Navigating Long-Term Care in California

Today, we want to help you learn about long-term care, caregiving, and long-term care insurance in California. California offers incredible resources and programs that can help you or your loved one get the care they need at an affordable cost.

Below, we've broken down this page into five sections:

• California State Programs and Resources for Long-Term Care
• Medi-Cal: Medicaid in California
• Long-Term Care Insurance in California
• Family Caregiver Resources in California
• Cost of Care Across California

You can use the links above to jump to the section you need or read along from the beginning for the most in-depth guide to California's unique programs. 

An Overview of Long-Term Care in California

California is the most populous state in the United States, with around 39 million residents. Among those, over 5.5 million are seniors, and many seniors receive long-term care from facilities, professional home care services, or family caregivers.

California's relaxed attitude and mild climate provide an excellent environment for retirement. Popular long-term care and retirement options include assisted living facilities, independent living communities, nursing homes, and continuing care retirement communities. 

The state holds its care facilities and staff to high standards, offering quality care to residents and extensive benefits to healthcare workers. Some of these benefits include movements to raise the minimum wage for healthcare workers.

As of October 23rd, 2023, the state has implemented a plan to gradually raise the minimum wage for healthcare workers to $25/hr over the course of several years, depending on the facility. This creates a better working environment for many healthcare workers and can ultimately lead to a higher quality of care.

According to the California Association of Health Facilities (CAHF), the state has over 1,230 licensed long-term care nursing facilities. The CAHF estimates that around 400,000 people receive care in licensed long-term care facilities annually. However, the number of people who need care in California may be higher due to the fact that many people receive care from family members at home. 

In California, there are several ways to cover the cost of long-term care, including state programs, Medi-Cal (California's Medicaid program), Long-Term Care Insurance, out-of-pocket payments, and having a family member provide in-home care. 

California State Programs and Resources for Long-Term Care

There are thousands of resources in California for caregivers, long-term care recipients, and seniors. It's nearly impossible to cover all these resources in a single article, but we've compiled a collection of California's most valuable and widespread opportunities. 

Find Your Area Agency on Aging

Phone: 1-800-510-2020 (Redirects to your nearest AAA)

In many states, you can contact your local Area Agency on Aging (AAA) to find support, long-term care services, and other aging resourcing near you or your loved one. California is no different, with a comprehensive list of Area Agencies on Aging serving even the most remote corners of the state. 

Each area has its own website, phone number, and headquarters. These agencies offer programs, including, but not limited to:

• Caregiver support and respite care resources.
• Assistance with long-term care.
• Vouchers, coupons, and healthy food programs.
• Elder abuse resources.
• Medicaid, Medicare, or health insurance guidance.
• Educational information for seniors and caregivers.

If you're not looking for resources but instead want to find care providers, facilities, and services near you or your loved one, you can use LTC News's Care Directory. This tool can connect you with high-quality care options to choose the best provider for you or your loved one. 

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California Department of Aging

Phone: (916) 419-7500 (Public information number)

The California Department of Aging provides easy access to essential resources serving aging and disabled individuals, family caregivers, and long-term care residents across the state. They offer a one-stop website where you can find nearly any long-term care resource you could need within California.

Long-Term Care Ombudsman

Phone: 1-800-231-4024 (Crisis and complaint number)

The Long-Term Care Ombudsman is a state resource for all long-term care residents, regardless of their age. This resource takes complaints about facilities and offers elder abuse support, keeping long-term care residents safe. 

California offers a 24/7 crisis line for long-term care residents to use for complaints about long-term care facilities, which is listed above. 

CalVet: California Veterans Affairs

Phone: 1-800-952-5626 (General CalVet information number)

California's Veterans Affairs department (also known as CalVet) offers veterans healthcare, education, employment, housing, and advocacy resources. Veterans Affairs covers long-term care, unlike most traditional healthcare or health insurance plans. 

Veterans Affairs offers several federal long-term care resources, including but not limited to facility care, home care, payment for a family member to take care of you, transportation, and help with specific conditions like dementia.

However, each state may offer additional resources or programs. CalVet provides two additional long-term care services to veterans outside of the traditional federal programs:

• CalVet Veteran Homes. This program offers veteran-oriented facilities for Veterans and their spouses to live in. There are eight facilities across the state, including care options like independent living, assisted living, skilled nursing care, and memory care. 
• Healthcare Transportation. This California program reimburses Veterans for their medical travel expenses and mileage. In some cases, they can also arrange for special modes of transportation. 

Medicare in California

Phone: 1-800-434-0222 (HICAP’s Medicare information number)

Medicare is a federal health insurance plan for older Americans. Medicare does not cover long-term care expenses. However, Medicare may cover small amounts of skilled nursing care. 

