a patient to qualify for Medi-Cal benefits as early as possible in the event that they ever require nursing home care, without the need to spend their life savings towards their nursing care. Whether in advance or in response to an unanticipated need for care, “Medi-Cal Planning” can be accomplished to preserve your assets and protect your estate for your spouse or children.
Proper Medi-Cal planning covers the following three areas:
1. Asset Eligibility Planning – to strategize how to qualify financially for Medi-Cal benefits;
2. Income Planning – to reduce or potentially eliminate a Medi-Cal beneficiary’s monthly “Share of Cost” co-payment obligation; and
3. Estate Recovery Planning – to potentially reduce or eliminate Medi-Cal recovery against the Medi-Cal beneficiary’s estate.
For married couples, a Court petition pursuant to California Probate Code Section 3100 is often a valuable tool used to significantly increase the standard Medi-Cal asset eligibility limit, reduce or possibly eliminate the “Share of Cost” co-payment obligation and to protect all assets from potential Medi-Cal estate recovery pay back.
For single individuals, numerous “conversion” strategies (which turn otherwise countable assets into exempt asset categories) and “spend down” strategies are available to quickly qualify an individual for Medi-Cal benefits.
Unfortunately, many people are misinformed about the eligibility criteria Medi-Cal uses to determine eligibility. Such misinformation is likely due to the ever changing and complicated Medi-Cal regulations. Despite what you might have heard, you do not have to be destitute in order to qualify for Medi-Cal benefits.
For more information please contact the Law Office of Sean D. Ethington at (661)295-4604 or visit our website at www.ElderLawSite.com.