Understanding Medicaid long-term care coverage: How the Program Helps Cover Expenses

Are you concerned about covering long-term care expenses? You’re not alone in your concern about care costs. Medicaid long-term care coverage helps millions of Americans afford essential care services. Your program covers nursing home care, home health services, and community-based support. 

You’ll discover how Medicaid eligibility works for long-term care in 2025 and 2026. We’ll explain the different program types available to you specifically. You’ll learn about income and asset limits in your state. Your guide covers application steps, spend-down strategies, and service options. 

By the end, you’ll understand how Medicaid can help cover your long-term care costs.

Key Takeaways

Understanding Medicaid long-term care helps you plan for future needs. You can access affordable care through various program options. Eligibility depends on your medical and financial situation.

• Medicaid covers nursing home care and home-based services 
• You must meet income and asset requirements 
• Home and Community-Based Services (HCBS) keep you at home 
• Spend-down strategies help you qualify for coverage 
• The application process involves multiple steps and documentation

What is Medicaid Long-Term Care Coverage?

Medicaid long-term care is a government program for people needing extended care. You qualify when you are unable to perform daily activities independently. The program helps cover the costs of care services and support.

Long-term services and supports cost extremely high amounts annually. Medicare and regular health insurance don’t cover most care expenses. Medicaid paid for more than half of $415 billion in 2022. Most funding went to home and community-based services for people.

Medicaid vs. Regular Medicaid

Regular Medicaid covers doctor visits and hospital stays for you. Medicaid long-term care specifically covers extended care and support services. You might qualify for one program but not another.

What Counts as Long-Term Care?

Long-term care refers to assistance with daily activities for an extended period. You require help with bathing, dressing, eating, or mobility. Memory care and skilled nursing also count as long-term care.

Types of Medicaid Long-Term Care Programs

You can access three main types of Medicaid long-term care. Each program serves different needs and care settings. Understanding your options helps you choose the right program.

Nursing Home Medicaid

Nursing Home Medicaid covers your care in skilled nursing facilities. You receive 24-hour medical supervision and personal care assistance. Does Medicaid pay for nursing home care? Yes, when you meet requirements.

Your nursing home must accept Medicaid payments for coverage. The facility provides meals, housing, and medical care services. You keep a small personal allowance from your income.

Aged, Blind, and Disabled (ABD) Medicaid

Aged, Blind, and Disabled (ABD) Medicaid serves people over 65 or with disabilities. You can receive care in various settings with this program. The program covers institutional and community-based care options.

Your eligibility depends on age, disability status, and financial limits. Aged, Blind, and Disabled (ABD) Medicaid often coordinates with other long-term care programs. You may be eligible for multiple services under this program.

Home and Community-Based Services (HCBS) Waivers

Medicaid home and community-based services (HCBS) help you stay home. You receive personal care, meal delivery, and transportation services. Home and Community-Based Services (HCBS) waivers prevent unnecessary nursing home placements for you.

About 700,000 people wait for Home and Community-Based Services (HCBS) waiver services nationwide. Most waiting lists include people with intellectual or developmental disabilities. Your state determines the available waiver programs and their corresponding waiting times.

What Services Does Medicaid Long-Term Care Cover?

Medicaid covers a wide range of long-term care services. Your covered services depend on your program and the state in which you reside. Understanding coverage helps you plan your care needs.

Service Type	Nursing Home	HCBS Waivers
Personal Care	✓	✓
Medical Care	✓	✓
Meals	✓	✓
Transportation	Limited	✓
Home Modifications	✗	✓
Adult Day Care	✗	✓

Institutional Care vs. Home and Community-Based Services (HCBS) Waivers – Complete Comparison

Understanding your care options helps you make informed decisions. Institutional care and Home and Community-Based Services (HCBS) waivers serve different needs completely. Your choice significantly affects costs, independence, and care quality.

Institutional Care Benefits

Institutional care provides complete 24-hour supervision in nursing facilities. You receive all meals, medical care, and personal assistance daily. Your facility handles medication management and emergency medical needs. Staff provide rehabilitation services and complex medical management to support your needs. You get immediate help during medical emergencies or crises.