If you have further questions, you can visit the Medicare website or contact the Health Insurance Counseling and Advocacy Program (HICAP) for information on Medicare in California. 

Covered California

Phone: (800)-300-1506 (Connect with a Covered California service center representative)

Covered California helps residents get health insurance from top insurance providers, including Medi-Cal. This free program is the only one offering high-quality policies at a discounted price for qualified residents. 

The Patient Protection and Affordable Care Act established Covered California, and the program works closely with the California Department of Health Care Services to ensure its offerings and website are up to date. 

Medi-Cal: Medicaid in California

California’s Medicaid program, also known as Medi-Cal, helps individuals with little to no income and assets access free or low-cost healthcare, including coverage for long-term care services.

For the purposes of this page, we will be focusing primarily on using Medi-Cal to cover the cost of long-term care and benefits, specifically for seniors or older adults who need help covering costs.

As California's population ages, the demand for long-term care services rises. In fact, two-thirds of Californians needing long-term care rely on Medi-Cal to help cover the expenses. These long-term care services include in-home care, assisted living, and nursing home care.

However, eligibility comes with stringent criteria. To qualify, Californians must meet specific financial requirements and contribute part of their income toward care costs. A doctor must also certify that the individual's need for long-term care services is medically necessary.

Below, we'll cover how to qualify for Medi-Cal and the different long-term care programs offered through Medi-Cal.

How To Qualify for Medi-Cal: Income Requirements

Medi-Cal eligibility is determined mostly through income requirements. In general, your income may be a maximum of 138% above the poverty line to qualify. For instance, a single adult with an annual income of $20,783 or below can qualify, while the income limit for a family of four is $43,056.

Please visit Medi-Cal's qualifying requirements page for income requirements and other special circumstances. 

How To Qualify for Medi-Cal: Asset Requirements

As of January 1st, 2024, Medi-Cal no longer counts assets towards eligibility.

This change allows individuals to qualify for Medi-Cal benefits, including long-term care benefits, regardless of their assets, including:

• Individuals living in a skilled nursing facility or an immediate care facility.
• Individuals who qualify for home and community-based services.
• Individuals aged 65 or older.
• Individuals who are blind or disabled.
• Low-income individuals with dependent children.
• Children under age 21.
• Pregnant women.
• Individuals receiving Supplemental Security Income (SSI).

Individuals applying for Medi-Cal after January 1st, 2024, do not have to spend-down their assets. Asset transfers after this date will not be considered either. Now, eligible residents needing long-term care can receive coverage even if they own a home or other property.

Any asset transfers or spend-down requirements before this date still apply to applicants who applied for or received Medi-Cal benefits before January 1st, 2024.

For more information, you can learn about Medi-Cal asset requirements through California Advocates for Nursing Home Reform (CAHNR).

Monthly Resident Cost (Share of Cost)

The monthly resident cost, formerly known as share of cost, is how much money a skilled nursing facility resident must contribute towards their care each month.

The monthly resident cost can be thought of as a "rent" to the facility for providing care. This monthly payment goes towards covering the total cost of care, and then Medicaid benefits cover the rest. 

Monthly resident costs are calculated by deducting out-of-pocket medical expenses and the Personal Needs Allowance ($35) from an individual's gross monthly income. A Personal Needs Allowance is the amount of money an individual can keep for personal use while receiving Medicaid benefits in a facility.

Residents on Supplemental Security Income (SSI) have an increased Personal Needs Allowance of $50. Residents receiving VA Aid and Attendance benefits are entitled to a total Personal Needs Allowance of $125.

Any Medi-Cal beneficiary with a monthly resident cost of $500 or more will no longer have their Medicare Part B premium covered by Medi-Cal. Instead, the premiums will be deducted from their Social Security check. This does not apply to Medi-Cal-eligible nursing home residents. 

How To Use Medi-Cal Benefits To Pay for Long-Term Care

Three main Medi-Cal programs cover the cost of long-term care. These are:

