Medicare vs Medicaid and Medi-Cal for long-term care
Medicare is federal health insurance that covers short-term skilled nursing and home health care but not long-term custodial care; Medicaid, called Medi-Cal in California, is the public program that can pay for long-term care, including nursing homes, for people who meet income and asset rules.[1][2][3] In California, Medi-Cal also funds assisted living services in 15 counties through the Assisted Living Waiver.[4]
Side-by-side comparison
| Care | Medicare | Medicaid / Medi-Cal |
|---|---|---|
| Long-term custodial care | Not covered[1] | May be covered if eligible[1] |
| Skilled nursing facility | Up to 100 days per benefit period after a 3-day inpatient stay; $217/day for days 21–100 in 2026[2] | Long-term nursing home care for eligible people[3] |
| Assisted living | Not covered[3] | Some services, depending on the state; not room and board[3][5] |
| Home health | Covered for eligible homebound people[6] | Home and community-based services; state programs vary[7] |
| Respite | Up to 5 days for hospice patients[8] | May help pay[8] |
Medicare’s skilled nursing benefit
Part A covers SNF care for a limited time when a person has a qualifying inpatient hospital stay of at least three consecutive days, enters a Medicare-certified SNF generally within 30 days, and needs daily skilled care. In 2026, days 1–20 cost $0 after the $1,736 Part A deductible, days 21–100 cost $217 per day, and the patient pays all costs after day 100.[2] Medicare also covers part-time home health care with no charge for covered services if the person is homebound and eligible.[6]
Medicaid and long-term care
Medicare.gov notes that people who are not eligible for long-term care under Medicare may be eligible through Medicaid if they meet their state’s requirements.[1] Many states offer home and community-based services, adult foster care and personal care services through Medicaid, and some pay family caregivers.[7] NCAL reports that 17% of assisted living residents rely on Medicaid for daily services.[5]
Medi-Cal in California
Asset limit (from January 1, 2026)
Medi-Cal began counting assets again on January 1, 2026, for people who are 65 or older, have a disability or live in a nursing home, among others. Through June 30, 2027, the limit is $130,000 for one person plus $65,000 for each additional household member (up to 10). Starting July 1, 2027, the limit becomes $21,000 for one person and $31,000 for two, plus $1,550 for each additional person.[9]
Assisted Living Waiver
The Medi-Cal Assisted Living Waiver (ALW) is a home and community-based services waiver available in 15 counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma. The current waiver term runs March 1, 2024, through February 28, 2029.[4] Participants must be 21 or older, have full-scope Medi-Cal with zero share of cost, have care needs equal to Medi-Cal nursing facility residents, and be able to live safely in an assisted living setting or publicly subsidized housing. Participants pay their own room and board.[4]
Frequently asked questions
Does Medicare pay for nursing home care?
Only short-term skilled nursing: up to 100 days per benefit period after a qualifying 3-day inpatient hospital stay. Medicare does not pay for long-term custodial nursing home care.[2][1]
What is Medi-Cal's asset limit in 2026?
From January 1, 2026, through June 30, 2027, the Medi-Cal asset limit is $130,000 for one person plus $65,000 for each additional household member; it drops to $21,000 for one person on July 1, 2027.[9]
Is the Assisted Living Waiver available in San Diego?
Yes. San Diego is one of the 15 California counties where the Medi-Cal Assisted Living Waiver operates.[4]
See also
References
Web pages accessed September 28, 2026 unless noted. See sources and methodology.
- ^ "Long-term care (coverage page)". Medicare.gov, Centers for Medicare & Medicaid Services.
- ^ "Skilled nursing facility care (coverage page; 2026 cost-sharing amounts)". Medicare.gov, Centers for Medicare & Medicaid Services. 2026 amounts.
- ^ "Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care". National Institute on Aging (NIH).
- ^ "Assisted Living Waiver". California Department of Health Care Services.
- ^ "Assisted Living Facts and Figures". National Center for Assisted Living (NCAL/AHCA).
- ^ "Home health services (coverage page)". Medicare.gov, Centers for Medicare & Medicaid Services.
- ^ "Paying for Long-Term Care". National Institute on Aging (NIH).
- ^ "What Is Respite Care?". National Institute on Aging (NIH).
- ^ "Asset Limit Frequently Asked Questions (Medi-Cal)". California Department of Health Care Services. Limits effective January 1, 2026.