Medicaid long-term care is a set of Medicaid programs that help eligible older adults pay for ongoing medical and personal care, such as nursing home care, personal care assistance, home-based support, and some home modifications. These services can be expensive, and Medicaid provides financial relief for people who meet state-specific income, asset, and medical requirements. Because Medicaid rules vary widely, your loved one’s eligibility will depend on where they live, their financial situation, and the level of care they need. This guide explains who may qualify for Medicaid long-term care, what it covers, and how to apply.
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Medicaid long-term care works by offering different programs that help older adults receive the support they need based on their health, daily limitations, and living situation. Depending on your loved one’s needs, Medicaid may cover care in a nursing home, services at home, or support in a community setting. Each state decides which programs are available and what they include, so families often need to compare options to understand the best fit. Knowing how these programs work can help you make informed decisions and plan the next steps in your loved one’s care.
Denise Lettau, J.D., an attorney and former wealth management advisor, notes that her clients often begin with the question “How can I stay in my house?” A critical related question, she says, is “How much assistance will I need?”
Also, she says, our idea of what Medicaid is for may need some updating.
“Medicaid was created for people with low incomes, but it’s increasingly needed by people who have what could be considered middle class incomes.”
States offer several pathways for people who qualify for long-term care Medicaid. Coverage, benefits, and eligibility criteria differ, but three categories are available in most states.
HCBS waivers allow people who meet a nursing home level of care to receive support at home or in a community setting instead of moving to a facility. Covered services may include personal care assistance, home-delivered meals, transportation, and home modifications. States have different waiver programs, and many have enrollment caps, which can lead to waitlists.
“Most people start with needing help with meals,” Lettau says. “Then they move on to needing more help at home, even if it’s only a few hours each day.”
ABD Medicaid provides medical and personal care services to people who meet disability criteria or are age 65 or older. States set their own income and asset limits for this program. Depending on the state, ABD Medicaid may cover personal care services at home, adult day programs, or limited support in certain community settings. Exact benefits differ by state.
This program pays for care in a Medicaid-certified nursing home for people who need 24-hour supervision and medical support. To qualify, your loved one must meet the state’s nursing facility level of care criteria, showing they cannot safely live independently. Medicaid typically covers room and board, medical care, and personal care in the facility. Because not all nursing homes accept Medicaid, availability can be limited.
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The services covered by each state’s Medicaid long-term care programs vary. Some of the different services you can expect to be covered include:
According to Lettau, the biggest shock for most people is that Medicare doesn’t cover long-term care.
“Medicare covers rehabilitation in a skilled nursing facility for up to 100 days, which is often confused with long-term care. Additionally, Medicare does not cover adult diapers, homemaker services, or respite care — a few examples of expenses that Medicaid will cover for eligible seniors,” she explains.
Medicaid is designed to help low-income individuals pay for their health care needs. To qualify for Medicaid long-term care, your loved one must meet medical requirements (such as needing the level of care that a nursing home can provide) and financial requirements (income and asset limits). Because Medicaid is administered at the state level, specific eligibility requirements for long-term care coverage vary.
Generally, a person must need the same level of support provided in a nursing home, even if they are applying for services at home. States determine medical need by assessing how well someone performs ADLs such as bathing, dressing, eating, using the toilet, and moving safely. People must also be aged 65 or older or meet disability criteria.
There are also financial criteria for people who apply for Medicaid. To qualify, a person’s assets and income must not exceed specific limits dictated by their state.
Income limits for long-term care Medicaid often fall between roughly $994 and $2,982 per month for an individual, though exact amounts differ.[01]
Your loved one must have limited countable assets to qualify for Medicaid long-term care. This limit is $2,000 for a single person in most states ($3,000 to $4,000 for couples).[01] However, not all assets count toward this limit. Here are some assets that do not generally count toward the asset limit for Medicaid long-term care:
In many cases, older adults may have income above the Medicaid threshold yet still find themselves in need of public assistance due to high long-term care costs. Several states address this through a Medicaid “spend down,” which allows individuals to reduce their countable income by subtracting allowable medical expenses.[02] By lowering their countable income, these individuals may become eligible for Medicaid long-term care. This may also be referred to as the medically needy pathway to Medicaid eligibility.
Lettau says that the Medicaid spend down and look-back period are common sources of confusion for seniors and their caregivers.
“What most folks do before they seek professional help is get a lot of bad advice from friends and family. They transfer money to their kids because someone mentioned that they can’t have too many assets.”
But many people don’t think about, or don’t know about, the five-year look-back period, she says.
“During the look-back period, the applicant’s expenditures have to be for qualifying products and services,” Lettau cautions. “Modifying your house to make it more accessible, or buying needed medical equipment, are acceptable ways to ‘spend down.’”
Engaging a professional during the Medicaid planning stage can save you time, frustration, and money down the road.
“A professional might charge $7,000 to $10,000 to develop a long-term care plan, but that plan will save you $40,000 in the long run,” Lettau says.
For example, a single person might receive $2,000 each month in income but live in a state that requires Medicaid recipients to have a monthly income below $1,200. If their state permits spending down, they could qualify for Medicaid by spending $785 each month on medical expenses, including prescription drugs, doctor copays, and long-term care costs.
Spend-down periods vary by state and may be anywhere from one month to six months in length. After an individual spends down to their state’s medically needy income limit, they’re eligible for Medicaid for the rest of the period (if they meet all other criteria). It’s important to track and document all medical expenses if your loved one is considering a Medicaid spend down.
