Medi-Cal for long-term care: the 2026 asset-limit reinstatement, the 30-month look-back, and what families who planned during the no-limit window need to know.

Medi-Cal is California’s Medicaid^? program, administered by the Department of Health Care Services (DHCS^?). For families navigating long-term care, three Medi-Cal facts dominate planning: the 2024–2025 asset-limit pause and its 2026 reinstatement, California’s unique 30-month look-back^?, and the state’s probate^?-only estate recovery^?.

How Medi-Cal eligibility works in 2026

Three tests must be met:

• Medical eligibility. Functional need for long-term services and supports, demonstrated through a DHCS-contracted assessment for the appropriate care setting.
• Income.No specific income cap for nursing- facility Medi-Cal; instead, a share-of-cost model where nearly all of the applicant’s monthly income goes to the facility, minus the personal needs allowance ($35/month, one of the lowest in the country) and any community-spouse MMMNA^? allocation. Home and community-based waivers (HCBA, ALW, MSSP) have different income mechanics.
• Assets. $130,000 limit per individual applicant (2026), $65,000 added per additional household member. CSRA^? (community-spouse resource allowance) at the federal maximum: $162,660 in 2026. MMMNA $4,067/month (federal max for 2026).2

The 30-month look-back — California's unique window

Federal Medicaid uses a 60-month look-back for institutional eligibility. California has never adopted the federal 60-month period — the historic CA look-back was 30 months, and that is what DHCS is restoring for transfers on or after January 1, 2026.3

Practical implications:

• Transfers made before 1/1/2024: reviewable if within 30 months of an application, but most are now out of window.
• Transfers made 1/1/2024 through 12/31/2025: permanently excluded. Even after the asset limit returned in 2026, transfers during the no-limit window do not generate a penalty.
• Transfers made on or after 1/1/2026: reviewable for 30 months from application.

California’s penalty divisor (the Average Private Pay Rate, or APPR, used to convert a gifted amount into a penalty period) is approximately $11,300/month for 2026. A $100,000 gift on 1/15/2026 with a 2027 application produces ~8.8 months of penalty during which Medi-Cal won’t pay.

Probate-only estate recovery

California is one of the most narrowly-applied estate-recovery states in the country. After AB 1066, effective January 1, 2017, Medi-Cal estate recovery is limited to the probate estate only.4 Assets held in a revocable living trust^?, in joint tenancy with right of survivorship, or with a named beneficiary (retirement accounts, life insurance, TOD/POD designations) are not subject to recovery.

Practical implication: California families with a properly- funded revocable living trust have an estate-recovery profile much closer to zero than families in most states. This is material — in some states, estate recovery can claw back hundreds of thousands of dollars from a family home post-death. In CA, with the trust in place, it generally doesn’t.

Spousal protections and "Just Say No"

California recognizes spousal refusal^?under Medi-Cal regulations — sometimes called “Just Say No.” A community spouse may refuse to make assets or income available to the institutionalized spouse; DHCS must determine eligibility based on the institutionalized spouse’s individual resources.5The state can later seek contribution, but the institutionalized spouse receives coverage in the interim. This is a powerful, relatively uncommon tool nationally; in CA it’s well- understood and used by experienced elder-law attorneys.

IHSS — California's separate in-home care program

In-Home Supportive Services (IHSS^?) is a Medi-Cal-funded in-home care program but is administered separately from traditional Medi-Cal long-term care benefits. IHSS provides personal care, domestic services, and protective supervision for Medi-Cal-eligible Californians who would otherwise be at risk of out-of-home placement.

Key IHSS facts:

• Eligibility is Medi-Cal-linked but has its own functional assessment
• The recipient can hire their own provider — often a family member (excluding a legally responsible relative such as a spouse or parent of a minor)
• Provider wages set by county. 2026 minimum: $16.90/hour statewide, $23.00/hour in San Francisco County
• Average IHSS authorization: ~80 hours/month

IHSS is one of the country’s most expansive publicly-funded in-home care programs and is materially under-claimed by families who don’t know about it.

CalAIM Community Supports

California’s 1115 Medicaid demonstration waiver, CalAIM, allows Managed Care Plans to elect from 14 optional “Community Supports” that approximate HCBS^? benefits without full waiver enrollment.6 Supports include housing transition navigation, medically tailored meals, asthma remediation, sobering centers, day habilitation, and personal care/homemaker services for some populations.

Availability varies sharply by county and managed-care plan. Ask your parent’s Medi-Cal MCP specifically which Community Supports they offer.

What to do this quarter

• Pull bank statements going back 30 months (CA look-back).
• If transfers happened during 1/1/2024–12/31/2025, document them carefully; they’re excluded from look-back but the documentation matters if questioned.
• Confirm a revocable living trust is properly funded — the centerpiece of CA estate-recovery avoidance.
• Check whether your parent qualifies for IHSS even if they’re not in a facility setting.
• If a community-spouse situation, talk to a CA elder-law attorney about spousal refusal before doing anything.

For the broader federal Medicaid framework, see our Medicaid pillar. For Florida’s contrasting approach (60-month look-back, full estate recovery), see Florida Medicaid.