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. 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:

Read this overview first, then open the guide that matches your most-pressing question.

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), still built on the prior-year poverty guideline because Medi-Cal refreshes its MAGI levels on its own schedule; expect it to rise toward 138% of the 2026 guideline ($15,960/year for one person) when DHCS updates the chart. 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. DHCS is expected to publish the formal 2026 Aged & Disabled FPL program figures in an All County Welfare Directors Letter; verify the current limit on the DHCS Medi-Cal eligibility page before relying on a specific 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. The maintenance need level is $600/month for one person and $934 for two. The applicant pays medical bills up to the share-of-cost each month, and Medi-Cal pays the rest. For long-term care specifically, California's own statute (W&I §14005.13(a)) treats income above the personal-needs allowance as producing a patient liability rather than ineligibility, so excess income 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 community spouse resource allowance DHCS publishes for California is $162,660. DHCS publishes a single CSRA for the state and does not publish a California minimum, so do not assume a separate floor applies to your case.4

Read the full guide: Medi-Cal Eligibility & Income Limits 2026.

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

The dedicated guide: Medi-Cal Asset Limits 2026

California's 2024-2026 asset-test policy is one of the most consequential in the country.

• 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.3
• 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 period, because the asset test did not apply during those months. This protects gifts given during the no-asset-test window. It does not shield assets you still hold today: anything currently in your name counts against the reinstated $130,000/$195,000 limit.3

What ACWDL 25-18 does not say: the letter states that the penalty period "is referred to as the period of ineligibility (POI) for nursing facility level-of-care," and that "[t]he POI does not apply to Medi-Cal members enrolled in community-based Medi-Cal programs." That describes whom the nursing-facility penalty reaches. It is not a statement that an HCBS-waiver applicant escapes the look-back, so do not treat a gift as consequence-free because home care is the goal. 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. 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

Read the full guide: Medi-Cal Asset Limits 2026.

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

The dedicated guide: How to Apply for Medi-Cal

Medi-Cal eligibility is determined county-by-county, but every county uses the same statewide portal and back-end. Applying follows a defined sequence.

Read the full guide: How to Apply for Medi-Cal.

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

The dedicated guide: Medi-Cal Managed Care Plans

Roughly 90% of Medi-Cal enrollees receive care through a managed care plan (MCP) rather than fee-for-service. Effective January 1, 2024, Medi-Cal managed care operates under five county models: County Organized Health System (COHS), Single Plan, Two-Plan, Geographic Managed Care (GMC), and Regional. In COHS counties, DHCS contracts with a single county-run plan and members have no plan choice.6

The 2024 statewide procurement awarded five commercial plans (Anthem Blue Cross, Blue Shield of California Promise, Community Health Group, Health Net, and Molina), and Kaiser Permanente holds a separate direct contract under AB 2724 serving 32 counties.6

Choosing and switching plans: Members enroll in and switch plans through Health Care Options (HCO) at 1-800-430-4263. After approval in a managed-care county you must choose a plan within 30 days, depending on the county, or Medi-Cal assigns one for you. Ask HCO directly about the current switching windows and good-cause exceptions for your county.2

Read the full guide: Medi-Cal Managed Care Plans.

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 a type of Medicare Advantage plan available only to dual-eligibles. They combine Medicare Part A, B, and D services and wrap-around Medi-Cal services into a single plan, so a member enrolls once and receives all of their Medicare and Medi-Cal benefits through the same plan, network, and care coordinator.6

The 2026 expansion: Effective January 1, 2026, Medi-Medi Plans expanded from 12 counties to 41 counties, adding 29 counties. Verify which plans serve your county on the 2026 DHCS Medi-Medi Plan list.6

Read the full guide: California Medi-Medi Plans 2026.

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. The full list of post-eligibility deductions is not something to reconstruct from memory, so build any share-of-cost calculation from 42 C.F.R. §435.725 and your county's own instructions.4,5

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

• Community Spouse Resource Allowance (CSRA): $162,660, effective 1/1/20264
• 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.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

Read the full guide: Medi-Cal Long-Term Care.

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 from their own funds. It runs in 15 counties and carries a large waitlist. 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 ($130,000 for one person plus $65,000 per additional household member, through June 30, 2027) applies, as do the spousal-impoverishment protections above. On transfers, see the caution in the asset-limits section: ACWDL 25-18's statement that the nursing-facility penalty does not reach members already in community-based programs is narrower than "waiver applicants are exempt."7

Read the full guide: California HCBS Waivers.

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, authorized in state law by AB 133 (2021). 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 (formerly In Lieu of Services) that Medi-Cal managed care plans may elect to offer in place of standard State Plan services.8
• Short-term rental assistance (which DHCS has also called Transitional Rent) provides up to six months of rent or temporary housing. Its authority comes from the BH-CONNECT demonstration, not the CalAIM Community Supports list, so it is not a fifteenth Community Support. 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 optional for everyone else; 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: On January 26, 2023, California became the first state approved to offer Medicaid services to incarcerated youth and adults for up to 90 days before release.8
• BH-CONNECT (Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment) is a Section 1115 demonstration effective January 1, 2025.8

Read the full guide: CalAIM 2026 Explained.

