How to Apply for Long-Term Care Medicaid

Applying for Long-Term Care Medicaid is complex, and it can feel overwhelming, especially when a parent or spouse has just gone into a nursing home. This guide walks through the process step by step: who applies, what to gather, how long it takes, what happens after you apply, and what to do if the answer is no. It is general education, and it is not a substitute for experienced help (see Why Working With a Certified Medicaid Planner Matters). The exact forms and offices differ by state, and each state guide explains how to apply there.

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

Before you start: three things to know

1. There is no fee to apply. Applying through your state Medicaid agency is free.
2. The date you apply matters. Medicaid can sometimes pay for care in the months before you apply (see “Retroactive coverage” below), and the look-back is counted back from the application date.
3. You do not need every document to start. You can file an application and send missing papers afterward, within the deadlines the caseworker gives you.

Step 1: Decide who will apply

The application can be filed by:

• the person who needs care;
• their spouse;
• an agent under a power of attorney, or a court-appointed guardian;
• an authorized representative named on the state’s form. This can be a family member or another trusted person, and in many states a nursing home staff member.

If the person cannot sign because of dementia or illness and there is no power of attorney, the state’s authorized representative rules or a guardianship may be needed. See Powers of attorney.

Step 2: Understand which program you are applying for

Long-Term Care Medicaid usually comes in two main forms:

• Nursing home Medicaid, which pays for care in a Medicaid-certified nursing facility. There is generally no waiting list.
• Home and community-based services (HCBS) waivers, which pay for care at home, in adult day programs or in assisted living. Many waivers have waiting lists or enrollment caps.

Some states also offer PACE and other programs. The application process can differ by program. See Applying for nursing home Medicaid and Applying for a waiver.

Step 3: Check the basic rules

Before applying, it helps to know whether the person is close to meeting the rules. In general:

• Medical need. The person usually must need a nursing-home level of care. The state decides this through an assessment.
• Income. Many states have an income cap. In 2026 the cap in many states is $2,982 a month (300 percent of the federal SSI benefit). People over the cap may need a Qualified Income (Miller) Trust. Other states use a “medically needy” approach with no fixed cap.
• Assets. A single applicant can usually keep about $2,000 in countable assets. Where the single limit is $2,000, a couple who both apply can usually keep $3,000. Some states differ; for example, Pennsylvania’s limit is $2,400 per spouse in its medically needy program, and New York and California have much higher limits.
• Spouse at home. If the applicant is married, the spousal rules protect assets and income for the spouse at home.
• Look-back. Gifts in the past 60 months (in most states) can cause a penalty.

Your state guide lists the 2026 figures for your state.

Step 4: Gather documents

Gather what you can. Caseworkers commonly ask for:

Identity and status – Photo ID, Social Security card and Medicare card – Proof of age (birth certificate) and proof of U.S. citizenship or qualified immigration status – Proof of state residence (a utility bill, lease or property tax bill) – Marriage certificate, divorce decree or death certificate of a spouse, if they apply

Income – Social Security award letter for the current year – Pension, annuity and retirement payment statements – Any other income: rental income, interest, dividends, VA benefits – The spouse’s income, if married

Assets – Statements for every bank, credit union and investment account, often for the full 60-month look-back – Retirement account statements (IRAs, 401(k)s) – Life insurance policies showing face value and cash value – Prepaid funeral or burial contracts – Deeds, property tax bills and mortgage statements for any real estate – Vehicle titles – Records of any sale or gift of property in the past five years

Insurance and care – Health insurance cards (Medicare, Medicare supplement, Part D, other) – Long-term care insurance policies – Medical records or a doctor’s statement about care needs, if requested

Legal papers – Power of attorney, guardianship order, or authorized representative form – Trust documents, if any

A printable list is planned at Application documents checklist. If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Step 5: File the application

Most states accept applications:

• online, through the state’s benefits portal;
• by mail or fax;
• in person at the local Medicaid, social services or county office;
• in some states, by phone.

Keep a copy of everything you submit and write down the date. If you file in person, ask for a stamped receipt. If you file online, save the confirmation page.

