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Program Information Page 3

Non-Medical Out-of-Home Care (NMOHC) Payment
NMOHC is a payment supplement that boosts a person's monthly SSI check because they live in a licensed assisted living home rather than an apartment or house.
In California, if a person lives in a Residential Care Facility for the Elderly (RCFE), the state recognizes that costs are much higher than someone living independently. To help cover this, the person moves from the "Independent Living" rate to the "NMOHC" rate.
1. Confirm Financial Eligibility (The "Paper" Test)

Since NMOHC is part of the SSI program, you can verify the financial requirements now.

  • Income: For 2026, total "countable" monthly income must be less than $1,626.07.
  • Assets: As of January 1, 2026, asset limits are reinstated. An individual must have less than $2,000 in countable resources ($3,000 for a couple).
  • Note: One car and the primary home are usually excluded from this limit.
2. Verification with Social Security (The "Pre-Move" Call)

Visit a local Social Security office in person for a living arrangement interview to confirm NMOHC eligibility and the supplement amount.

  • Tell them the person plans to move into a licensed RCFE.
  • Ask for the new SSI payment calculation based on the 2026 NMOHC rate.
"Room and Board" and "Assisted Living" Payments
The MCP member is responsible for paying the RCFE the 'room and board' portion and the MCP is responsible for paying the RCFE the 'assisted living' portion.
For members eligible for SSI/SSP and the 2026 Non-Medical Out of Home Care payment (NMOHC), SSI/SSP is bumped up to $1,626.07. The member usually retains $182 for personal needs expenses and the RCFE receives the $1,444.07 balance as payment for "room and board". Also, members eligible for the NMOHC will pay at least $1,447.00 to the RCFE. Members who receive more than this amount can pay more for 'room and board' for a private room or to open up RCFEs in more expensive areas.
Members not eligible for the NMOHC will still have a 'room and board' obligation but the amount could be flexible depending on the RCFE and the assessed tiered level.
Members who cannot pay any room and board portion usually are not eligible for the CS since program requirements mandate a 'room and board' payment from the member (or their family).
Working with CalAIM is at the discretion of the RCFEs. Many RCFEs, especially in more expensive areas, most likely will not participate in CalAIM. Families looking to place members in expensive real estate areas should have the realistic expectation that CalAIM RCFEs might only be located in more affordable areas.
Share of Cost (SOC)
A Share of Cost (SOC) is like a monthly deductible for Medi-Cal. It's the amount of money you may have to pay each month towards medical-related services or supplies before your Medi-Cal coverage begins to pay.
This happens when your income is above the limit for free Medi-Cal but you still qualify for the program.
Members cannot apply for CalAIM with a SOC. It must be eliminated before becoming eligible to apply for CalAIM.
Read more about eliminating share of cost at the California Advocates for Nursing Home Reform (CANHR).
Eliminating Medi-Cal Share of Cost: The Key to CalAIM

If you have Medi-Cal with a Share of Cost, you may be missing out on life-changing benefits. Programs like CalAIM (which provides care coordination and placement in residential care homes) generally require members to have Full-Scope, $0 Share of Cost Medi-Cal.

For many seniors and disabled individuals, a monthly income above $1,856 (the 2026 limit) triggers a high Share of Cost. However, California’s 250% Working Disabled Program (WDP) offers a legal way to eliminate that cost and keep more of your money.