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. The honest, fully-sourced answer in 2026: for most families, no, because California has one of the most caregiver-friendly Medicaid Estate 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 additionally protect heirs, 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 substantial-hardship waiver ground "subject to federal approval," not an automatic exemption. The aged, blind, or disabled heir must have lived in the decedent's home continuously for at least one year before the death, still reside there, and be unable to obtain financing to repay the State. The caregiver ground requires two or more years of care that prevented or delayed institutionalization, and that the caregiver resided and continues to reside in the decedent's home. No hardship exists where estate-planning methods were used to divert or shelter assets to avoid recovery. File the waiver application (form DHCS 6195) within 60 days of the date on the DHCS estate-recovery claim letter; DHCS must then decide within 90 days of submission.9

Read the full guide: California Medi-Cal Estate Recovery. For federal context, the OBRA-93 mandate, 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 aggregates every Medi-Cal-anchored program into a single directory: managed-care plans, HCBS waivers, IHSS, CalAIM Enhanced Care Management and Community Supports, county Behavioral Health plans, Medicare Savings Programs, Medi-Medi Plans, CBAS, the Medi-Cal Rx pharmacy carve-out (administered fee-for-service by Magellan since January 1, 2022), Medi-Cal Dental, and children's programs such as EPSDT and California Children's Services.6

Read the full guide: California Medi-Cal Programs Hub.

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. Although it sits administratively under Medi-Cal, its implications cross into the caregiver pillar, because paid family caregivers make up much of the IHSS provider workforce. One thing we can state with a source: 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 for HCBS-waiver recipients, the paid-parent provider expansion, and the Live-In Difficulty-of-Care income exclusion under IRS Notice 2014-7. Verify current county wages and provider rules on the CDSS IHSS page.

Read the full guide: California IHSS Deep Guide.

What Makes Medi-Cal Different from Other State Medicaid Programs

Four framings every California Medi-Cal applicant should understand:

1. The Medi-Cal Asset Test Was Removed, Then Restored With a Deadline

California removed the non-MAGI asset limits outright for 2024 and 2025, and AB 116 brought them back on January 1, 2026 at $130,000 for one person, far above the $2,000 federal SSI resource limit that anchors most states' rules. Read that alongside its expiration date: DHCS publishes the $130,000 figure as running through June 30, 2027, dropping to $21,000 for one person on July 1, 2027. The generous number is the temporary one.3,1

2. California's Transfer Look-Back Is 30 Months, Not 60

California's look-back is 30 months, half the federal 60 months that applies to disposals made on or after February 8, 2006, and it is still phasing in one month at a time from July 1, 2026. Transfers made between January 1, 2024 and December 31, 2025, when no asset test applied, are not reviewed at all. What that does not mean is that a gift is safe if the plan is home care: ACWDL 25-18's carve-out is about members already enrolled in community-based programs, not about waiver applicants.4,7

3. Spousal Impoverishment Reaches Home and Community-Based Services

Through DHCS ACWDLs 17-25 and 18-19, implementing the ACA's broadened definition of "institutionalized spouse," California applies spousal-impoverishment protections to HCBS spouses whose community spouse lives at home, not only to institutional cases. Combined with the AB 116 asset limit, a married couple seeking HCBS Medi-Cal can protect substantially more than the individual limit alone.4,7

4. Estate Recovery Is Among the Most Consumer-Friendly (Post-SB 833)

SB 833 restricted recovery to the probate estate, barred it against a surviving spouse or registered domestic partner, and narrowed the recoverable services; IHSS has been outside the State's claim since 2000. Most California families with basic planning lose little or nothing to estate recovery.9

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 guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.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, or within 10 days of the notice where no 10-day advance notice is required, is what keeps benefits running as Aid Paid Pending.11,12 Miss it and you may still appeal, but coverage can stop meanwhile, and if you keep benefits and lose, the agency may recoup what the continuation itself 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. 2026 is a pivotal year, and 2027 is the next one. The asset test returned January 1 at far higher limits than any other state, but DHCS publishes those limits as running only through June 30, 2027, dropping to $21,000 for one person and $31,000 for two on July 1, 2027. Plan against the date, not just the number.3,1
2. Save 1-800-430-4263. Health Care Options is the statewide entry point for managed-care and Medi-Medi Plan enrollment and plan changes.2
3. Do not assume home care makes a transfer safe. California's look-back is 30 months rather than the federal 60, and ACWDL 25-18 says the nursing-facility-level-of-care penalty does not apply to members enrolled in community-based programs. That is narrower than "HCBS applicants are exempt," and it is not planning advice. Take any past gift to your county eligibility worker.7
4. The 2024-2025 transfer shield is real, for eligibility. Per ACWDL 25-18, transfers made during the no-asset-test window are not reviewed in the eligibility look-back. That letter is about eligibility; it does not address estate recovery, which runs on its own rules.3
5. Most families lose little to estate recovery with proper planning. Record a Transfer on Death deed on the home, keep beneficiary designations current, and consult a Certified Elder Law Attorney before applying for nursing-facility Medi-Cal.9

The hardest part of Medi-Cal is navigation. This guide is the map.

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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.