DraftCalifornia Department of Health Care ServicesPolicy N/A

Reinstate Medi-Cal Asset Limit (Proposed Trailer Bill Amendments)

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Proposed amendments to reinstate or set resource limits for non‑MAGI Medi‑Cal eligibility, require federal approvals and systems readiness before implementation, mandate quarterly reporting on eligibility losses due to asset limits, and expand state payment of Medicare premiums/deductibles/coinsurance including pursuing a Medicare Part A buy‑in; affects counties, DHCS systems, and non‑MAGI beneficiaries.

Policy Summary

PayerCalifornia Department of Health Care Services

PolicyReinstate Medi-Cal Asset Limit (Proposed Trailer Bill Amendments)

Policy CodePolicy N/A

Change TypeAdded resource limitsMedicare premium assistancereporting

Effective DateJan 1, 2027

Next Review DateN/A

Key ActionCounties must determine Medicare low‑income eligibility categories and enroll eligible applicants/beneficiaries while DHCS pursues federal approvals and a Medicare Part A buy‑in.

SourceLink

POLICY UPDATE CHANGES

Department shall seek federal approval to implement a disregard of $130,000 in nonexempt property for a one‑member case and $65,000 for each additional household member (up to 10) with implementation not before Jan 1, 2026, conditioned on systems programming and written notification to Department of Finance.

Alternate language establishes resource limits of $2,000 for one‑member households, $3,000 for two‑member households, and $150 per additional member (up to 10), operative no sooner than Jan 1, 2027 with application at first annual redetermination for current beneficiaries.

Department must publish quarterly data on the number of Medi‑Cal enrollees who lost eligibility due to the asset limit and consult stakeholders on data elements including reasons for termination.

Provisions to pay Medicare premiums, deductibles, and coinsurance for qualified Medicare beneficiaries whose income and resources meet specified limits, and to enter into a Medicare Part A buy‑in agreement, with varying operative and repeal dates in different sections.

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DraftCalifornia Department of Health Care ServicesPolicy N/A

Reinstate Medi-Cal Asset Limit (Proposed Trailer Bill Amendments)

Customize your policy alerts

Sign up for all California Department of Health Care Services policy alerts

Know when California Department of Health Care Services releases new policies or updates existing guidance.

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Policy Summary

PayerCalifornia Department of Health Care Services

PolicyReinstate Medi-Cal Asset Limit (Proposed Trailer Bill Amendments)

Policy CodePolicy N/A

Change TypeAdded resource limitsMedicare premium assistancereporting

Effective DateJan 1, 2027

Next Review DateN/A

Key ActionCounties must determine Medicare low‑income eligibility categories and enroll eligible applicants/beneficiaries while DHCS pursues federal approvals and a Medicare Part A buy‑in.

SourceLink

POLICY UPDATE CHANGES

Department must publish quarterly data on the number of Medi‑Cal enrollees who lost eligibility due to the asset limit and consult stakeholders on data elements including reasons for termination.

Medicare Cost Sharing and Eligibility Coverage Criteria

Coverage and implementation criteria

Coverage and implementation conditions for state payment of Medicare cost sharing and related eligibility thresholds are provided below. Conditions include income/resource limits, spend‑down handling, county enrollment responsibilities, and prerequisites for implementation.

State payment of Medicare premiums, deductibles, and coinsurance is provided to qualified beneficiaries enrolled in Medicare to the extent required by federal law

ALL of the following

ONE of
- Income does not exceed the federal poverty level and resources do not exceed the amount specified in subdivision (a) of Section 14005.62 (per one draft)
- Income does not exceed the federal poverty level and resources do not exceed 300% of the SSI standard (plus CPI adjustment) as specified in Section 14005.11 (alternate draft)

ALL of the following

For beneficiaries enrolled as of the operative date, the income/resource rules shall apply beginning with the beneficiary's first annual redetermination on or after the operative date (per alternate draft)

ALL of the following

If a Medi‑Cal beneficiary has a spend down of excess income but is ineligible for assistance under the primary provision, or ineligible for any other federally funded assistance for Medicare Part B premiums, the department shall pay the beneficiary's Medicare Part B premium in the month following each month that the beneficiary's spend down has been met