• Nursing Home & Institutional Medicaid. This entitlement program covers all essential costs for seniors who need a nursing facility level of care. It covers room and board, long-term care, medical care, and social activities. However, it does not cover optional services or preferences like specialized food plans or private rooms. 
• Home and Community-Based Services (HCBS) Waivers. This program helps seniors who need a nursing facility level of care receive care at home or in their community. This is not an entitlement program, and it is available only on a limited basis. Under the scope of HCBS Waivers, there are four different waivers to use in California:
• Medi-Cal Assisted Living Waiver. This waiver allows recipients who need a nursing facility level of care to receive care in an assisted living facility. 
• Multipurpose Senior Services Program Waiver. This waiver allows recipients who need a nursing facility level of care to receive care in their or their loved one’s home. 
• Home and Community-Based Alternatives Waiver. This waiver allows recipients who are “medically fragile” or “technology dependent” to receive care in their or their loved one’s home. 
• Community-Based Adult Services. This waiver allows recipients in need to receive care in an adult day services setting. 
• Aged, Blind, and Disabled (ABD) Medicaid. This branch of Medicaid is for those 65 or older, the blind, and the disabled. In California Medi-Cal, there is a long-term care program called In-Home Supportive Services (IHSS) that supports home care through four different smaller programs:
• Community First Choice Option. This program helps ABD Medi-Cal beneficiaries who do need a nursing facility level of care, get the long-term care service they need. 
• Personal Care Services Program. This program helps ABD Medi-Cal beneficiaries who don’t need a nursing facility level of care get the long-term care service they need. 
• IHSS Plus Option Program. This program helps family caregivers get paid for taking care of their loved ones. The care recipient must be a Medi-Cal beneficiary. 
• IHSS Residual Program. This program helps individuals who aren’t eligible for the full scope of Medi-Cal services become eligible for partial long-term care services. 

You can visit this page for a moredetailed breakdown of the Medi-Cal benefits and information listed above. 

Pre-Approved Medi-Cal Providers

In addition to choosing the best Medi-Cal program or waiver for your needs and circumstances, you must also ensure that you choose a Medi-Cal-approved care provider.

Medi-Cal has contracts with skilled nursing facilities, home health agencies, and other long-term care providers that meet state standards and agree to Medi-Cal's reimbursement rates. 

Medi-Cal beneficiaries must choose a pre-approved provider to receive coverage for their services. Residents receiving care from providers outside Medi-Cal's network are unlikely to receive coverage for their care costs, except those in specific, pre-authorized situations.

Medi-Cal Estate Recovery

Estate recovery is when the government seeks repayment for Medicaid expenses after a Medicaid beneficiary passes away. The government will send the beneficiary's survivors an estate recovery claim, asking for repayment. 

In California, estate recovery claims are limited to the beneficiary's estate assets and medical care expenses related to nursing facilities, home and community-based services, or hospital and prescription drugs. You can read this estate recovery brochure from CANHR for more information. 

It's important to remember that Long-Term Care Insurance Partnership policies can protect you from Medicaid estate recovery requirements if you ever use all the money in your policy to pay for long-term care. We'll discuss Long-Term Care Insurance in California in more detail below. 

Long-Term Care Insurance in California

Long-Term Care Insurance is an effective way to plan for future long-term care needs. As we age, a majority of us will need long-term care, and unfortunately, long-term care can get expensive. 

California is one of the most expensive states for long-term care, making insurance extra important to protect income and assets.

Luckily, California offers many options for LTC Insurance, including traditional, hybrid, and Partnership Long-Term Care Insurance policies. These policies offer key protections, keeping policyholders safe from rate increases and misleading coverage information. 

One such protection is rate stability rules, which prevent your policy’s premium from increasing unnecessarily. These rules force insurance companies to go through rigorous requirements to gain approval for a rate increase and do not allow premiums to increase without dire need and evidence from the company. 

Long story short, Long-Term Care Insurance premiums are safe from extreme increases, and most policies sold today should not experience major premium increases. To learn more, you can read our article about premium increases in Long-Term Care Insurance. 

California Long-Term Care Insurance Partnership Program 

Long-Term Care Insurance Partnership policies protect policyholders from losing all of their income or assets to Medicaid spend-down requirements and estate recovery. 

The way it works is simple: you buy a Partnership policy (that meets specific state requirements), and if you ever use your entire policy trying to pay for long-term care, you’ll be able to transition to receiving care through Medicaid after your policy ends without having to meet spend-down requirements. 

This protects you from potentially losing all your income and assets trying to qualify for Medicaid. It also protects your assets and income from Medicaid estate recovery. 

The California Department of Health Care Services works with private insurance companies to provide Partnership policies for California residents. 

Policies must meet specific requirements in order to qualify. In California, any individual under age 70 must have a 5% compound inflation rider on their policy. Those buying at age 70 or above, have the option for a simple inflation rider. 

Among states that participate in the Long-Term Care Insurance Partnership program, many of them offer reciprocity for individuals who move states. Reciprocity allows an individual to continue their Partnership protection within the new state they move to without purchasing a new policy. 

California does not participate in reciprocity for Partnership policies. 

Even though several insurance companies are certified and approved to sell Partnership policies, no company is actively selling them in California. The state is currently looking into changing partnership policy rules to make them easier to market and afford.

Your benefits are still valid if you already have a California partnership policy. 

Long-Term Care Insurance Tax Benefits & Proposals 

All Long-Term Care Insurance policies that meet specific federal guidelines under Section 7702(b) qualify for tax deductions and incentives. You can read our tax guide to learn more about tax incentives and deductions for Long-Term Care Insurance policies. 

