California Medi-Cal: Complete Guide (2026)

Medi-Cal is California's Medicaid program, which CMS describes as one of the nation's largest and most complex Medicaid systems. DHCS's Fast Facts report put certified eligibles at 13,910,180 in April 2026, and DHCS says about one-third of Californians receive health care services it administers.

Medi-Cal is administered by the California Department of Health Care Services (DHCS), the federally designated single state agency, with eligibility intake handled by California's 58 County Welfare Departments. 2026 brought three headline changes: under AB 116, the non-MAGI asset test returned on January 1, 2026 at $130,000 for one person, a limit DHCS says holds only through June 30, 2027; Medi-Medi Plans for dual-eligibles expanded to 41 counties; and a new enrollment freeze means some adults can no longer sign up for full-scope Medi-Cal because of their immigration status, though adults who already have it keep it so long as they renew on time. If that coverage does lapse, DHCS gives you three months to sign up again; miss the three months and you must reapply, and only restricted-scope Medi-Cal is available, which still covers emergency care, pregnancy care, and nursing home care. This guide maps the central Medi-Cal questions to the dedicated article that answers each one. The single number to save: Health Care Options at 1-800-430-4263.1

How This Guide Is Organized

The central Medi-Cal questions map to dedicated deep-dive articles:

1. Who Qualifies for Medi-Cal? Eligibility & Income Limits 2026

The dedicated guide: Medi-Cal Eligibility & Income Limits 2026

Medi-Cal eligibility splits into two frameworks: MAGI (Modified Adjusted Gross Income, used for ACA-style adult and children's coverage) and non-MAGI (used for older adults, people with disabilities, and long-term-care applicants).

MAGI Adult Expansion: 138% of the Federal Poverty Level. The limit DHCS currently publishes for a household of one is $21,597/year (about $1,800/month). Take that as the figure DHCS publishes today rather than as 138% of the current federal guideline, which would be $22,024.80; no source here says when DHCS will restate the chart, so check it before relying on the number. No asset limit applies to MAGI categories. This is the path for non-disabled adults under 65.3

Non-MAGI (Aged & Disabled): For adults 65+ or with disabilities, non-MAGI Medi-Cal uses the SSI Federal Benefit Rate framework ($994/month individual / $1,491/month couple in 2026), and the AB 116 asset limit of $130,000 individual / $195,000 couple applies through June 30, 2027. Verify the current Aged & Disabled figures on the DHCS Medi-Cal eligibility page before relying on a dollar amount.3

Medically Needy with Share-of-Cost: Above the income limit, applicants enter the Medically Needy program with a monthly share-of-cost, against a maintenance need level of $600/month for one person and $934 for two: you pay bills up to the share-of-cost each month and Medi-Cal pays the rest. For long-term care, excess income produces a patient liability rather than ineligibility (W&I §14005.13(a)), so it does not by itself close the door.3,4

Categories exempt from the AB 116 asset limit: SSI-linked Medi-Cal recipients remain under SSI's $2,000/$3,000 limits, and the Pickle, Disabled Adult Child, and Disabled Widow(er) programs stay exempt from the asset test.3

Spousal impoverishment extends beyond institutional care to home- and community-based services, under the ACA's broadened definition of "institutionalized spouse" as implemented by DHCS ACWDLs 17-25 and 18-19. The 2026 figures, and the limits on when the $162,660 resource allowance actually applies, are in section 6 below.4

2. What About Assets? Medi-Cal Asset Limits 2026

The dedicated guide: Medi-Cal Asset Limits 2026

• 2024-2025: Under the second phase of AB 133, California eliminated the non-MAGI asset limits entirely, effective January 1, 2024.3
• 2026: Under AB 116 (Chapter 21, Statutes of 2025), asset limits returned January 1, 2026 at $130,000 for one person plus $65,000 for each additional household member ($195,000 for two), up to a maximum of 10 people. The restoration is not universal: ACWDL 25-18 says the Pickle, Disabled Adult Child, and Disabled Widow(er) programs stay exempt from the asset test until further guidance, so a limit did not come back for those beneficiaries. None of these figures is a count of everything a family owns, either. DHCS says the home you live in, one vehicle, household items, and some savings such as retirement accounts do not count, against a counted list of bank accounts, cash, and more than one house or vehicle.3,4,1
• The 2027 step-down: DHCS's Medi-Cal Changes page states the $130,000/$65,000 figures apply "Through June 30, 2027," and that "Starting July 1, 2027, the asset limit is: $21,000 for one person / $31,000 for two people / Add $1,550 for every extra person." Any plan built on the $130,000 number needs that date in it.1