Hospital and nursing home social workers, and Area Agencies on Aging, can often explain the forms. For complex situations, see Why working with a Certified Medicaid Planner matters.

Step 6: The medical (level of care) assessment

For long-term care, the state must decide that the person needs a nursing-home level of care. Usually:

• a nurse or assessor reviews the person’s needs, often in person;
• the assessment looks at help needed with daily activities like bathing, dressing, eating, moving around and using the toilet, and at memory and supervision needs;
• for nursing home admission, a federally required screening (PASRR) is also done.

This assessment may happen before, during or after the financial application, depending on the state.

Step 7: Respond to requests

After you apply, the caseworker will usually send a written request for more information (often called a verification request). This is normal.

• Watch the mail and the online portal closely.
• Meet every deadline. Missing one is one of the most common reasons applications are denied.
• If you need more time, ask for an extension in writing before the deadline.
• Some states hold an interview, by phone or in person.

How long it takes

Under federal rules, states must decide most applications within 45 days, or 90 days when the application is based on disability. In practice, long-term care applications often take that long or longer, because of the look-back review and verification requests.

Medicaid pending

When someone enters a nursing home and has applied but not yet been approved, they are often called Medicaid pending. Many nursing homes accept residents in this status, expecting Medicaid to pay once the application is approved. The resident usually still pays their monthly income toward care while waiting. See Medicaid pending.

Retroactive coverage

If the person would have qualified in the months before applying, Medicaid can pay for care in those months.

• For applications filed through December 31, 2026: up to 3 months before the month of application.
• From January 1, 2027: under a 2025 federal law (Public Law 119-21), the window drops to 2 months for older adults and people with disabilities.

This makes applying promptly, once care starts and the person is close to qualifying, more important than before. See Retroactive coverage.

What happens after approval

When the application is approved, the state sends a written notice of approval. It usually shows:

• the date coverage starts;
• the person’s monthly patient liability (also called share of cost). This is the part of their income that goes to the nursing home each month after the personal needs allowance and any allowance for a spouse at home;
• any allowance for a spouse at home;
• any penalty period from the look-back.

After approval:

• Pay the patient liability to the nursing home each month.
• Report changes in income, assets or address within the time the state sets, often 10 days.
• Keep assets under the limit. Savings that build up from unspent allowances can push someone over.
• Move the spouse at home’s assets into that spouse’s name, if needed, within the time allowed.
• Renew each year. Medicaid is reviewed at least once a year (a renewal or redetermination). See Renewals.

If the application is denied

A denial notice must be in writing and explain:

• the reason for the decision;
• the rules it is based on;
• your right to a fair hearing, and how and by when to ask for one.

Common reasons for denial:

• missing documents or a missed deadline;
• assets over the limit;
• income over the cap without a Qualified Income Trust;
• not meeting the level of care;
• a transfer penalty from the look-back.

What you can do:

1. Read the notice carefully and note the deadline.
2. If the denial was for missing paperwork, ask the caseworker whether you can send it now. Some states will reopen the application if the papers are sent quickly, which can keep the original application date.
3. Reapply if circumstances have changed, such as assets now being under the limit. A new application usually gets a new date.
4. Ask for a fair hearing if you believe the decision is wrong.

See Denied? What to do next.

Fair hearings

Everyone who applies for Medicaid has a right to a fair hearing, an appeal before an impartial hearing officer.

• Deadline. Federal rules allow states to set a deadline of up to 90 days from the date the notice was mailed. Many states set a shorter time. The exact deadline is on the notice.
• Keeping benefits. If you already have Medicaid and the state plans to reduce or end it, asking for a hearing before the change takes effect (often within 10 days of the notice) usually keeps benefits going until the hearing decision.
• How to ask. Usually in writing, by phone, online or in person, as the notice explains.
• Before the hearing. You can ask to see your case file and the evidence the state relied on.
• At the hearing. You can explain your side, bring documents and witnesses, and have someone help or speak for you.
• The decision. Federal rules generally require a final decision within 90 days of the hearing request.

If the hearing officer rules in your favor, coverage can be put in place back to the date it should have started. See Fair hearings and appeals. Free legal aid organizations in many areas help with Medicaid appeals. See How free legal aid works.