Recently, California has also proposed an LTC Tax program that may impact individuals who don’t currently own a Long-Term Care Insurance policy. 

This proposal follows in the footsteps of Washington state, which adds an extra tax for individuals above a certain age who do not currently own a Long-Term Care Insurance policy. 

This tax aims to encourage people to purchase coverage and plan for long-term care. The ultimate goal is to reduce the strain on family caregivers and state-funded long-term care programs like Medicaid. 

This policy has not yet been passed in California and is not currently effective. To learn more, you can read this article discussing the current state of the California LTC tax. 

Family Caregiver Resources in California

When our loved ones fall ill or start to need help due to aging, we often step in to help in any way we can. Unfortunately, caring for a loved one can be draining to both our emotional and financial well-being. 

To combat this, California offers many programs and resources for family caregivers. This includes educational help, respite care, supplemental services, and guidance on transitioning from informal to professional care.

How To Get Paid As A Family Caregiver in California

In general, there are three main ways to get paid as a family caregiver, no matter what state you live in. These options include Long-Term Care Insurance, Medicaid, and Veterans Affairs. 

Please keep in mind that there are more programs available regardless of the state you live in that we will not mention below but are discussed in our article on how to get paid as a family caregiver. 

Below, we’ve included a list of programs that are specific to the state of California:

• In-Home Supportive Services. Under Medi-Cal’s Home and Community-Based Waiver program, is a waiver called In-Home Supportive Services (IHSS). This program is unique to California and basically allows for self-directed care chosen by the care recipient. California has very lenient policy writing for this program, making it easy for family caregivers to qualify and receive payments as a part of the Medi-Cal program. 
• Paid Family Leave Act. California has a Paid Family Leave Act, which pays Californians 60-70% of their prior income for eight weeks during a 12-month period. Individuals can use these benefits to care for an elderly loved one. 
• Area Agency on Aging. Across the country, Area Agencies on Aging (AAA) provide care resources to seniors and their caregivers. In California, there are 33 AAAs with local resources on caregiving, which may include supplemental benefits. Each AAA offers different resources and programs, so it can vary greatly depending on where you live. 

California Caregiver Resource Centers

California’s Caregiver Resource Centers (CRC) are designed to aid family caregivers caring for a loved one with disabilities, illness, or simply experiencing the consequences of aging. There are 11 CRCs across the state, each with unique resources to support family caregivers. 

CRCs are funded and backed by the California Department of Aging. Each center focuses on helping their area at a local level, offering services including, but not limited to:

• Caregiving and illness education, workshops, advice, and training.
• Guidance and support through the caregiving journey.
• Community resource connections.
• Counseling, emotional support, and caregiver support groups.
• Legal and financial guidance.
• Respite care. 

Family Caregiver Support Program 

The Family Caregiver Support Program (FCSP) is a program that helps connect seniors and their caregivers with local resources like AAAs. Its main goals are to:

• Help caregivers and seniors access resources like education, transportation, and other support services.
• Support caregivers through respite care, support groups, and supplemental services like assistive caregiving equipment. 

Cost of Care Across California

California has a reputation for being one of the most expensive states in which to live and pay for long-term care. Below, you can use our cost of care calculator to see how much care costs today and the projected cost nationally, statewide, and in your metro area.

Los Angeles, California

Los Angeles is California’s largest metro area, with over 12.5 million people as of 2024. While it isn’t California’s most expensive area across the state, it’s not cheap either. 

In Los Angeles, the median monthly cost based on care option is:

• Adult Day Care Center: $1,707
• Assisted Living Facility: $5,841
• Home Health Aide: $6,508
• Homemaker Services: $6,335
• Semi-Private Nursing: $10,377
• Private Nursing: $12,763

San Francisco, California

San Francisco and the Bay Area is California’s second-largest metro area, with around 7.5 million people in the Bay Area as of 2022. In the numbers below, we’ll be focusing on San Francisco proper, not the entire Bay Area. 

In San Francisco, the median monthly cost based on care option is:

• Adult Day Care Center: $1,955
• Assisted Living Facility: $6,718
• Home Health Aide: $7,701
• Homemaker Services: $7,000
• Semi-Private Room Nursing: $12,093
• Private Room Nursing: $13,889

San Diego, California

San Diego is California’s third largest metro area, with over 3.2 million people in the county as of the 2020 consensus. 

In San Diego, the median monthly cost based on care option is:

• Adult Day Care Center: $1,955
• Assisted Living Facility: $6,038
• Home Health Aide: $6,177
• Homemaker Services: $6,108
• Semi-Private Nursing: $10,402
• Private Nursing: $13,039