The transfer shield: Under AB 116 and DHCS ACWDL 25-18, transfers made from January 1, 2024 through December 31, 2025 are not reviewed in the look-back, because no asset test applied then. It does not shield assets you still hold: anything in your name today counts against the reinstated $130,000/$195,000 limit.3

What ACWDL 25-18 does not say: it states that the period of ineligibility "does not apply to Medi-Cal members enrolled in community-based Medi-Cal programs," which describes whom the nursing-facility penalty reaches. That is not a statement that an HCBS-waiver applicant escapes the look-back. Take any past transfer to your county eligibility worker.7

The phased look-back: California's look-back is 30 months, shorter than the federal 60 months that applies to disposals made on or after February 8, 2006, and the maximum period of ineligibility is likewise 30 months from the date of transfer. Beginning July 1, 2026 the months reviewed increase by one each month, until the full 30-month review applies to long-term-care applications on or after July 1, 2028. The penalty divisor is the statewide Average Private Pay Rate (APPR) for nursing-facility care; counties do not follow up when transfers fall under the APPR or the applicant was within the asset limits on the transfer date. That is the exception, not the rule: where it appears the applicant was over the asset limits and transferred property over the APPR, the county follows up, and ACWDL 25-18 states a presumption that assets transferred by someone in long-term care were transferred to establish eligibility. That presumption may be refuted with evidence the transfer was made for another reason, and refuting it is the family's remedy. A penalty is also not automatic and not a denial: every case must be reviewed for undue hardship first, no period of ineligibility may be imposed without approval from the DHCS Medi-Cal Eligibility Division, and counties are told not to issue a total denial but to grant restricted eligibility instead. DHCS did not print the 2026 APPR figure in ACWDL 25-18, and the roughly $14,440/month often quoted comes from a secondary source, so confirm the current rate with your county.4

3. How Do I Apply? How to Apply for Medi-Cal

The dedicated guide: How to Apply for Medi-Cal

Every county uses the same statewide portal and the same sequence.

4. What Managed-Care Plan Should I Pick? Medi-Cal Managed Care Plans

The dedicated guide: Medi-Cal Managed Care Plans

Most Medi-Cal members receive care through a managed care plan (MCP) rather than fee-for-service. DHCS's plan-model fact sheet sets out five operating models: County Organized Health Systems (COHS), Geographic Managed Care (GMC), Two-Plan, Regional, and Single Plan. The MCP contracts now in force began January 1, 2024. In a COHS county DHCS contracts with a single county-run plan that is the sole MCP there, and COHS plans are generally exempt from many federal managed-care requirements including plan choice, so a COHS county normally offers one plan rather than a choice.6

That single-plan rule is not absolute, and the exception matters to older Californians: Kaiser Permanente holds a separate direct Medi-Cal contract under AB 2724 covering 32 counties, and DHCS says any dual member, or any foster or former foster youth, living in Kaiser's footprint may enroll in Kaiser's Medi-Cal plan. If you have both Medicare and Medi-Cal in a COHS county, ask Health Care Options whether Kaiser is a second option for you.6

Choosing and switching plans: Health Care Options (HCO), 1-800-430-4263, handles enrollment and plan changes. Ask HCO about switching windows and good-cause exceptions in your county.2

5. What's the Dual-Eligible Option? California Medi-Medi Plans 2026

The dedicated guide: California Medi-Medi Plans 2026

For California's full-benefit dual-eligibles (people with both Medicare and full-benefit Medi-Cal), 2026 was a landmark year.

Medi-Medi Plans are Medicare Advantage plans available only to dual-eligibles, combining Medicare and Medi-Cal benefits into one plan, network, and care coordinator.6

The 2026 expansion: Effective January 1, 2026, Medi-Medi Plans reach 41 of California's 58 counties, up from 12. The expansion is uneven: 22 counties get them in all plans, but in 7 more they are newly available in at least one plan only, so your own plan may not offer one, and the remaining 17 counties are phased in after 2026. Verify your county on the 2026 DHCS Medi-Medi Plan list.6

6. How Does Long-Term Care Work? Medi-Cal Long-Term Care

The dedicated guide: Medi-Cal Long-Term Care

Medi-Cal pays for long-term care in nursing facilities and in the community through HCBS waivers and state-plan services.