How the 250% Working Disabled Program Works
  • Higher income allowed: up to $3,260 per month with a $0 monthly premium and $0 Share of Cost.
  • Broad definition of “work”: no traditional full-time job required. “Working” can include part-time tasks like pet sitting, consulting for a neighbor, or even recycling. No minimum hours required.
  • Income protection: most disability-related income (like SSDI or private disability) is not counted toward the limit. Even if SSDI converted to Social Security Retirement, it may still be exempt.
  • CalAIM ready: once Share of Cost is $0, you can qualify for CalAIM services, including Enhanced Care Management and Community Supports for care home placement.
Additional SOC Reduction Strategies (County Eligibility Process)
1. The "Excess Income" Room and Board Adjustment
Under California law (and often reflected in RCFE admission agreements), there is a distinction between what an SSI recipient pays and what a private-pay or high-income resident pays.
  • The SSI Rate Cap: for residents on SSI, room and board is strictly capped (around $1,444.07 for 2026).
  • The Non-SSI Exception: if a member has income other than SSI, the facility may charge the basic room and board amount plus additional contract-based charges.
  • The Strategy: increasing room and board obligations on the admission agreement (minus the $182 personal needs allowance) may reduce countable income.
2. The "Medical Expense" Spend-Down (Paperwork Fix)
When board-and-care deduction is unavailable because CalAIM is paying for care, a spend-down strategy can still reduce SOC by documenting incurred medical or remedial expenses.
  • Remedial care expenses: the RCFE amount above standard room and board may be treated as remedial care expense.
  • How to report: submit RCFE invoices to County Social Services (DPSS) as incurred medical expenses. Member out-of-pocket payments count toward SOC.
3. Purchase Supplemental Insurance (Often the Cleanest Fix)
Lower gross countable income before SOC calculation by documenting deductible premiums and insurance deductions.
  • Dental/Vision/Health premiums: monthly premiums are deductible by the county.
  • Medicare Part B/D: ensure all premiums are captured by the county eligibility worker.
Summary of Where to Go
Take the following to the County Social Services Eligibility Worker (not the health plan):
  • Revised admission agreement: showing higher room and board obligation up to available income.
  • Medical receipts: out-of-pocket costs (incontinence supplies, OTC meds, transportation, etc.).
  • Insurance proof: monthly supplemental premium documentation.
Crucial note: once county deductions are entered and the case reflects zero SOC, the CalAIM managed care plan typically sees eligibility updates in about 24-48 hours.
Who to Contact for Help
1. HICAP (Health Insurance Counseling & Advocacy Program)
Free, unbiased counseling on Medicare and Medi-Cal. Experts at the Working Disabled Program.
2. Health Consumer Alliance (HCA)
Free legal assistance for Californians struggling with Medi-Cal eligibility or high Share of Cost.
3. Your Local County Social Services (DPSS)
Contact your local county eligibility worker and ask for an “evaluation for the 250% Working Disabled Program.”
Online Portal: BenefitsCal.com
Benefitscal.com
A one stop shop to apply and review Medi-Cal benefits including possible share of cost information and to add for the member an authorized representative/power of attorney.
Visit www.benefitscal.com for current SOC verification and more information.
Individual Service Plan (ISP)
An Individual Service Plan (ISP) is a comprehensive assessment conducted by the Managed Care Plan's (MCP) clinical team to determine the member's care needs and to approve them for the program. The ISP assessment is a critical step for getting the MCP's authorization. The ISP is either done virtually (Health Net) or in-person (Kaiser) by a Connections' MSW/RN to administer a tool to determine level of care (the amount the MCP will pay for the 'assisted living' portion). For Health Net, the tiered level is determined by Connections. For Kaiser, the tiered level is determined by Kaiser.
CalAIM Turnaround Time
For Health Net (5-7 business days):
  1. We compile all the required documents, have a RN do a virtual ISP visit with appropriate party.
  2. We determine the tiered rate.
  3. We recommend RCFEs to the family (in many cases, the family already knows the RCFE they would like for their relative).
  4. We submit the authorization request and receive the determination (approval or denial) within 5-7 business days.
For Kaiser (2-4 weeks):
  1. Compile required documents & Request Authorization.
  2. Receive authorization determination.
  3. If approved, send RN (or MSW with RN sign off) to do in-person visit with ISP tool.
  4. Send ISP tool to Kaiser for tier level.
  5. Receive tier level and recommend RCFEs to family.
  6. Once RCFE is selected sent RCFE to Kaiser for contracting and when RCFE receives Kaiser contract member can move into the RCFE.
Next Steps: The Application
The next section is for filling out the CS Summary Form. This is the core of your application.
Based on the selections you make in the summary form (like the pathway), a personalized list of other required documents will be generated for you to upload.
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