Why Working With a Certified Medicaid Planner Matters

Applying for Long-Term Care Medicaid alone is risky. The application is complex. It brings together income and asset rules, a five-year review of past transfers, special rules for married couples, medical assessments and strict deadlines. A single mistake can cost a family months of unpaid care or thousands of dollars in savings. For most families, working with an experienced Medicaid planner, preferably a Certified Medicaid Planner (CMP), is the safer path. A CMP has passed a certification exam on Medicaid planning, agreed to a code of ethics and keeps up with continuing education.

What can go wrong when families apply alone

• Denials. A mother’s application is denied because one bank statement from three years ago was never sent in by the deadline. She has to start over, and the months in between go unpaid.
• Delays. A family answers a verification request late, and the nursing home bills pile up while the application sits.
• Penalty periods from transfers no one knew counted. A father gave each grandchild $15,000 for college, thinking it was safe because it was under the gift tax limit. Medicaid counts those gifts, and he faces months without coverage.
• Lost spousal protections. A couple spends their savings down to almost nothing before applying, not knowing the wife at home could have kept up to $162,660 in 2026 in some states.
• Missed retroactive coverage. A family waits until savings run out to apply, and the earlier months of care that Medicaid could have paid are lost. From 2027 this window shrinks from 3 months to 2.
• Overspending during the spend-down. A family pays the nursing home privately with money that could have been spent in allowed ways, such as home repairs, paying off debts or a prepaid funeral plan, or that could have been protected for the spouse at home.

When a Certified Medicaid Planner matters most

• Married couples, where the spouse at home’s assets and income need protecting.
• Gifts or transfers in the last five years, including adding a child to a deed or account.
• A home or a business, and questions about keeping, selling or transferring it.
• Income over the state’s cap, which may call for a Qualified Income (Miller) Trust.
• Trusts or annuities, which must meet strict rules.
• Denials and fair hearings, where deadlines are short and the record matters.

What professional help typically costs

Experienced help is not free, and it is better to know that before the first meeting. Published fee surveys and price lists show a wide range. As a rough guide:

Fees vary by state, by the type of professional and, most of all, by how complex the situation is. Gifts in the look-back, a spouse at home, a home or business, trusts or a denial all tend to push the cost higher. Many professionals charge a flat fee for a defined service, and some offer a free or low-cost first consultation.

Questions to ask before hiring anyone

Ask about cost up front and get it in writing. Neutral questions to ask:

• Are you a Certified Medicaid Planner (CMP), and is your certification current? You can check with the credentialing board, as explained in What is a Certified Medicaid Planner?
• How much experience do you have with Long-Term Care Medicaid in our state?
• What exactly is included, and what is not?
• How is your fee set (flat fee, hourly or another way), and what will the total likely be?
• Who handles verification requests, denials and fair hearings if they come up?
• If you are not an attorney, which attorney drafts any legal documents we need?
• Will you put the agreement in writing?

Red flags: a guarantee of approval, pressure to sign or pay right away, advice to hide assets or leave things off the application, or a fee charged only to fill out and submit forms. See Questions to ask before paying anyone for help.

Free options for paperwork

Your state Medicaid agency, the nursing home’s business office and the State Health Insurance Assistance Program (SHIP) offer free help. They can explain forms and the process, but they generally do not give planning strategy, such as how to protect assets for a spouse or handle past gifts.

Common mistakes to avoid

• Waiting too long to apply. With retroactive coverage shrinking in 2027, a late application can leave bills unpaid.
• Making gifts while applying. Gifts can cause a penalty. See Gifts and the look-back.
• Leaving things off the application. Applications are signed under penalty of perjury. Report all accounts and transfers.
• Missing a deadline. Mark every due date.
• Applying alone in a complex situation. See Why working with a Certified Medicaid Planner matters. Filing itself is free, so be wary of anyone who charges only to submit forms. See Questions to ask before paying anyone for help.

Related guides

• The five-year look-back, explained
• Spousal impoverishment rules
• Medicaid pending
• Denied? What to do next
• Fair hearings and appeals
• State guides, each with how to apply in that state

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