Changes to Medi-Cal in 2026

The rules of Medi-Cal changed on January 1, 2026. For the last couple of years, many people didn’t have to worry about an “asset test.” In plain English, that meant the amount you had in savings and investments often didn’t keep you from qualifying, as long as you truly needed the medical care.

Now the asset test is back for 2026. For many people (especially older adults and those who need long-term care), Medi-Cal once again looks at what you own.

What are the Changes to Medi-Cal in 2026 Asset Limits?

In 2026, a single person who has a medical necessity can often qualify for Medi-Cal if they have $130,000 or less in countable liquid assets (think: money in bank accounts, investment accounts, and similar resources).

Your primary residence is commonly treated differently than cash/investments and is often exempt (but the details matter).

If you have more than $130,000, you may need “spend down” planning to qualify — the right kind of planning, done the right way, before a crisis.

For a married couple, the common guideline is $195,000 in countable liquid assets between them. If you’re above that amount, you may need spend down planning to qualify.

And if you own rental properties or additional real estate, that can create an “over-property” problem — meaning you may not qualify without planning ahead.

You may be asking yourself, “Why should I care about Medi-Cal?” The main reason is the cost of a skilled nursing facility. A nursing home in California can cost around $13,656 per month (and in many areas it can be even higher). And every year, those costs tend to rise. That kind of monthly bill will wipe out most families’ life savings and hard-earned assets. In real life, there are only four ways families end up paying for a nursing home:

1) Write a check every month

This is private pay. It drains savings quickly — and it usually doesn’t take long before a family realizes, “We can’t keep doing this.”

2) Long-Term Care Insurance

Long-term care insurance can help for some people, but here’s what I see all the time:

• You usually can’t get a policy once your health has already declined.

• You have to buy it while you’re healthy, then pay premiums for years.

• When families finally need it, they’re often surprised by the limits, exclusions, and the “waiting period” (sometimes called an elimination period) before benefits really start.

  
  

3) Medicare

Medicare is the health insurance most people get when they start collecting Social Security. It can pay for a limited stay in a skilled nursing facility, usually when the goal is rehabilitation and you continue to improve.

For example, if you go to the hospital with a broken hip and then transfer to a skilled nursing facility for rehab, Medicare may pay for a period of time (often up to 100 days under the right circumstances). But Medicare is not designed to pay for long-term custodial nursing home care. If you plateau or decline, Medicare typically stops paying — and then you’re back to two choices: private pay or Medi-Cal.

4) Medi-Cal

Medi-Cal can pay for long-term nursing home care and many prescription drugs — but you must qualify. And with the 2026 rule changes, that qualification is now harder for families who have built up savings, investment accounts, or multiple properties.

You also need to understand Medi-Cal Estate Recovery. Medi-Cal can seek repayment after death in certain cases. Under today’s rules, for people who die on or after January 1, 2017, recovery is generally limited to assets that go through probate, and the types of services subject to recovery are more limited than they used to be. That’s why planning matters — both for qualifying and for protecting what you’ve built.

What is Medi-Cal planning?

Medi-Cal planning means preparing your estate before a crisis so you can qualify for Medi-Cal if long-term care is needed — and so your hard-earned assets are used to take care of your spouse and children, not unnecessarily spent down on a nursing home bill.

The Medi-Cal rule changes for 2026 have brought back the need to plan ahead, especially for people with rental properties or investment accounts. It is important to have your situation reviewed by an elder law attorney who knows the Medi-Cal rules and also understands living trust planning.

3 warning signs you need Medi-Cal planning now

• You’re over (or close to) the 2026 asset limits — roughly $130,000 for a single person or $195,000 for a married couple — and most of it is in bank/investment accounts. (dhcs.ca.gov)

• You own rental property or extra real estate (anything beyond the primary residence can create an “over-property” problem if long-term care is needed).

• A health event is likely in the next 12–24 months — a recent diagnosis, increasing falls, memory decline, caregiver burnout, or a doctor mentioning assisted living or skilled nursing.

  
  

If any of these sound familiar, the best time to plan is before the emergency. I’m Russell C. Miller, Esq., the author of this blog, and I help families with these issues. I’m available by appointment. Just Call (559) 625-4205 for a free consultation. Go to www.visaliaestateplanning.com to learn more about Russell.