Understand how Medicaid covers nursing homes, assisted living, and home care for seniors and adults with disabilities. Learn about eligibility requirements, application process, and state-specific programs in 2026.
Covers 7.6 million long-term care recipients
Medicaid is the largest payer of long-term care in the United States, covering approximately 62% of all nursing home residents and funding home and community-based services for millions of seniors and adults with disabilities. Unlike Medicare, which provides limited post-hospital skilled nursing coverage, Medicaid pays for ongoing custodial care when individuals meet financial and medical eligibility requirements.
Medicaid long-term care is available to both seniors age 65 and older and younger adults with disabilities who meet program requirements. While commonly associated with older adults, Medicaid does not have an age requirement—eligibility is based on income, assets, and level of care needed regardless of age.
Each state administers its own Medicaid program within federal guidelines, which means coverage, eligibility requirements, and available services vary significantly by location. This guide covers federal Medicaid standards while noting where state programs differ.
Important: While this guide focuses on Medicaid for seniors age 65+, the same programs and eligibility criteria apply to younger adults with disabilities who require long-term care services. Medicaid eligibility is based on financial need and care requirements, not age.
Medicaid covers different long-term care services depending on the setting and state program. Coverage includes nursing home care, home care services, and limited assisted living services through specific waiver programs.
Medicaid pays 100% of costs in Medicaid-certified nursing homes once eligibility is established. This is the most comprehensive Medicaid long-term care benefit.
Cost to Resident: Medicaid recipients contribute most of their monthly income toward nursing home costs (keeping only $50-75 for personal needs). Medicaid pays the difference between the individual's contribution and the facility's Medicaid reimbursement rate.
HCBS waivers allow states to provide Medicaid-funded services in home and community settings as an alternative to nursing home care. These programs help individuals who qualify for nursing home level of care remain at home or in assisted living.
State Variation: HCBS waiver programs differ significantly by state. Some states have extensive programs serving thousands of individuals, while others have limited slots with waiting lists. Contact your state Medicaid office for specific program details.
Medicaid coverage for assisted living is limited and varies by state. Most states that offer assisted living waivers cover personal care services but not room and board.
Financial Consideration: Since Medicaid doesn't cover room and board in assisted living (typically 60-70% of total cost), residents need approximately $1,500-$2,500/month from Social Security or other income to cover these expenses.
Medicaid eligibility requires meeting both financial criteria (income and assets) and medical criteria (level of care needed). Requirements vary by state and program type.
| Program Type | Monthly Income Limit | Annual Income Limit | Notes |
|---|---|---|---|
| Nursing Home Medicaid | $2,982 | $35,784 | Applies in most states |
| HCBS Waivers | $2,982 | $35,784 | 300% of SSI Federal Benefit Rate |
| Community Medicaid | $1,304 - $1,732 | $15,648 - $20,784 | Varies by state |
| Assisted Living Waivers | Varies by state | Varies by state | Check your state program |
If income exceeds limits, you may still qualify through:
Single individuals applying for Medicaid can keep up to $2,000 in countable assets. Amounts over this limit must be spent down on care or other qualifying expenses before Medicaid eligibility.
When one spouse applies for nursing home Medicaid, the at-home spouse can keep up to $162,660 in countable assets. The applicant spouse is limited to $2,000.
Beyond financial eligibility, applicants must demonstrate need for nursing home level of care. This assessment evaluates functional abilities and medical needs.
Activities of Daily Living (ADLs):
Typically need assistance with 2-3+ ADLs:
Medical Needs:
Note: Level of care assessments are performed by state-designated assessors (often nurses or social workers) using standardized evaluation tools. The assessment typically occurs in the applicant's current residence or care facility.
Medicaid reviews all financial transactions for the 60 months (5 years) prior to application. Gifts, transfers, or sales below fair market value during this period can result in a penalty period of Medicaid ineligibility.
During the 10-month penalty period, the applicant must find alternative payment for nursing home care (private pay, family support, etc.).
Critical Warning: Do not make large gifts or transfer assets without consulting an elder law attorney who specializes in Medicaid planning. Improper transfers can result in lengthy periods of Medicaid ineligibility at precisely the time you need coverage most. Attorney fees for Medicaid planning ($2,000-$5,000) are far less than months of private-pay nursing home costs ($7,000-$12,000/month).