Income and Share-of-Cost: California does not apply a gross-income cap to institutional Medi-Cal. Excess income produces a share of cost, not ineligibility (W&I §14005.13(a)). DHCS states that "[t]he nursing home resident is allowed only $35 for personal needs," with the remainder of countable income going toward the monthly share of cost; that $35 floor is statutory, at W&I §14005.12.4

That $35 is one item on a list, not the whole of what a resident may keep. The same statute runs a cumulative list of maintenance-need purposes: personal and incidental needs, upkeep and maintenance of the home, support of minor children or a disabled relative where there is no community spouse, support and care of a community spouse and dependents living with them, the community spouse monthly income allowance "established at the maximum amount permitted," and the family allowance. Ask your county to apply every item that fits your household before you accept a share-of-cost figure. For anything beyond that list, use 42 C.F.R. §435.725 and the county's own instructions.4

The $35 itself is also not flat. Under 22 CCR 50605(a) it applies to a resident who will be in long-term care for the entire calendar month; a resident with therapeutic wages gets $35 plus a further allowance, and a resident in long-term care for only part of a month is held to the ordinary maintenance need instead, not to $35.5

Spousal impoverishment (2026), per DHCS ACWDL 26-02:

• Community Spouse Resource Allowance (CSRA): $162,660, effective 1/1/2026, but not an unconditional ceiling on every couple. ACWDL 26-02 says the 2026 value "will only apply to cases being newly determined under SI provisions from January 1, 2026, onward," that cases determined eligible before that date "will not be subject to this limit at the 2026 annual renewal," and that the CSRA "applies to the initial month of eligibility only." At a 2026 renewal of a pre-2026 case, DHCS says members "may transfer out of their name more than the $162,660 CSRA amount since the CSRA limit does not apply at annual renewal." If your case was open before 2026, do not let anyone tell you your resources are capped at renewal.4
• Minimum Monthly Maintenance Needs Allowance (MMMNA): $4,067/month, effective 1/1/2026 (DHCS rounds the federal maximum of $4,066.50 to the whole dollar; California's 2025 MMMNA was $3,948). Medicare and other health-insurance premiums are deducted when the community spouse's gross income is measured against it4

DHCS publishes a single CSRA and a single MMMNA for California. ACWDL 26-02 publishes no California CSRA minimum or MMMNA floor, so treat the federal §1924 minimums quoted elsewhere ($32,532 in resources; $2,705/month effective 7/1/2026) as federal standards, not figures DHCS has adopted for your case. No source here establishes that $162,660 is an amount a community spouse can never exceed, so ask DHCS or an elder law attorney rather than assuming it is the end of the conversation.4

California extends these protections beyond institutional care to home- and community-based services, under the ACA's broadened definition of "institutionalized spouse" as implemented by DHCS ACWDLs 17-25 and 18-19. The MMMNA applies when the institutionalized spouse is in a skilled nursing facility, is on the HCBS waitlist, or is actively participating in an HCBS program. Note that in HCBS community cases there is no $35 personal needs allowance.4

7. What HCBS Waivers Exist? California HCBS Waivers

The dedicated guide: California HCBS Waivers

California delivers home- and community-based services through several distinct programs rather than one waiver, each with its own authority, lead agency, and access rules:7

An MSSP age discrepancy worth knowing before you call: DHCS's MSSP page says clients "must be 65 years of age or older," while the California Department of Aging, the administering agency, publishes "Persons 60 years of age or older." Two state sources disagree, so if you are 60 to 64, apply rather than self-screen out.7

The Assisted Living Waiver pays for care in a Residential Care Facility for the Elderly, an Adult Residential Facility, or subsidized public housing, but not room and board, which the resident pays themselves. PACE, meanwhile, is paused: DHCS Policy Letter 25-02 paused the PACE application process effective November 20, 2025, until at least November 19, 2027.7

How the money rules apply: financial eligibility for the non-managed-care waivers follows non-MAGI Medi-Cal, so the AB 116 asset test and the spousal-impoverishment protections above both apply. On transfers, see the caution in the asset-limits section.7

8. What Is CalAIM? CalAIM 2026 Explained

The dedicated guide: CalAIM 2026 Explained

CalAIM (California Advancing and Innovating Medi-Cal) is a Section 1115(a) demonstration plus a parallel Section 1915(b) managed-care waiver, established in California statute by AB 133 (2021), Chapter 143. CMS approved both on December 29, 2021, effective through December 31, 2026, with CalAIM launching January 1, 2022. DHCS submitted its renewal application to CMS on May 11, 2026, seeking a five-year renewal that would implement the demonstration through December 31, 2031.8