ALL of the following

Department shall also pay applicable additional premiums, deductibles, and coinsurance for drug coverage extended to qualified beneficiaries; deductible payments may be covered by providing the same drug coverage as offered to categorically needy recipients

ALL of the following

When a county is informed that an applicant or beneficiary is eligible for Medicare, the county shall determine eligibility for the Qualified Medicare Beneficiary, Specified Low‑Income Medicare Beneficiary, or Qualifying Individual programs and enroll the individual in the appropriate program

ALL of the following

The department shall enter into a Medicare Part A buy‑in agreement by submitting a state plan amendment to CMS with a proposed effective date
Implementation of coverage provisions is conditioned on federal approval and is to be carried out only to the extent consistent with federal law and available federal financial participation; operative timing is subject to systems programming readiness and any specified operative/repeal dates in the enacted language

ALL of the following

Department to publish quarterly data on the number of Medi‑Cal enrollees who lost eligibility due to the asset limit and to consult stakeholders on data elements (reporting requirement tied to asset limit provisions)

ALL of the following

ONE of
- Certain draft language conditions implementation not before Jan 1, 2026 with a repeal date (where specified) and subject to systems programming and written notification to the Department of Finance (per one draft)
- Alternate draft establishes operative date no sooner than Jan 1, 2027 with application beginning at first annual redetermination for current beneficiaries (per alternate draft)

Resource Limit Parameters and Alternate Drafts

Resource limits (alternate draft) — Section 14005.62 (alternate language)

Resource limit — one‑member household$2,000 in nonexempt property

Resource limit — two‑member household$3,000 in nonexempt property

Resource limit — additional household members$150 in nonexempt property for each additional member (up to 10 members)

Implementation conditionEffective no sooner than January 1, 2027 and only after systems programming is complete and communicated in writing to Department of Finance

Application to current beneficiariesFor beneficiaries enrolled as of the operative date, limits apply beginning with the beneficiary's first annual redetermination on or after the operative date

Disregard proposal (alternate draft) — Section 14005.62 (original high‑disregard language)

County Enrollment Obligations and Medicare Part A Buy-In Actions

Documentation Required

County must determine Medicare eligibility category and enroll; Department to pursue Medicare Part A buy‑in

When a county is notified that an applicant or beneficiary is eligible for Medicare, the county must determine whether the individual qualifies for the Qualified Medicare Beneficiary (QMB), Specified Low‑Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI) program and enroll the person in the appropriate program. Separately, the Department will seek to enter into a Medicare Part A buy‑in agreement (subject to federal approvals and availability of federal financial participation) by submitting a state plan amendment with a proposed effective date; implementation timing depends on systems readiness and required federal approvals.

County responsibility: determine eligibility for QMB, SLMB, or QI and enroll eligible applicants/beneficiaries in the appropriate program (chunks 6 and 11).
Department responsibility: submit a state plan amendment to enter into a Medicare Part A buy‑in agreement; effective date tied to Jan 1, 2025 or later based on systems programming, and implementation only to the extent federal approvals and FFP are available (chunks 6 and 11).
Timing/conditions: Medicare Part A buy‑in effectiveness is conditioned on the department communicating systems readiness to the Department of Finance; implementation only if necessary federal approvals and federal financial participation are obtained (chunks 6 and 11).

Key Definitions: Non‑MAGI Populations and Part A Buy‑In

Applicant or beneficiary whose eligibility is not determined using MAGI — definition and scope

Definition — Non‑MAGI populationsApplicants or beneficiaries whose eligibility is not determined using MAGI‑based financial methods as specified in 42 U.S.C. §1396a(e)(14)

Scope — affected eligibility rulesSubject to resource limits or disregards established for non‑MAGI cases (e.g., the $130,000/$65,000 disregard or the $2,000/$3,000/$150 resource limits)

Implementation conditionAny limits or disregards for non‑MAGI populations are implemented only after systems programming and required federal approvals or notifications

Medicare Part A buy‑in agreement — definition and implementation

Definition — Medicare Part A buy‑in agreementAn agreement authorized by 42 U.S.C. §1395v under which the state pays Medicare Part A premiums for qualified individuals enrolled in both Medicare and Medi‑Cal