Long-Term Care Medicaid State Guides

Long-Term Care Medicaid is one national program in name only. Federal law sets the framework, but each state runs its own version, with its own name, its own agency, its own programs for care at home and in assisted living, and many of its own figures. A family in Ohio and a family in New York can face the same diagnosis and the same savings and still get different answers. That is why we publish a separate guide for every state and the District of Columbia.

Figures change periodically. Double-check current amounts before relying on them.

How to use these guides

Every state guide follows the same template, in the same order, so it is easy to compare one state with another:

1. At a glance. The 2026 income rule, asset limits, home equity limit, spousal allowances, look-back period, penalty divisor and personal needs allowance.
2. Programs that pay for long-term care. Nursing home Medicaid, home and community-based waivers, state plan personal care and PACE, where offered.
3. Who qualifies. The money test, the care test and the residency test as the state applies them.
4. Rules for married couples. How much the spouse at home can keep.
5. Your home and estate recovery. When the home is protected, and what the state can recover after death.
6. If you are over the limits. Whether the state uses a medically needy spend-down or a Qualified Income (Miller) Trust.
7. How to apply. The official agency and the ways an application can start.
8. Common questions about that state.

If you are helping a parent who lives in another state, use the guide for the state where the parent lives, or the state where they will receive care. Medicaid eligibility follows residency, not the location of the adult child handling the paperwork. See Citizenship and residency rules.

What is the same everywhere

Some rules come straight from federal law and apply in every state:

• a 60-month look-back on gifts and transfers (California is still phasing in its look-back);
• the federal spousal impoverishment protections for the spouse at home, with a federal minimum and maximum each year;
• a federal home equity limit range, with each state choosing a figure inside it;
• estate recovery for people 55 and older who received long-term care services;
• the rule that a Medicaid-certified nursing home must accept Medicaid’s payment as payment in full.

For the national figures, see 2026 figures at a glance.

What differs from state to state

• Asset limits. Most states use $2,000 for a single applicant, but some are higher, and a few states use much higher limits.
• Income rules. Some states have a hard income cap and require a Qualified Income Trust above it; others let applicants with higher income “spend down” to a medically needy level.
• Home equity limit. States choose either the federal minimum or the federal maximum, or a figure in between.
• Personal needs allowance. The monthly amount a nursing home resident keeps for personal items ranges from the federal minimum to well over $100 in some states.
• Penalty divisor. The figure used to turn gifts into a penalty period usually tracks the state’s average private-pay nursing home cost, so it varies a lot.
• Programs for care at home. Waiver names, services, waitlists and rules for paying family caregivers differ widely.

2026 quick figures by state

The table below pulls a few key figures from the “At a glance” box in each state guide. Click a state for the full guide, including the income rule, couple limits and spousal allowances, which do not fit in a short table. Where a cell says “See state guide” or “Not listed”, the state does not publish a single figure that fits here, and the guide explains how that state handles it.

Reading the table

Asset limit (single). This is the most a single applicant can have in countable assets, such as bank accounts and investments, and still qualify. The home, one car, personal belongings and certain other items usually do not count. See Exempt assets.

Home equity limit. If the applicant’s equity in the home is above this figure, Medicaid will not pay for long-term care unless a spouse, a child under 21 or a blind or disabled child lives there. See Home equity limits.

Personal needs allowance. This is the small monthly amount a nursing home resident on Medicaid keeps from their income. Nearly everything else goes to the nursing home as the resident’s share of cost. See Personal needs allowance.

Penalty divisor. Gifts made during the look-back are divided by this figure to find the number of months Medicaid will not pay. Some states publish a daily figure, some a monthly one, and a few use the facility’s own rate. See How the penalty period is calculated.

Comparison charts across all states

For single-topic charts covering every state, see:

• Asset limits by state
• Income limits by state
• Home equity limits by state
• Personal needs allowance by state
• Nursing home costs and penalty divisors by state
• Estate recovery rules by state
• Assisted living rules by state

Getting help with a state’s rules

State rules interact with federal rules in ways that are hard to see from a chart. The same savings can be handled very differently in a medically needy state than in an income cap state, and the protections for a spouse at home depend on choices each state makes. A Certified Medicaid Planner works with these rules every day and can explain how they apply to a particular family before anyone moves money or signs an application.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.