Guide
Medi-Cal and IHSS in California: nursing home and home care
Updated October 15, 2026 · Reviewed against official sources
California has one of the broadest systems of help for older adults in the country. But the names are confusing: Medi-Cal, IHSS, CBAS, RCFE, share of cost. In this guide, we explain each piece in plain language so you know what to ask for and where.
Medi-Cal and long-term care
Medi-Cal is California's Medicaid program. For people who are 65 or older, blind or disabled, it covers medical services and also long-term care:
- A stay in a nursing home (skilled nursing facility) when there's a medical need.
- Personal care at home through IHSS.
- Adult day health centers through CBAS.
- Services in assisted living through the Assisted Living Waiver, in the counties where it's offered and depending on available slots.
Many older adults have Medicare and Medi-Cal at the same time (they're called "Medi-Medi" or dual eligible). In that case, Medicare pays first for medical care, and Medi-Cal covers what Medicare doesn't pay for, such as a long stay in a nursing home. Read what Medicare covers for long-term care.
Share of cost
If a person's income is above a certain level, Medi-Cal may assign them a share of cost. It's a monthly amount the person pays toward medical expenses before Medi-Cal pays the rest, similar to a monthly deductible. In a nursing home, almost all of the person's monthly income usually goes toward their care (they keep a small amount for personal needs), and Medi-Cal covers the difference.
The asset limit came back in 2026
For a few years, California didn't count assets for these programs. That has changed. According to the Department of Health Care Services (DHCS), starting January 1, 2026, the asset limit was brought back for Medi-Cal programs for people who are older, blind or disabled, including long-term care:
| Household | Asset limit starting January 1, 2026 |
|---|---|
| One person | $130,000 |
| Couple | $195,000 |
| Each additional person | $65,000 more |
In general, the main home, one vehicle, personal belongings and some other assets don't count. Ask your county what counts in your case, and keep your account statements handy.
Change expected in 2027: according to DHCS, the 2026-27 state budget keeps the current limit and plans to lower it to $21,000 for one person and $31,000 for two people starting July 1, 2027, at the earliest. If your loved one has savings between those amounts, it's worth learning more early and confirming the details with DHCS or your county.
If your loved one has savings close to those limits, talk with an elder law attorney before moving any money. Medi-Cal reviews asset transfers, and a poorly planned gift can cause a penalty period.
IHSS: help at home paid for by Medi-Cal
IHSS (In-Home Supportive Services) is a Medi-Cal program run by the counties. It pays a provider to help people at home who are 65 or older, blind or disabled, who have Medi-Cal and who, with that help, can keep living safely in their own home.
IHSS can cover help with:
- Bathing, dressing, using the bathroom and eating.
- Preparing meals and cleaning.
- Doing laundry and shopping.
- Going along to medical appointments.
- Protective supervision, in certain cases for people with memory problems.
A family member can get paid to provide care
This is one of the most common questions: yes, a son, a daughter or another relative can be the IHSS provider and get paid. In IHSS, the person who receives the services acts as the employer and chooses their provider. The provider must enroll with the county, which usually requires:
- Filling out the provider enrollment form.
- Attending an orientation.
- Passing a background check (with fingerprints).
There are special rules for spouses and for parents of minor children, so ask the county social worker about your situation. If you care for your mom or dad, also read help for family caregivers and our article on caregiver burnout.
How to apply for IHSS
- The person must have Medi-Cal (or apply for it at the same time).
- Call or visit your county social services office and ask for an IHSS application.
- A licensed health care professional fills out the Health Care Certification form.
- A social worker visits the home to assess which tasks are needed and for how many hours.
- You get a letter with the authorized hours. If you don't agree, you can ask for a state hearing within the deadline given in the letter.
If you want to compare this with the cost of hiring a caregiver privately, use our home care calculator.
CBAS: adult day health centers
CBAS (Community-Based Adult Services) is the Medi-Cal program for adult day health centers. It replaced the old ADHC program in 2012. During the day, it offers nursing care, therapy, meals, activities and social support, in a place with trained staff. For working families, it can be a big relief. Look for options in our adult day center directory and read our guide to adult day centers.
Board and care (RCFE) and SSI
In California, many small care homes are called RCFEs (Residential Care Facilities for the Elderly), also known as board and care homes. They're licensed by the Department of Social Services (CDSS). Medi-Cal doesn't pay the rent in these homes, but people who get SSI receive a special payment for "nonmedical out-of-home care":
| Item | Starting January 1, 2026 |
|---|---|
| Federal SSI | $994.00 a month |
| State supplement (SSP) | $632.07 a month |
| Total for nonmedical out-of-home care | $1,626.07 a month |
Homes that accept SSI usually charge that amount as full payment. You can check each place's license and reports in the official CDSS search tool; if anything raises questions, feel free to ask the administrator. See our directory of nursing homes in California, which also lists licensed assisted living facilities.