Home and Community-Based Services (HCBS) Waivers Benefits

Home and Community-Based Services (HCBS) waivers let you receive care in your home. You receive regular visits from personal care assistants at your home. Your meal delivery services bring nutritious food to you. Home modifications, such as ramps or grab bars, are covered. 

Transportation to medical appointments is included in your waiver. You maintain independence while receiving necessary care and support.

Cost Comparison for Your Budget

Institutional care costs average $108,000 annually per person nationwide. Home and Community-Based Services (HCBS) waivers typically cost 60-70% less than nursing homes. Your state saves money by keeping you at home. You earn more personal income with Home and Community-Based Services (HCBS) programs.

Which Option Works Best for You

Choose institutional care if you need complex medical management. Your safety concerns at home might require 24-hour supervision. Select Home and Community-Based Services (HCBS) waivers if you prefer to stay at home. Your family support system can effectively supplement waiver services.

Medicaid Long-Term Care Eligibility Requirements

You must meet both medical and financial requirements to be eligible for coverage. Medicaid long-term care eligibility for 2025 and 2026 includes specific income limits. Your state determines exact qualification standards and application procedures.

Medical Requirements

You need a medical evaluation to demonstrate the necessity of care first. A doctor must confirm that you are unable to perform daily activities. Your cognitive abilities and physical limitations are carefully assessed. 

Level of care determinations happen through state assessments. You may need nursing facility-level care for coverage. Some programs require specific medical conditions or disability ratings.

Financial Requirements

Your income and assets must stay below state limits. Financial requirements vary significantly between different states nationwide. You can keep certain exempt assets while qualifying.

Comprehensive State-Specific Asset & Income Limits (2025 and 2026)

Your state determines the exact financial limits for Medicaid eligibility. Income and asset limits vary dramatically across different states. Understanding your state’s limits helps you plan qualification strategies.