The Medicaid application process typically takes 45-90 days from submission to approval. Starting early and submitting complete documentation helps avoid delays.
Collect all necessary documents before starting your application. Incomplete applications are the primary cause of delays.
Personal Documents:
Financial Documents (5 years):
Income Verification:
Medical Documents:
Applications can be submitted through multiple channels depending on your state:
A state-designated assessor (nurse, social worker, or case manager) will evaluate level of care needs. The assessment usually takes 45-90 minutes and covers functional abilities, medical needs, cognitive status, and safety concerns. This can occur at home, in the hospital, or at the care facility.
Medicaid staff review all submitted financial documents, verify account balances, and investigate any transfers or gifts made in the past 60 months. They may request additional documentation or clarification during this process.
You'll receive written notification of approval or denial, typically within 45-90 days. Approved applications include:
Medicaid eligibility must be recertified annually. You'll need to submit updated financial documents and undergo periodic care assessments to maintain benefits.
Free assistance is available from:
Medicaid programs vary significantly by state. Select your state below to find specific eligibility requirements, application instructions, covered services, contact information for your state Medicaid office, and details about available HCBS waiver programs.
Medicaid covers 100% of nursing home costs in certified facilities for eligible individuals. It also covers home and community-based services (HCBS) through waiver programs, including in-home care, adult day services, and personal care services in assisted living (varies by state). Medicaid does not typically cover room and board in assisted living facilities.
For 2026, most states use an income limit of $2,982 per month for nursing home Medicaid and HCBS waivers. Some states have lower limits for community Medicaid ($1,304-$1,732 per month). Income limits vary by state and program type. Social Security, pensions, and other income count toward these limits.
Yes, your primary residence is typically exempt from Medicaid asset limits up to $713,000 in equity value (2026 limit in most states). However, Medicaid may place an estate recovery lien to recoup costs after death. If a spouse, disabled child, or certain other family members live in the home, additional protections may apply.
Medicaid applications typically take 45-90 days to process once submitted with complete documentation. Emergency applications for nursing home residents may be expedited to 30 days. Incomplete applications or complex financial situations can extend processing time to 4-6 months.
Medicaid does not cover room and board in assisted living facilities. However, many states offer Home and Community-Based Services (HCBS) waivers that cover personal care services, medication management, and other care services provided in assisted living. Residents must pay for room and board separately through personal funds or other resources.
Medicaid has a 5-year (60-month) look-back period that reviews all financial transactions and asset transfers made before applying. Gifts or sales below fair market value during this period can result in a penalty period of Medicaid ineligibility. The penalty period length depends on the total value transferred divided by the average monthly cost of nursing home care in your state.
Yes. Medicaid long-term care is available to adults of any age who meet financial and medical eligibility requirements. There is no minimum age requirement—young adults with disabilities, individuals with chronic illnesses, or anyone requiring nursing home level of care may qualify regardless of age. The same income limits, asset limits, and coverage benefits apply to younger adults and seniors.
If you receive Medicaid in a nursing home, you contribute most of your Social Security and other income toward your care costs, keeping only a small personal needs allowance ($50-$75 per month in most states). Medicaid pays the difference between your contribution and the full cost of care. If you're on a home care waiver, you typically keep more of your income for living expenses (rent, utilities, food) since Medicaid only covers care services, not room and board.
Medicaid treats life insurance differently based on type. Term life insurance (no cash value) is exempt and not counted. Whole life or universal life insurance with cash value is counted if the total face value exceeds $1,500. If policies exceed this limit, you may need to cash them out and spend down the proceeds before Medicaid eligibility, or convert them to irrevocable funeral trusts which are exempt regardless of value.
If your Medicaid application is denied, you have the right to appeal the decision. Appeals must be filed within 30-90 days of the denial notice (varies by state). The appeal process includes a fair hearing before an administrative law judge where you can present evidence and testimony. Common reasons for denial include excess income or assets, failure to meet medical criteria, or incomplete applications. Many denials can be successfully appealed, especially with help from an elder law attorney or benefits counselor.
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