Medi-Cal and immigration status
California has its own rules, and they changed in 2026. According to DHCS:
- Starting January 1, 2026, adults 19 and older without satisfactory immigration status who apply for the first time only qualify for restricted Medi-Cal (emergency and pregnancy services). This includes older adults.
- In California, restricted Medi-Cal does include nursing home care. However, DHCS says it doesn't give access to waivers for services at home (HCBS waivers). Ask your county about IHSS in your case.
- People who already had full Medi-Cal keep it if they renew on time. If coverage is lost because of a late renewal, there's a short window to fix it, so answer letters right away.
These rules are sensitive and keep changing. Read our guide on immigration status and benefits and, if you have questions, check with a nonprofit legal aid organization.
How to apply for Medi-Cal
- Online, by phone, by mail or in person: through your county social services office. The county will tell you which online portal to use (in most counties, it's BenefitsCal).
- Free help with Medicare: the HICAP program gives free guidance to people with Medicare.
Practical tips:
- Open and answer all mail from Medi-Cal. Many people lose coverage just because they didn't renew on time.
- Keep copies of everything you turn in, and write down who you talked to and when.
- Ask for an interpreter if you need one. You have the right to get help in Spanish at no cost.
Starting January 1, 2027, for new applications from older adults or people with disabilities, federal law cuts Medicaid retroactive coverage from 3 months to 2 months before the month of the application. If your loved one needs to move into a nursing home urgently, apply for Medi-Cal as soon as possible.
Other help in California
- PACE program: several counties have PACE centers. Read the PACE program.
- Local agencies for older adults: meals, respite care and support. Eldercare Locator: 1-800-677-1116.
- If your loved one is leaving the hospital, see hospital discharge.
- If you're not sure what type of care your loved one needs, use our guided search or the care needs scales (they're a guide, not a diagnosis).
Frequently asked questions
Can I get paid to care for my mom if I live with her?
In many cases, yes. IHSS lets a family member, even one who lives in the same home, be the provider. The hours depend on the county's assessment.
Does the house count toward the $130,000 limit?
The main home generally doesn't count. Check with your county, especially if the house is in several people's names or if your loved one no longer lives there.
Does Medi-Cal pay for a board and care home?
Medi-Cal doesn't pay for rent or food. If your loved one gets SSI, that special payment usually covers the rate at homes that accept it. In some counties, the Assisted Living Waiver pays for care services.
Medi-Cal rules change often. This guide is for information only and is not legal or immigration advice.
Sources
- DHCS, letter on reinstating the asset limit: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf (accessed October 15, 2026)
- DHCS, asset limit frequently asked questions: https://www.dhcs.ca.gov/medi-cal/help/asset-limit-frequently-asked-questions/ (accessed October 15, 2026)
- DHCS, 2026-27 budget highlights: https://www.dhcs.ca.gov/wp-content/uploads/2026/07/DHCS-FY-2026-27-Budget-Act-Highlights.pdf (accessed October 15, 2026)
- DHCS, SSI/SSP payment standards effective January 1, 2026: https://www.dhcs.ca.gov/services/medi-cal-resources/medi-cal-eligibility-division/all-county-welfare-directors-medi-cal-eligibility-division-information-letters/ssi-ssp-payment-standards-effective-january-1-2026/ (accessed October 15, 2026)
- DHCS, Community-Based Adult Services (CBAS): https://www.dhcs.ca.gov/services/community-based-adult-services/ (accessed October 15, 2026)
- DHCS, Medi-Cal changes: https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/ (accessed October 15, 2026)
- DHCS, MEDIL I 25-27 on the enrollment pause for adults without satisfactory immigration status: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/I25-27.pdf (accessed October 15, 2026)
- DHCS, immigrant eligibility frequently asked questions: https://www.dhcs.ca.gov/medi-cal-immigrant-eligibility-faqs/ (accessed October 15, 2026)
- CDSS, licensed facility search: https://www.ccld.dss.ca.gov/carefacilitysearch/ (accessed October 15, 2026)
- CDSS, information for residents and families (RCFE): https://www.cdss.ca.gov/inforesources/senior-care-licensing/resources-for-residents-and-families (accessed October 15, 2026)
- CMS, summary of changes under P.L. 119-21 (retroactive coverage): https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf (accessed October 15, 2026)
Senior living in the cities with the most options
Only those that accept Medicaid: Sacramento · Los Angeles · Fresno · San Diego · San Jose · Bakersfield · Roseville · Anaheim · Riverside · Torrance
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
Home care
A caregiver from an agency or hired by your family, Medicare home health and Medicaid (IHSS, STAR+PLUS): typical costs and your duties as an employer.
Does Medicaid pay for care?
Yes, Medicaid pays for a nursing home if your loved one qualifies. 2026 limits, the 5-year look-back, spouse protections, waivers and how to apply.
Immigration status and benefits
Who can get Medicaid and Medicare based on immigration status in 2026: emergency Medicaid, state programs and public charge. An informational guide.
Help for family caregivers
What the National Family Caregiver Support Program is, who qualifies, its five services and how to apply. Plus FMLA and Medicaid for family caregivers.