State	Official Resource	Income Limit (Individual / Couple, 2025 and 2026)	Asset Limit (Individual / Couple)
Alabama	https://medicaid.alabama.gov/	$2,901 / $5,802	$2,000 / $3,000
Alaska	https://health.alaska.gov/en/services/division-of-public-assistance-dpa-services/apply-for-medicaid/	$2,901 / $5,802	$2,000 / $3,000
Arizona	https://www.azahcccs.gov/	$2,901 / $5,802	$2,000 / $3,000
Arkansas	https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx	$2,901 / $5,802	$2,000 / $3,000
California	https://www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx	$1,801 / $2,433	$2,000 / $3,000
Colorado	https://www.healthfirstcolorado.com/	$1,459 / $5,802	$2,000 / $3,000
Connecticut	https://portal.ct.gov/husky	$2,901 / $5,802	$1,600 / $2,400
Delaware	https://dhss.delaware.gov/dhss/dmma	$2,417 / $5,802	$4,000 / $6,000
Florida	https://ahca.myflorida.com/medicaid	$2,901 / $5,802	$2,000 / $3,000
Georgia	https://medicaid.georgia.gov	$2,901 / $5,802	$2,000 / $3,000
Hawaii	https://medquest.hawaii.gov	$1,819 / $2,452	$2,000 / $3,000
Idaho	https://www.idmedicaid.com/	$1,470 / $2,433	$2,000 / $3,000
Illinois	https://hfs.illinois.gov/medical	$1,304 / $1,762	$2,000 / $3,000
Indiana	https://www.in.gov/medicaid/	$1,763 / $5,802	$1,500 / $2,250
Iowa	https://hhs.iowa.gov/medicaid	$1,450 / $5,802	$2,000 / $3,000
Kansas	https://www.kancare.ks.gov/	$2,901 / $5,802	$2,000 / $3,000
Kentucky	https://chfs.ky.gov/agencies/dms/pages/default.aspx	$1,304 / $5,802	$2,000 / $3,000
Louisiana	https://www.lamedicaid.com/provweb1/default.htm	$2,901 / $5,802	$2,000 / $4,000
Maine	https://www.maine.gov/dhhs/oms	$2,901 / $5,802	$2,000 / $3,000
Maryland	https://health.maryland.gov/mmcp/pages/home.aspx	$2,901 / $5,802	$2,500 / $4,000
Massachusetts	https://www.mass.gov/topics/masshealth	$2,901 / $5,802	$2,000 / $3,000
Michigan	https://www.michigan.gov/mdhhs/assistance-programs/medicaid	$2,901 / $5,802	$2,000 / $3,000
Minnesota	https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/programs-and-services/medical-assistance.jsp	$2,344 / $5,802	$3,000 / $6,000
Mississippi	https://medicaid.ms.gov/	$2,901 / $5,802	$4,000 / $6,000
Missouri	https://mydss.mo.gov/mhd	$1,499 (both)	$1,000 / $2,000
Montana	https://dphhs.mt.gov/MontanaHealthcarePrograms/MemberServices	$967 / $1,450	$2,000 / $3,000
Nebraska	https://dhhs.ne.gov/Pages/Medicaid-Eligibility.aspx	$1,305 / $1,762	$4,000 / $6,000
Nevada	https://www.medicaid.nv.gov/	$1,304 / $2,220	$2,000 / $3,000
New Hampshire	https://www.dhhs.nh.gov/programs-services/medicaid	$1,304 / $2,220	$2,500 / $4,000
New Jersey	https://www.nj.gov/humanservices/dmahs/clients/medicaid/	$2,901 / $5,802	$2,000 / $4,000
New Mexico	https://yes.nm.gov/nmhr/s/yesnm-health-and-benefits?language=en_US	$2,901 / $5,802	$2,000 / $3,000
New York	https://www.health.ny.gov/health_care/medicaid/	$2,901 / $5,802	$32,396 / $48,594
North Carolina	https://medicaid.ncdhhs.gov	$1,763 / $2,752	$2,000 / $3,000
North Dakota	https://www.hhs.nd.gov/medicaid	$1,800 / $2,433	$3,000 / $6,000
Ohio	https://medicaid.ohio.gov	$2,901 / $5,802	$1,500 / $2,250
Oklahoma	https://oklahoma.gov/ohca	$1,814 / $2,451	$2,000 / $3,000
Oregon	https://www.oregon.gov/oha/HSD/OHP	$2,901 / $5,802	$2,000 / $3,000
Pennsylvania	https://www.compass.state.pa.us	$1,762 / $2,901	$2,400 / $4,800
Rhode Island	https://eohhs.ri.gov/consumer/health-care	$2,901 / $5,802	$4,000 / $6,000
South Carolina	https://www.scdhhs.gov	$2,901 / $5,802	$2,000 / $3,000
South Dakota	https://dss.sd.gov/medicaid	$2,901 / $5,802	$2,000 / $3,000
Tennessee	https://www.tn.gov/tenncare	$2,901 / $5,802	$2,000 / $3,000
Texas	https://www.yourtexasbenefits.com	$3,261 / $5,000	$2,000 / $3,000
Utah	https://medicaid.utah.gov	$1,305 / $1,763	$2,000 / $3,000
Vermont	https://dvha.vermont.gov/members	$2,901 / $5,802	$1,000 / $2,000
Virginia	https://coverva.org	$2,000 / $3,900	$2,000 / $3,000
Washington	https://www.hca.wa.gov/health-care-services-supports/apple-health-medicaid-coverage	$1,450 / $2,658	$2,000 / $3,000
West Virginia	https://dhhr.wv.gov/bms	$2,901 / $5,802	$2,000 / $3,000
Wisconsin	https://www.dhs.wisconsin.gov/badgercareplus	$2,901 / $5,802	$2,000 / $3,000
Wyoming	https://health.wyo.gov/healthcarefin/medicaid	$1,450 / $2,658	$2,000 / $3,000

Important Notes for Your Planning: Income limits are updated annually in accordance with the federal poverty guidelines. Your spouse can keep higher income amounts when married. Asset limits don’t include your primary home or car. Life insurance policies with a face value of less than $1,500 don’t count toward the limits.

How to Become Eligible Through Medicaid Spend-Down

Medicaid spend-down for long-term care helps you qualify financially for this benefit. You spend excess income on medical expenses each month. Once you meet spend-down amounts, Medicaid coverage begins.