If your family member is planning to apply for Medicaid, it’s a good idea to contact their state’s Medicaid agency and an estate planning attorney for more details.
“The planning is where you need a professional,” Lettau says. “You can apply on your own. But the planning is the hardest part.”
Lettau says that the least expensive place to start care planning is at your local Aging and Disability Resource Center or Area Agency on Aging. You can use the Administration for Community Living’s Eldercare Locator to find these resources in your community. Geriatric care managers can also help.
“These are good resources and they’ll get you started. They won’t develop legal documents, but they may know enough about your situation to be strategic with your assets, and they are good places to start,” she says.
Yes, a person can have private long-term care insurance and Medicaid. In fact, many states offer partnerships for long-term care that combine public assistance with private insurance. That said, in most states, Medicaid will only cover costs that aren’t paid by the private insurance. It’s also important to note that certain types of long-term care insurance policies may affect eligibility for Medicaid, as they may be included in an individual’s income and asset calculation.
“I tell everyone to start thinking about long-term care insurance when they’re in their 40s. Rates are the best they’ll be in your 40s, and if you wait until age 60, you may not be able to get coverage,” she cautions.
Medicaid typically pays for most long-term care costs for eligible individuals, including nursing home care, home health services, and personal care. However, recipients must contribute most of their monthly income toward care, except for a small personal needs allowance and certain deductions.
Medicaid covers approved long-term care services, but recipients must contribute a portion of their monthly income toward their care. This amount is called patient liability and is like a copayment. States allow certain deductions from income, including a small personal needs allowance and possible deductions for a spouse or dependent. Allowance amounts vary by state. After allowable deductions, the remaining income usually goes toward care.
So, while Medicaid will generally cover all the costs of long-term care, the coverage is not free, as patients are still required to pay some percentage of their income.
Lettau says that patient liability is a confusing concept for most people.
“The greatest misconception that I see is that people think they’ll continue getting their Social Security payments and that Medicaid will pay for the nursing home, for example. But that’s not how it works. Typically, the Social Security benefits go to the nursing home, and you’ll get a monthly personal needs allowance of less than $100.”
Additionally, most people need to wait for Medicaid coverage to start.
“You typically pay for the first month yourself,” Lettau says. “And you still have copays. Medicaid keeps you from absolute poverty, but it won’t pay for everything.”
There is no set limit on how long a person can receive long-term care covered by Medicaid. If your loved one qualifies for a Medicaid long-term care program, they will continue receiving coverage. However, eligibility must be maintained over time, which means individuals must continue to meet medical and financial requirements.[02]
Medicaid will periodically reassess people to ensure they still qualify for the program. So, any changes in income, assets, or care needs could impact eligibility for Medicaid coverage.
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Applying for Medicaid long-term care can be a complex and time-consuming process. Let’s look at some of the main steps.
Medicaid offers various long-term care programs, such as Nursing Home Medicaid, ABD Medicaid, and HCBS waivers. Review the services available in your loved one’s state and evaluate their care needs to decide which program best suits them.
To qualify for Medicaid long-term care, your loved one must meet medical and financial requirements. Assess their income, assets, and care needs. If you’re unsure, consult a Medicaid planner or elder law attorney for assistance.
The exact process and types of documentation individuals need depend on the state, but these are the general requirements:
Each state has its own Medicaid application form. In most cases, the most hassle-free option will be to apply online, but applications can also be submitted by mail or in person through the state’s Medicaid office or local department of health and human services. Complete all fields carefully and include all required documents to avoid delays.
In most cases, Medicaid must send out determination letters within 45 days. That said, if the applicant is applying for long-term care based on a disability, this timeframe is increased to 90 days. Respond quickly to any requests for additional information.
If your loved one is eligible for Medicaid long-term care and needs a nursing home level of care, Medicaid will only cover care when it’s provided in a Medicaid-certified nursing home. Unfortunately, not all nursing homes accept Medicaid, so it’s crucial to ensure the facility your loved one chooses participates in the program. Even if your loved one qualifies for Medicaid long-term care, they may not be able to immediately move into a nursing facility, as availability in Medicaid-certified facilities can be difficult to find.
Once approved for a program, secure a spot in a Medicaid-eligible care facility or arrange for home- and community-based services for your loved one. Keep in mind that in many states, Medicaid-eligible facilities have long waitlists due to high demand. While in theory all qualifying individuals are entitled to Medicaid long-term care, it may not be possible to receive care immediately.
If you’re looking for guidance finding care for an aging loved one, A Place for Mom’s Senior Living Advisors can help you find options that match your loved one’s needs and budget. While A Place for Mom doesn’t refer families who are using public pay options like Medicaid to cover senior living services, an advisor can recommend a short-term stay at an assisted living facility or temporary home care to help you through a Medicaid spend-down period.
States review how safely a person completes daily tasks and whether they need frequent assistance and/or supervision. An assessor observes functional abilities, medical needs, and risks to decide if long-term care is appropriate.
Medicaid doesn’t transfer between states, so coverage must end in one state and be reapplied for in the new state. Medicaid programs, eligibility requirements, covered services, and availability may differ.
Medicaid reassesses eligibility regularly. If needs increase or decrease, the type or amount of care approved may change to better match the person’s current condition.
Each state designs its own Medicaid programs, setting rules, services, and funding priorities within federal guidelines. This leads to differences in eligibility, available supports, and whether waitlists exist.
Centers for Medicare and Medicaid Services. (2025, December 9). CMCS informational bulletin – 2026 SSI, spousal impoverishment, and Medicare Savings Program resource standards.
Medicaid.gov. Medicaid eligibility policy.
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