Medicaid and Long-Term Care

What Medicaid Covers for Long-Term Care

Medicaid covers two main categories of long-term care:

Nursing Home Care

All states are required to cover nursing home care for Medicaid-eligible individuals who need that level of care. Medicaid pays the nursing home directly, and the resident contributes most of their income toward the cost of care, keeping a small personal needs allowance.

Home and Community-Based Services (HCBS)

Many states offer Medicaid HCBS waiver programs that pay for personal care, homemaker services, adult day services and other supports that allow people to remain in their homes or communities rather than entering a nursing home. These programs are optional for states, and availability, covered services and waiting lists vary significantly.

Medicaid Eligibility for Long-Term Care

To qualify for Medicaid long-term care benefits, a person must generally meet both financial and medical eligibility requirements.

Financial Eligibility

Medicaid has income and asset limits that vary by state. Generally:

• Income limits: most states require that income be below a certain threshold; in some states, income above the limit can be placed in a "Miller Trust" (qualified income trust) to qualify
• Asset limits: typically $2,000 in countable assets for a single person (amounts vary by state)
• Exempt assets: the primary home (with conditions), one vehicle, personal belongings and certain other assets are typically exempt
• Spousal protections: federal law protects a portion of assets and income for a community spouse (the spouse who does not need nursing home care)

Medical Eligibility

The person must need a nursing-home level of care or, for HCBS waiver programs, meet the state's functional eligibility criteria. This is assessed through a functional needs assessment.

The Medicaid Look-Back Period

Medicaid has a look-back period — typically 60 months (5 years) — during which it reviews asset transfers. If assets were transferred for less than fair market value during this period, Medicaid may impose a penalty period during which it will not pay for care.

How to Apply and Find Your State Agency

Medicaid applications are processed by state agencies. To apply or get information about your state's Medicaid long-term care programs:

• Visit Medicaid.gov and use the "Find My State's Medicaid Agency" tool
• Contact your local Area Agency on Aging through the Eldercare Locator (eldercare.acl.gov or 1-800-677-1116)
• Contact a State Health Insurance Assistance Program (SHIP) counselor for free guidance
• Consult a certified elder-law attorney for complex situations involving asset planning

Official Medicaid information: Medicaid.gov — Long-Term Services and Supports