Headline initiatives:

• Enhanced Care Management (ECM) is a statewide Medi-Cal benefit for members with complex needs, organized around defined Populations of Focus and delivered by a single Lead Care Manager.8
• Community Supports are 14 pre-approved services addressing members' health-related needs. DHCS says plans are "encouraged to offer as many of" them "as possible" rather than required to offer them all, so which ones you can actually get varies by plan and county. They are available to eligible members whether or not they qualify for Enhanced Care Management.8
• Short-term rental assistance (which DHCS has also called Transitional Rent) is a room-and-board-only support, with no clinical services included in the payment. Its authority comes from the BH-CONNECT demonstration, not the CalAIM Community Supports list, so it is not a fifteenth Community Support. The six months is a combined cap, not a personal allowance: CMS approved up to six months per household per demonstration period, and applies a combined six-month cap across all CalAIM and BH-CONNECT housing supports per beneficiary in any 12-month period, usable in one or more episodes. Per CMS Special Terms and Conditions 10.10 it was optional for plans no sooner than July 1, 2025; mandatory no sooner than January 1, 2026 only for members meeting the access criteria for specialty mental health services, Drug Medi-Cal, or DMC-ODS; and mandatory for all eligible populations no sooner than January 1, 2027. Outside those behavioral-health populations, ask your plan whether it offers the benefit today.8
• Justice-Involved Pre-Release Services and BH-CONNECT, the behavioral-health Section 1115 demonstration effective January 1, 2025, round out the initiative.8

9. Will They Take the House? California Medi-Cal Estate Recovery

The dedicated guide: California Medi-Cal Estate Recovery

The most-asked question in California elder law, and for most families the answer in 2026 is no: California has one of the most caregiver-friendly recovery programs in the country.

SB 833 (Stats. 2016, Ch. 30), codified at Welfare & Institutions Code §14009.5, rewrote California estate recovery for members who die on or after January 1, 2017. Recovery is now:9

• Probate-only. California defines the recoverable "estate" as the probate estate only, so assets that pass outside probate (a Transfer on Death deed, joint tenancy, beneficiary designations, or a properly funded trust) are beyond DHCS's reach.9
• Limited in scope. Recovery reaches only nursing-facility services, home and community-based services, and related hospital and prescription-drug services.9
• Barred against a surviving spouse or registered domestic partner. For members who die on or after January 1, 2017, W&I §14009.5(b)(2)(B) bars the claim outright when there is a surviving spouse or a surviving registered domestic partner. A surviving child under 21, or a blind or disabled child, also bars the claim. (An older regulation, 22 CCR §50963, still describes a lifetime deferral for a registered domestic partner rather than a bar; that is the pre-SB 833 rule, and the later statute controls, but a family in that situation should ask DHCS to confirm in writing.)9
• Excluded from IHSS. In-Home Supportive Services are not part of the State's recovery claim.9

Hardship waivers can protect heirs further, but each ground carries conditions that are easy to miss. A homestead of modest value (fair market value 50% or less of the county's average home price at the date of death) is a ground "subject to federal approval," not an automatic exemption. An aged, blind, or disabled heir must have lived in the home for at least a year before the death, still reside there, and be unable to get financing to repay the State. The caregiver ground requires two or more years of care that prevented or delayed institutionalization and that the caregiver still resides in the home. No hardship exists where estate planning was used to shelter assets from recovery. File form DHCS 6195 within 60 days of the date on the claim letter; DHCS decides within 90 days.9

For federal context and the cross-state planning toolkit, see Medicaid Estate Recovery Explained.

10. What Programs Are Available? California Medi-Cal Programs Hub

The dedicated guide: California Medi-Cal Programs Hub

The programs hub is the single directory of every Medi-Cal-anchored program: managed-care plans, HCBS waivers, IHSS, CalAIM, county Behavioral Health plans, Medicare Savings Programs, Medi-Medi Plans, CBAS, Medi-Cal Dental, and children's programs. It also covers Medi-Cal Rx, the pharmacy carve-out: pharmacy claims moved to fee-for-service on January 1, 2022, but drugs billed on a medical or institutional claim stay with your plan.6

11. How Does IHSS Work? California IHSS Deep Guide

The dedicated guide: California IHSS Deep Guide

In-Home Supportive Services (IHSS) is California's flagship in-home personal-care program, and paid family caregivers make up much of its provider workforce. IHSS is not part of the State's estate recovery claim for recipients who died after September 1, 2000.9 The deep guide covers the assessment process, the WPCS waiver supplement, the paid-parent provider expansion, and the Live-In Difficulty-of-Care income exclusion under IRS Notice 2014-7. Verify current county wages on the CDSS IHSS page.

