Table of Contents
FAQs
When do Medi-Cal’s protections against spousal impoverishment apply?
Medi-Cal’s protections against spousal impoverishment apply when one spouse needs long-term services and supports (LTSS), which includes both nursing home care and home and community-based services (HCBS). California HCBS programs include:
- In-Home Supportive Services (IHSS) (in some cases),
- Multipurpose Senior Services Program (MSSP),
- Community-Based Adult Services (CBAS) program,
- Home and Community-Based Alternative (HCBA) waiver, and
- Other Medi-Cal waiver programs.
Protections against spousal impoverishment apply both to married couples and registered domestic partners.
Do the protections apply to all spouses receiving In-Home Supportive Services (IHSS)?
No, the protections only apply to the almost half of the IHSS recipients who have a “2K” aid code. These are persons who have been determined to need a level of care that is roughly equivalent to the level of care provided in a nursing home. Their IHSS coverage is provided through the Community First Choice Option (CFCO).
How do these protections work?
Long-term services and supports can be extremely expensive – potentially over $100,000 per year. The protections help protect a spouse financially when the other spouse needs LTSS. Specifically, the spouse not needing services (called the “community spouse”) is allowed to retain specified amounts of the couple’s income and assets, as explained in more detail below.
How are the financial protections calculated?
Depending on the couple’s finances, the spouse seeking Medi-Cal coverage for LTSS may be able to assign some income and resources to the community spouse. The income allocation from the spouse seeking coverage can be up to an amount that increases the community spouse’s total monthly countable income up to a federally-set maximum called the Maximum Monthly Maintenance Needs Allowance (MMMNA). In 2025 the MMNA was $3,948. Effective January 2026, the asset limit in Medi-Cal is reinstated. Accordingly, the spousal impoverishment resource allocation will also be reinstated, which permits the community spouse to retain total countable resources up to an annually adjusted maximum–$157,920 in 2025. (These are the income and resource limits as of May 2025; they are adjusted annually to account for inflation and can be found on the Centers for Medicare & Medicaid Services website).
For much more information about how to calculate income and resources, see the Department of Health Care Services All County Welfare Department’s Letters (ACWDL) 17-25 and 18-19, and Medi-Cal Eligibility Division Information Letter (MEDIL) I-24-16.
Do the protections require proof of a medical need?
Yes, the person must show a need for HCBS at a level equivalent to nursing home care. This need is established automatically if the person is enrolled in a Medi-Cal waiver program or in the IHSS CFCO program (aid code 2K). Otherwise, the person can submit a completed and signed Doctor’s Verification form (MC 604 MDV) so that a doctor can certify a need for the required level of care. The doctor’s certification generally is needed for persons on a Medi-Cal waiver program waitlist, since they are not yet enrolled in an HCBS program.
Can you provide an example to illustrate these rules?
Of course. We’ll call our sample couple Mr. and Mrs. Fuentes. Each spouse is 72 years old and thus potentially eligible under Medi-Cal’s program for aged (at least 65 years old) or disabled adults. Eligibility will require that they also qualify financially, based on resources and income.
Mr. Fuentes’ doctor has completed and signed an MC 604 form, certifying that Mr. Fuentes requires a level of care equivalent to care in a nursing home. Mr. Fuentes intends to receive the necessary care at home, through Medi-Cal-funded home and community-based services. As an HCBS recipient, his Medi-Cal eligibility calculations include protections against the impoverishment of Mrs. Fuentes.
Here is the financial information for the couple:
Joint resources: $200,000
Income:
Mr. Fuentes: $2,000 per month from Social Security
Mrs. Fuentes: $1,000 per month from a teacher’s pension
First, we consider countable resources (which does not include the value of a home). Because California had eliminated the asset limit for Medi-Cal eligibility effective January 2024, in 2025 couples did not need to transfer assets to the community spouse because they were not factored in eligibility determinations. However, in 2026 the asset limit will be reinstated to $130,000 for an individual and $65,000 for each additional household member. As of January 2026, Mr. Fuentes can keep $130,000 under Medi-Cal rules, and the remaining $70,000, which is less than the $157,940 maximum that can be held by a community spouse, can be allocated to Mrs. Fuentes. To establish eligibility, the couple must transfer the $70,000 to the sole ownership of Mrs. Fuentes. You can read more about the 2026 Medi-Cal asset limit reinstatement here.
Next, we consider income. The relevant income standard is $1,801 for 2025 (138% of the Federal Poverty Limit), which is the income limit for an individual who is either aged (at least age 65) or disabled. To reach this level, Mr. Fuentes must allocate at least $199 of his monthly income to his wife, since this will reduce his countable income from $2,000 to $1,801. This allocation will raise Mrs. Fuentes’ monthly income from $1,000 to $1,199, which is well under her limit of $3,948 for a community spouse.
Mr. Fuentes becomes eligible because he is eligible under both countable resources ($130,000 limit) and monthly income ($1,801 limit). Mrs. Fuentes, is also eligible — her monthly income is only $1,199, and her countable resources total to $70,000, which is below the $130,000 limit. If spousal impoverishment protections were not available, the Fuentes’ countable resources of $200,000 would have been higher than $195,000, which is the resource limit for a couple, rendering them ineligible. Even if they would have spent $5,000 of their resources to meet the asset limit, without spousal impoverishment protections, Mr. Fuentes’ income would be too high, requiring him to spend all but $600 of his monthly income on health care before becoming eligible.
In summary, both Mr. and Mrs. Fuentes can qualify for Medi-Cal with the help of the protections against spousal impoverishment.
How can individuals receive retroactive spousal impoverishment protections for service and care needs as far back as January 2014?
In the past, California did not properly provide adequate protections against spousal impoverishment. To make up for this failure, and as the result of a court order, the California Medi-Cal program offers retroactive spousal impoverishment protections under certain circumstances. A couple may be eligible for retroactive protections if:
- One member of the couple needed HCBS at a nursing home level of care and applied for Medi-Cal on or after January 1, 2014, AND
- Either Medi-Cal was denied due to excess resources, or the Medi-Cal was granted, but with an obligation to pay a portion of the cost of care.
If someone meets these standards, they might be able to be compensated for the coverage that they should have received, or for the payments that they made towards the cost of care. To apply, they should contact their county welfare department and ask for a retroactive reassessment. It may also help to contact local legal services through the Health Consumer Alliance (888‑804‑3536); obtaining relief can sometimes be challenging due to the passage of time.
How is eligibility for retroactive IHSS determined?
A: Individuals who meet the standards discussed above should be evaluated for retroactive IHSS eligibility. If someone submitted an IHSS application in the past, the county can use that date to evaluate eligibility. However, even if a person never submitted an IHSS application, they must be allowed to submit a new application and then they can request a retroactive assessment of IHSS needs back to the date of the Medi-Cal eligibility. The county will determine retroactive eligibility and then the affected individual may request payment for up to 195 hours per month of IHSS wages back to the eligibility date using what is called Conlan process. Because this process can sometimes be time consuming and complicated, an applicant may want to contact their local legal services offices, as discussed above.