Real Examples of Spend-Down Strategies

Understanding spend-down strategies helps you qualify for Medicaid coverage. Your excess income and assets must be reduced legally. Professional guidance ensures that you follow the rules correctly, avoiding penalties.

Income Spend-Down Example 1

Your monthly income: $3,500 (Social Security + pension) 

Your state income limit: $2,829 

Your required spend-down: $671 per month 

Your qualifying expenses: Prescription medications ($200), medical equipment rental ($150), home care services ($200), and dental work payments ($121). You meet spend-down requirements through legitimate medical expenses.

Income Spend-Down Example 2

Your monthly income: $4,200 (retirement + investments) 

Your state income limit: $1,563 (medically needy program) 

Your required spend-down: $2,637 per month 

Your qualifying expenses: Nursing home private pay ($2,000), medical insurance premiums ($300), therapy services ($200), medical supplies ($137). Your high medical costs help you qualify quickly.

Asset Spend-Down Example 1

Your current assets: $25,000 in savings 

Your state asset limit: $2,000 

Your excess assets: $23,000 to spend down 

Your spend-down options: Prepay funeral expenses ($8,000), purchase an exempt burial plot ($3,000), buy household items ($2,000), or pay off a mortgage ($10,000). You can keep $2,000 while meeting the legal requirements.

Asset Spend-Down Example 2

Your current assets: $150,000 (savings + investments) 

Your state asset limit: $2,000 

Your excess assets: $148,000 to spend down 

Your spend-down strategy: Create a qualifying annuity ($75,000), establish a special needs trust ($50,000), home accessibility improvements ($15,000), prepaid burial contracts ($6,000), and keep an allowable $2,000. You protect wealth while qualifying for benefits.

Advanced Strategy Example

Your situation: Married couple with $300,000 assets 

Your planning approach: Spousal asset protection allows you to keep $154,140 (2025 and 2026 limit). Transfer the remaining $145,860 through legal strategies before the application. Your spouse keeps the home, car, and protected assets completely.

Can You Have Long-Term Care Insurance and Medicaid?

You can have both long-term care insurance and Medicaid. Your private insurance pays first, then Medicaid covers the remaining costs. Only 80,000 people filed private long-term care claims in 2021.

Partnership policies protect additional assets from Medicaid spend-down requirements. You keep assets equal to insurance benefits received. Partnership programs exist in most states for residents.

How Much Does Medicaid Cover for Long-Term Care?

Medicaid covers most long-term care costs when you qualify. Your coverage depends on the services you need and the program type. Understanding payment structures helps you plan care expenses.

Medicaid enrollees using long-term services have eight times higher spending. The program paid over $200 billion for long-term care. Most spending goes toward home and community-based services.

Nursing home costs average $108,000 annually in most states. Medicaid covers room and board, as well as medical care, completely. You contribute most of your income toward care costs.

HCBS waiver costs vary depending on the daily services you need. Personal care, meals, and transportation are typically covered fully. Pay small copayments for some services.

How Long Can You Receive Medicaid Long-Term Care?

You can receive Medicaid long-term care as long as needed. Coverage continues as long as you meet the eligibility requirements. Annual reviews ensure that you continue to qualify for services.

Your medical condition determines the length of coverage you receive. Progressive conditions might need lifelong care and support services. Temporary conditions only need short-term coverage periods.

Income and asset reviews are conducted annually for most individuals. You must report changes in financial circumstances immediately. Significant changes can affect your continued eligibility for coverage.

How to Apply for Medicaid Long-Term Care

Applying for Medicaid long-term care involves several essential steps. You need proper documentation and medical evaluations for approval. The process typically takes 45-90 days for completion.

Complete Eligibility to Service Delivery Flowchart

Understanding your Medicaid journey helps you prepare for each step of the way. Your process follows a specific set of stages, from initial assessment to service delivery. Each stage has particular requirements and timelines that you should be aware of.

Step 1: Determine Which Medicaid Program is Right

You need to choose between nursing home and Home and Community-Based Services (HCBS) programs. Your medical needs and preferences guide program selection. Consider your ability to live safely at home. 

