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The MSSP waiver is designed to help California seniors who are at risk of nursing facility placement, and who can and wish to remain living in their homes or in the community. The program achieves this objective by arranging assistance and managing a broad set of services outside of the seniors' homes or primary residences. Medical care is not covered under this waiver, but adult day care, home medications, and care management services are some of the covered benefits. In particular, this waiver is an important lifeline for seniors who are ready to return home after a stay in the hospital or nursing home for rehabilitation.
This program is not available statewide but is available in all counties except the following seven: Del Norte, Nevada, Plumas, San Benito, San Luis Obispo, Sierra, and Sutter counties. However, availability of the waiver program does not mean automatic enrollment. In some counties, there may be waiting lists. The program is structured to allow for approximately 12,000 concurrent participants.
The MSSP Waiver has age, geographic, functional and financial eligibility requirements. Applicants must be at least 65 years of age and live in (or willing to move to) one of the 48 California counties where the waiver is available. Functionally, applicants must require the level of care typically provided in a nursing home. The financial requirements for the waiver are the same as the financial requirements for aging assistance programs under Medi-Cal.
2018 Medi-Cal Income Limits
Despite seemingly rigid income guidelines, there is some flexibility to the income requirement. Individuals with countable monthly income of less than $1,235 per month are eligible. Couples can have monthly income up to $1,664. Persons with income exceeding that amount, but who have high medical or care expenses may still be eligible through the spend-down program in which they are required to pay a share-of-cost. Typically share of costs enrollees can retain about $600 per month for personal needs.
For individuals who are close to the income limit may be able to reduce their countable income by deducting the cost of supplemental health insurance. Given the complexity of the income rules for California residents, if you are concerned about how to qualify, consult with a Medi-Cal planning professional.
2018 Medi-Cal Asset Limits
A single applicant for Medi-Cal has an asset limit of $2,000. A married couple has an asset limit of $3,000, but only if both spouses are applying at the same time. When determining the value of the applicant's assets, many resources including their home and vehicle are not counted.
Under certain circumstances, Medi-Cal exempts the value of assets in a 401K account, and traditional or Roth individual retirement accounts (IRAs). Persons who have questions about how to navigate the retirement account exemption should contact a Medi-Cal specialist or their financial planner.
Given the high value of real estate in coastal California, it is worth mentioning that an applicant's home equity is only exempted up to $858,000. To be clear, Medicaid counts the portion of the home which is owned not the home’s total value. Any outstanding mortgage will be deducted. Medi-Cal will count the value of the applicant's primary residence that exceeds the maximum home value.
As with the income limits, persons who exceed these asset limits and even those who have some questions whether they exceed the limits should consider professional assistance for benefits planning to ensure they qualify.
The state of California intends this program to help individuals remain living at home and, therefore, the benefits of the program are selected to help them reach this goal. Program staff assess participants upon acceptance to make a final determination of benefits. They can include any of the following:
MSSP does include any services for seniors inside their home. However, seniors are permitted to use both the Multipurpose Senior Services Program and the In-Home Supportive Services (IHSS) at the same time. IHSS offers Medi-Cal recipients with personal care services in their home or in the home of a family or friend.
To receive services under MSSP is a two-staged process. First, one must be eligible for Medi-Cal (Medicaid) and then they must obtain a slot for services under the MSSP Waiver. Services are not entitlements and waiting list can exist. One can learn more, begin the application process or request to be put on a waiting list here or by calling 1-800-510-2020.
Over 30 community health nonprofit organizations administer MSSP at the local level throughout the state. Once a senior is Medi-Cal enrolled, then they can be referred to their local community service provider. For a list of the county-specific social service organizations, please review the contacts available here.