Long-Term Medi-Cal: Can Younger People Qualify?

When you picture a nursing home, who do you imagine there? Most likely, you envision relatively young nurses, therapists, and other staff, along with relatively old residents. But, although the elderly do make up the majority of those who live in nursing homes, they’re not the only ones who require and receive skilled nursing care in such facilities.

In 2000, around 10% of nursing-home residents nationwide were between the ages of 31 and 64. By 2010, that figure had grown by almost 50% to 14.2% of residents.

In 2014, the most recent year covered by the Centers for Medicare and Medicaid Services’ Nursing Home Data Compendium, it had grown again to 15%. In California that year, almost 20% of nursing-home residents were 31 to 64.

Younger people can require long-term care for the same reasons that older people do. They may have been injured in an automobile accident, been disabled by an illness or disease, or suffer from early-onset Alzheimer’s.

But whatever the cause, is long-term Medi-Cal coverage available for those younger than 65? Thankfully, it is—if your conditions meets certain requirements and you satisfy the usual asset limitations of the program.

Long-Term Medi-Cal Basic Eligibility

 In general, to qualify for long-term Medi-Cal coverage, a person must satisfy the following three requirements:

  • Be aged, blind, or disabled;
  • Have assets within the asset limits; and
  • Reside in or require care in a skilled nursing facility.

According to Medi-Cal regulations, a person is “aged” if he or she is 65 years old or older. To be “blind,” a person’s “central visual acuity” must be no more than 20/200 even with corrective lenses, or he or she must have tunnel vision (a visual field limited to 20 degrees or less).

And to be “disabled,” he or she must meet the definition of disabled used in the Social Security Disability Insurance or Supplemental Security Income programs (and in some other circumstances).

So, it is possible for a person younger than 65 to qualify for long-term Medi-Cal. But, in addition to being either blind or disabled, he or she must also meet the asset limitations of the Medi-Cal program. In general, these limits are:

  • $2,000 in non-exempt assets for a single person; or
  • $2,000 for the institutionalized spouse, and the community spouse can keep $123,600 (for 2018) in non-exempt assets.

 What are My Options?

Although we imagine the typical nursing-home resident to be an elderly person, the need for care in a skilled nursing facility can arise at any age. So, as with all things, it’s important to be prepared in the event that the need arises for you or a loved one.

One option that may be particularly attractive while you are still working and earning money is purchasing long-term care insurance through the California Partnership for Long-Term Care. Partnership policies can help shelter more of your non-exempt assets than are usually allowed by Medi-Cal.

If you are under 65 and need long-term Medi-Cal, or if you want to explore how you might be able to plan for the need should it arise, contact me to schedule a consultation today. And while you’re here, we can also talk about your estate-planning needs, especially if you are a parent with a young family.