If California Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road, but more than one clock starts the day the notice arrives.

Federal law gives Medicaid applicants and beneficiaries a right to a fair hearing before the state agency, and 42 CFR 431.220(a) names six categories of person who hold it, including a nursing facility resident who believes the facility has wrongly decided he must be transferred or discharged. The one case the regulation carves out is a benefit change that flows automatically from a federal or state law affecting a whole group.10 The federal 90 days at 42 CFR 431.221(d) is a ceiling on what a state may allow, counted from the mailing date, not a window you are owed.11

California gives you the full 90 days, counted from the day you receive the notice. DHCS tells Medi-Cal members to request the State Hearing within 90 days of receiving the Notice of Action, though a late request may be accepted for good cause such as illness.11

A second, earlier deadline matters more if you are already enrolled. Requesting the hearing by the notice's effective date keeps benefits running as Aid Paid Pending.11 Miss it and ask anyway: 42 CFR 431.231 lets the agency reinstate services when you request a hearing no more than 10 days after the date of action. Otherwise coverage can stop meanwhile, and if you keep benefits and lose, the agency may recoup what the continuation paid for.12

Most Medi-Cal members are in a managed care plan, which changes the order and the number. If a plan denied a service, finish the plan's internal appeal first, decided within 30 days, then request a State Hearing within 120 calendar days of the plan's written decision. That 120 days is not the eligibility-denial deadline; it runs only from a plan decision. Fee-for-service members go straight to a State Hearing inside the 90-day window.11

So when a notice arrives: find the effective date, request the hearing before it, and ask in writing that benefits continue. See California Medicaid Appeals and Fair Hearings for how to file and what happens after a decision.

Keeping California Medicaid Once You Have It

Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways people lose coverage they still qualify for.

Federal rules put much of the work on the agency, but how much depends on which Medi-Cal you are on, and the rule changed on July 31, 2026. For members whose eligibility runs on MAGI methods, the agency must first try to renew automatically from information it already holds, and may request documents only if it cannot13; if it does need paperwork, it must send a renewal form and give at least 30 days from the date of the form to return it.13 For the aged, blind, and disabled members excepted from MAGI, which is most readers of this guide, the revised 42 CFR 435.916(b) is weaker: the automatic step is conditioned on sufficient information being available, and the renewal-form package at paragraph (a)(3), including the 90-day reconsideration window below, is permissive for the state rather than required.13 Do not assume a form is coming. What DHCS tells members is that Medi-Cal is "looked at once per year," renewed by notice when the county can do it from data it already has, and otherwise by a mailed renewal form or Request for Information.2

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you submit the renewal form within 90 days after the termination (required for MAGI-based coverage; a state option otherwise).13 DHCS frames California's version by the letter rather than the termination: under 90 days from the date on the letter, turn in the form or the missing information and keep coverage without a new application; after 90 days, a new application is required.2

Keep your address current, open anything from California Medicaid, and return a renewal form the week it arrives. See California Medicaid Recertification and Renewal for the full cycle, what the packet asks for, and how to recover coverage that has already closed.

Where to Get Help

California Medi-Cal FAQ

The Bottom Line: What Every California Medi-Cal Applicant Should Know in 2026

1. Plan against the date, not just the number. The asset test returned January 1 at limits no other state matches, and DHCS publishes them as running only through June 30, 2027.3,1
2. Save 1-800-430-4263. Health Care Options handles managed-care and Medi-Medi Plan enrollment and plan changes.2
3. Do not assume home care makes a transfer safe. ACWDL 25-18's carve-out is about members already in community-based programs, not about waiver applicants. Take any past gift to your county eligibility worker.7
4. The 2024-2025 transfer shield is real, for eligibility only. It does not address estate recovery, which runs on its own rules.3
5. Most families lose little to estate recovery with basic planning. Record a Transfer on Death deed, keep beneficiary designations current, and see a Certified Elder Law Attorney before applying for nursing-facility Medi-Cal.9

Learn More

Find personalized help navigating California Medi-Cal at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.