Under California's Aged & Disabled (A&D) Medi-Cal program, individuals whose monthly income exceeds the eligibility threshold may still qualify for benefits — but must contribute a portion of their income toward their care costs each month. This monthly contribution is called the Share of Cost (sometimes referred to as a "spend-down").

Nursing Home / Skilled Nursing Facility: Medi-Cal pays the facility directly. The applicant contributes nearly all of their monthly income — minus a $35/month Personal Needs Allowance — as their Share of Cost. Health insurance premiums (Medicare Part B, Part D, Medigap) are deducted from income before calculating the Share of Cost.

Home Care / HCBS (IHSS, MSSP, Waiver Programs): The applicant must incur qualifying medical expenses equal to their Share of Cost each month before Medi-Cal coverage activates for that month. Income is reduced by health insurance premiums, a standard $20 unearned income deduction, and a $600/month Maintenance Need Allowance before calculating the Share of Cost.

California's Medi-Cal Estate Recovery Program (MERP) can seek reimbursement from your estate after death for Medi-Cal benefits paid on or after age 55 — including the value of your home. The home is exempt while you or your spouse lives there, but becomes subject to a recovery claim after death. Planning strategies (irrevocable trusts, life estates, proper titling) can significantly reduce or eliminate this exposure. This should be addressed before or at the time of application. Contact Elder Care Law CA at (866) 822-7211 for a free consultation.

To qualify for Medi-Cal long-term care benefits, countable assets must fall within the following 2026 limits:

Generally exempt (not counted): Primary home (while applicant or spouse resides there or intends to return), one vehicle of any value, personal belongings and furnishings, irrevocable prepaid burial plans, term life insurance, IRAs/401(k)s in required minimum distribution/payout status, and the community spouse's IRA or pension accounts. Many assets that appear countable can be legally restructured with proper planning.

The estimate above reflects a straightforward calculation. In practice, Medi-Cal planning attorneys — with 20+ years of experience — can often identify legal strategies to significantly reduce — and sometimes eliminate — the monthly Share of Cost:

• Maximize insurance deductions — Medicare Part B, Part D, Medigap, and supplemental dental/vision premiums all reduce countable income and lower the Share of Cost.
• Spousal income protection (MMMNA) — When one spouse applies, up to $4,067/month may be diverted to the community (at-home) spouse, reducing the applicant's Share of Cost dollar for dollar.
• Benefit coordination — Identifying program combinations or aid codes that reduce or eliminate the Share of Cost.
• Asset restructuring — Converting countable assets to exempt form to achieve eligibility without a spend-down.
• Estate recovery planning — Protecting the home and other assets from Medi-Cal reimbursement claims after death, which applies regardless of Share of Cost.

Our Medi-Cal planning attorneys have 20+ years of experience serving seniors throughout California. A consultation typically identifies strategies that can significantly reduce monthly costs — and protect family assets. Free, confidential, no obligation.