Board and Care Medi-Cal Deduction - Unavailable Income

"Board & Care Medi–Cal Deduction"—Unavailable Income

Does Medi–Cal Pay for Residential Care/Assisted Living?

Medi–Cal does not pay directly for care in Residential Care or Assisted Living, except for an experimental program—Assisted Living Waiver Pilot Project—in the counties of Los Angeles, Sacramento and San Joaquin, starting in January 2006. (Refer to Assisted Living Waiver Pilot Project (ALWPP) Fact Sheet.)

However, Medi–Cal can be very useful to pay for doctors, home health, medical equipment, and uncovered medications.

Can a Resident Receive Medi–Cal Benefits in a Residential Care/Assisted Living?

Yes. Persons on SSI/SSP or on the Aged and Disabled Federal Poverty Level Program (A & D FPL) are eligible for Medi–Cal benefits. In addition, there is a special "board and care deduction" (Title 22 Section 50515(a)(3)) that might make someone with countable income over $1081—the A & D FPL’s no share of cost rate—eligible for Medi–Cal. (Refer to A & D FPL Fact Sheet.)

How Does the "Board and Care" Deduction Work?

If someone living in the community had countable income over $1081, the individual could be eligible for Medi–Cal but would have a large share of cost, i.e., $1081 – $600 = $481. In this situation, the individual would have to pay or agree to pay $481 each month toward monthly medical expenses before Medi–Cal would begin paying.

However, if the individual lived in a residential care/assisted living facility, payments to the residential care facility above the monthly maintenance of need level (i.e. $600) are deemed "unavailable" in determining the share of cost. The result is that the individual might have no or only a small share of cost because all of their income is being used to meet residential care/assisted living expenses.

Example: An individual with monthly income of $1800 and who pays the facility $1800 would have no share of cost because the person would be able to retain the $600 monthly maintenance of need and the remaining $1200 would be considered unavailable since the facility charge is $1800 per month. If the facility only charged $1750 per month, then the share of cost would be $30, (i.e., $50 – $20 any income deduction).

What Are the Advantages of the "Board and Care" Deduction?

The principal advantage is that an individual might be able to remain in the residential care/assisted living facility especially when their assets have been spent down to the $2,000 Medi–Cal resource limit, and obtain certain Medi–Cal benefits such as paying for uncovered medical expenses, coverage of medical health and drug insurance premiums, and so forth.

This might also prevent premature placement in a skilled nursing facility.

What Are the Disadvantages of the "Board and Care" Deduction?

The major downside to this strategy is that at the end of each month the individual is left with limited discretionary income, except for the $20 any income deduction.

This lack of discretionary income can be handled if family or friends are able to meet the needs for clothing and other personal items. In situations where the residential care/assisted living rate is higher than the resident’s income, it is also possible for families to pay the difference in the monthly rate as long as the payment goes directly to the care provider.

Legal Citation

California Code of Regulations, Title 22 Section 50515(a) Income which is not available to meet current needs of a person or family shall not be considered in determining that person’s or family’s share of cost. Unavailable income includes, but is not limited to, the following: (3) That portion of the monthly income of a medically needy person residing in a licensed board and care facility which is both of the following: (A) Paid to the facility for residential care and support. (B) In excess of the appropriate maintenance need level as determined in accordance with Section 50603.


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