The Three Kinds of Long-Term Care Medicaid

When people talk about “getting Mom on Medicaid” for long-term care, they may mean one of three different things. Each has its own rules about where care is given, how many people can be served and sometimes even which financial limits apply. Knowing which kind you need helps you read your state’s rules and choose the right application.

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

The three kinds at a glance

	Nursing home Medicaid	Home and community-based waivers	Regular (state plan) Medicaid
Where care is given	A Medicaid-certified nursing facility	Home, adult day centers, and often assisted living	Mainly at home
Is it guaranteed if you qualify?	Yes, it is an entitlement	No, slots may be limited and there may be a waitlist	Yes, for services the state covers
Medical need	Nursing home level of care	Usually nursing home level of care	Varies; often a lower need
Typical financial rules	Long-Term Care Medicaid rules	Usually the same as nursing home rules	Often the stricter regular Medicaid limits
Look-back on gifts	Yes	Yes	Usually not, though some states apply it for home care

1. Nursing home Medicaid

This is the oldest and most familiar kind. Nursing facility services are a mandatory Medicaid benefit, so every state must cover them for adults who qualify. Anyone who meets the financial and medical rules is entitled to coverage. There are no waitlists for the program itself, though a particular nursing home may not have a Medicaid bed available.

What it pays for:

the nursing home’s daily rate, including a shared room, meals and nursing care;
help with activities of daily living, such as bathing, dressing and eating;
medications and supplies not paid for by Medicare;
therapy and other services included in the facility’s care.

The resident pays most of their income toward the cost each month, keeping a personal needs allowance of at least $30 a month under federal law (most states allow more). See Patient liability.

2. Home and community-based services (HCBS) waivers

Most people prefer to stay at home. Federal law lets states ask CMS to “waive” certain Medicaid rules so they can pay for care outside an institution. These programs are usually called HCBS waivers or, under Section 1915(c) of the Social Security Act, 1915(c) waivers. Every state has at least one.

Waivers can pay for services such as:

personal care aides and homemaker services;
adult day health programs;
respite care for family caregivers;
home-delivered meals;
personal emergency response systems;
home modifications and equipment;
care in an assisted living or adult foster home (the services, usually not the rent and food);
in some states, payment to a family member who provides care.

The key differences from nursing home Medicaid:

Limited slots. Waivers are not entitlements. A state can cap enrollment, and some have long waitlists.
Target groups. A state may have separate waivers for older adults, people with physical disabilities, people with brain injuries and others.
Cost limits. Many waivers require that the cost of home care not exceed what nursing home care would cost.

Many states now deliver these services through managed long-term services and supports (MLTSS) plans, where a private health plan coordinates care under contract with the state.

3. Regular (state plan) Medicaid with long-term care benefits

Some long-term care services are part of a state’s regular Medicaid program, called the “state plan.” The most common is personal care services, which a state may choose to offer to everyone on Medicaid who needs them. Some states also offer services under other parts of federal law, such as Section 1915(i) or Community First Choice (1915(k)).

The catch is that this route often uses the regular Medicaid financial rules for older and disabled people, which in many states have a lower income limit than nursing home Medicaid. The look-back usually does not apply. For people with modest income, this can be the quickest way to get some help at home.

Which kind fits?

Situation	Usually the best fit
Needs 24-hour supervision and skilled care; cannot be safely cared for at home	Nursing home Medicaid
Needs nursing home level of care but has family support at home	HCBS waiver
Lives in assisted living and needs help with daily activities	HCBS waiver (if the state covers assisted living)
Needs a few hours of help a week and has low income	Regular state plan personal care
On a waitlist for a waiver, and care needs are growing	Nursing home Medicaid may be needed in the meantime

A short example

Ruth, 79, has Parkinson’s disease and lives with her son. She needs help bathing, dressing and getting in and out of bed. Her doctor says she meets nursing home level of care. Her state has an HCBS waiver for older adults, but it has a six-month waitlist.

Her family has three choices:

Put Ruth on the waiver waitlist and arrange care privately in the meantime.
Apply for state plan personal care, which in her state requires lower income than Ruth has, so she does not qualify.
Apply for nursing home Medicaid if her needs exceed what her son can manage.

They put her on the waitlist and plan to pay privately for a few hours of help each week. A Certified Medicaid Planner (CMP) helps them plan so that Ruth meets the financial rules by the time a waiver slot opens.

Do the financial rules differ?

Usually the asset limit for HCBS waivers is the same as for nursing home Medicaid, and federal law currently requires states to give married couples the same spousal protections for home and community-based care as for nursing homes. Congress has extended this requirement several times on a temporary basis. The current end date is September 30, 2027, unless Congress extends it again.

Income rules can differ. Many states use a special income limit of up to 300% of the SSI federal benefit, which is $2,982 a month in 2026, for nursing home and waiver care. Others use a medically needy spend-down. Regular Medicaid often has a lower income limit. Each state guide lists its figures, and see Income limits by state.

There is also a difference in what the person keeps. A nursing home resident keeps a small personal needs allowance. A person receiving waiver services at home keeps a larger amount to pay rent, food and utilities, set by the state.

Common questions

Can I switch from a waiver to a nursing home, or the other way? Yes. Many people move between settings as their needs change. A move from a nursing home back to the community may be supported by a transition program.

Do waivers pay for assisted living rent? Usually not. Medicaid generally cannot pay room and board outside a nursing home. Some states help with rent through a state supplement.

Can my daughter be paid to care for me? In many states, yes, under a waiver or another program that allows self-directed care. Rules about which relatives can be paid vary. Spouses are often excluded.

Is there a waitlist for nursing home Medicaid? No, not for the program, but a specific facility may have no Medicaid bed open.

What is managed long-term care? A setup where a health plan, rather than the state directly, arranges and pays for long-term care services. You still must qualify for Medicaid through the state.

Does PACE count? The Program of All-Inclusive Care for the Elderly (PACE) is another option in many areas for people 55 and older who meet nursing home level of care and can live safely in the community. It combines Medicare and Medicaid services through one organization.

Comparing the monthly picture

The setting also changes what a person keeps each month. In a nursing home, nearly all income goes to the facility, and Medicaid covers room, board and care. At home under a waiver, the person keeps more income because they still pay rent or a mortgage, food and utilities, and Medicaid pays only for the care services. In assisted living, the person typically pays the facility’s room and board charge from income, and the waiver pays for care. Families should compare these budgets when choosing a setting.

Steps to take

Ask the person’s doctor whether they meet nursing home level of care. See Nursing home level of care.
Look up your state’s waivers and income rules in its state guide.
If there is a waitlist, apply early. Being on the list costs nothing.
Talk with a Certified Medicaid Planner (CMP) about which route fits the person’s needs and finances.

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