Nursing home programs are best suited for individuals with complex medical needs. HCBS waivers help people who want to stay at home. Your family support system affects program choice decisions.

Step 2: Review Medicaid Eligibility Requirements

Check your state’s specific income and asset limits carefully. Gather information about medical conditions requiring long-term care. Review the citizenship and residency requirements for your state.

Calculate your monthly income from all sources, including pensions. List all assets, including bank accounts and property ownership. Determine if you need spend-down strategies for qualification.

Step 3: Gather Necessary Documentation

You need medical records that clearly show your care needs. Financial documents include bank statements and tax returns. Gather the necessary identification and citizenship documents for your application.

Required documents typically include: 

• Medical evaluations and physician statements 
• Bank statements from the past three months 
• Social Security award letters and pension documents 
• Birth certificate or citizenship papers 
• Marriage certificates and divorce decrees, if applicable

Step 4: Submit Your Medicaid Application

Complete your application accurately with all required information. Submit applications to your local Medicaid office or online. Keep copies of all documents for your records.

Your caseworker reviews applications and requests any additional information that is needed. Respond quickly to requests to avoid application delays. Schedule required interviews and assessments promptly.

Step 5: Wait for Approval

Approval typically takes 45-90 days from submission date. You receive written notice of approval or denial. Appeals are available if your application gets denied. Once approved, you work with care coordinators. You develop service plans meeting your specific needs. Coverage begins according to your approval effective date.

Your Timeline Summary 

• Total process time: 3-4 months from start to services 
• Emergency placements: 1-2 weeks with expedited processing 
• HCBS waiver waiting lists: 6 months to 3 years, depending on your state

Finding Long-Term Care Providers That Accept Medicaid

You need providers who accept Medicaid payments for services. Not all facilities and agencies accept Medicaid coverage. Research options in your area before needing care.

Tips for Finding Long-Term Care Facilities with Medicaid

Start your search early, before you need urgent care. Contact the facilities directly for information on Medicaid acceptance and availability. Ask about waiting lists and admission procedures. Visit facilities to evaluate quality and staff interactions. Check state inspection reports and quality ratings online.

Ask current residents and families about their experiences. Consider location near family and friends for support. Transportation access affects your ability to maintain relationships. Proximity to medical providers ensures continuity of care.

Senior Living Options in All States

Medicaid covers various care settings across all states. Your options depend on state programs and availability. Understanding choices helps you plan care preferences.

At Home

HCBS waivers provide personal care in your home. You receive assistance with bathing, dressing, and meal preparation. Home modifications improve safety and accessibility for you.

Assisted Living

Some states cover assisted living through Medicaid waivers. You live independently with available support services. Assisted living costs less than nursing home care.

Memory Care

Specialized memory care units are designed to cater to individuals with dementia. You receive specialized programming and secure environments. Staff training focuses on dementia care techniques and best practices.

Congregate Living

Group homes provide care for small numbers of individuals. You live with other residents needing similar care. Staff provide 24-hour supervision and personal assistance.

Nursing Homes

Skilled nursing facilities provide comprehensive medical care daily. You receive rehabilitation services and complex medical management. Nursing homes accept Medicaid when you qualify.

Frequently Asked Questions

How much of long-term care does Medicaid cover?

Medicaid covers most long-term care costs when you qualify. You contribute most of your income toward care expenses. The program covers the remaining costs, including room and board.

What is the primary role of Medicaid in long-term care coverage?

Medicaid serves as the primary payer for long-term care. The program fills gaps left by Medicare and insurance. You access affordable care through various Medicaid programs.

Conclusion

Medicaid long-term care coverage provides essential support for millions. You can access nursing home care and home-based services. Understanding eligibility requirements helps you plan for future needs. 

The application process requires patience and proper documentation gathering. Home and Community-Based Services (HCBS) waivers allow you to stay at home while receiving care. Spend-down strategies can help you qualify for coverage benefits. Begin planning early to thoroughly understand your options. 

Professional guidance helps navigate complex eligibility rules and applications. Medicaid ensures you receive necessary care regardless of income. Your long-term care needs can be met through programs.