Medi-Cal Benefits are available under three major programs for adults, generally known as the “Categorically Eligible Medi-Cal” programs, the “Needs-based (Community) Medi-Cal” programs, and the “Medically Needy (Long-term Care) Medi-Cal” program. There are also other types of programs for certain children and for persons who suffer from specific illnesses, including End-stage Renal Failure (needing dialysis), Tuberculosis, and Breast or Cervical Cancer.
To qualify for any of the three main types of Medi-Cal programs, the individual must be either blind, aged 65 or over, or permanently and totally disabled. In addition, the individual must be “financially needy” for any of the three main types of programs. The Categorically Eligible Medi-Cal program only covers persons who are eligible for Supplemental Security Income (SSI) or who would be eligible for SSI but for the annual cost of living income increases by Social Security (this is called the Pickle Program). For the Medically Needy (Long-term Care) Medi-Cal program, the individual must also need medical care provided by a skilled nursing facility. Generally, this last requirement means that the person must be residing in a skilled nursing facility. However, there is a Medi-Cal “waiver” program that provides for some in-home or assisted living facility care for persons who would otherwise have to be in a skilled nursing facility. Unfortunately, there are relatively few slots available under the waiver program and it is only available in a few counties in California at this time.
At Sugai & Sudweeks, we focus on assisting our clients regarding the various Medi-Cal benefits and programs as they relate to special needs planning and Special Needs Trusts.