Who Qualifies for In-Home Care?

Most older adults want to stay in their own homes as long as possible. Long-Term Care Medicaid can help pay for care at home in every state, through home and community-based waivers and, in many states, through regular Medicaid personal care programs. The rules and the amount of help vary a great deal. This guide explains who qualifies, what services are available and how families can make the most of them.

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

The main programs

Program type	Medical need	Financial rules	Limits
HCBS waiver	Usually nursing home level of care	Usually the same as nursing home Medicaid, with spousal protections	Slots may be capped; waitlists common
State plan personal care	Often a lower need, such as help with one or two ADLs	Often regular Medicaid limits, which can be lower	Usually no waitlist; hours may be limited
Community First Choice and other state plan options	Often nursing home level of care	Varies	Available in some states
PACE	Nursing home level of care, able to live safely in the community	Medicaid rules if Medicaid pays; others may pay privately	Only in PACE service areas

See The three kinds of Long-Term Care Medicaid.

Who qualifies

Most in-home programs require:

Category: 65 or older, blind or disabled.
Medical need: for waivers, usually nursing home level of care. For state plan personal care, often a lower level, such as needing help with a certain number of ADLs. See Activities of daily living.
Assets: at or under the state’s limit, often $2,000 for a single person in 2026.
Income: under the program’s limit. Waivers often use the special income limit of $2,982 a month in 2026. Regular Medicaid programs may use a lower limit or a spend-down.
Look-back: waivers apply the 60-month look-back. State plan programs generally do not, though states may apply it to some home care.
Safety: the person must be able to live safely at home with the services provided.
Residency and citizenship.

What services may be covered

Depending on the state and program:

personal care aides for bathing, dressing, eating, toileting and transfers;
homemaker services such as light housekeeping, laundry and meal preparation;
adult day health programs;
respite care for family caregivers;
home-delivered meals;
personal emergency response systems;
home modifications, such as ramps, grab bars and widened doorways;
medical equipment and supplies not covered by Medicare;
care management to coordinate services;
skilled nursing visits in some programs;
transportation to medical appointments.

How many hours?

Programs approve hours based on an assessment of need, not a fixed amount. A person who needs help with bathing and dressing every morning might be approved for a few hours a day. Round-the-clock care at home is rarely approved. Families usually provide much of the care themselves and use Medicaid hours to fill specific gaps.

States often limit total costs, such as requiring that waiver services cost no more than nursing home care would.

Paying family caregivers

Many states let Medicaid recipients direct their own care, which can include hiring a family member as the paid aide. Under self-directed programs:

the person (or a representative) hires, trains and supervises the aide;
a fiscal agent handles payroll;
rules about which relatives can be hired vary; spouses and legal guardians are often excluded, though some states allow them.

Being paid as a caregiver can make it possible for an adult child to reduce other work. The pay is set by the state program.

What the person keeps at home

Unlike a nursing home resident, a person receiving waiver services at home keeps enough income to pay for housing, food and utilities. States set this “maintenance allowance” for waiver participants, often at or near the special income limit. Some states require a monthly cost-share above it. Each state guide gives the figure when known.

For married couples, the spouse at home receives the same CSRA and MMMNA protections as for nursing home care while federal law requires them for home and community-based care, currently through September 30, 2027.

A worked example

Betty, 80, lives alone and has heart failure and arthritis. She needs help bathing, dressing and getting in and out of bed. She has $1,400 a month in income and $3,500 in savings.

Medical need: She meets nursing home level of care.
Assets: $3,500 is over her state’s $2,000 limit. She buys a new mattress and pays a dental bill, bringing her savings under the limit.
Income: $1,400 is under the special income limit for her state’s waiver.
Program: She applies for the waiver for older adults. There is a three-month waitlist.
Meanwhile: She qualifies for the state’s regular Medicaid personal care program, which provides an aide for 10 hours a week while she waits.
Once enrolled: The waiver provides 25 hours a week of aide time, a medical alert system and a shower chair. Her niece is hired as her aide under the self-directed option.

Medicare home health vs. Medicaid home care

	Medicare home health	Medicaid home care
Who	Homebound people needing part-time skilled care	People meeting Medicaid’s financial and medical tests
What	Skilled nursing, therapy, some aide visits tied to skilled care	Personal care and supportive services
How long	While skilled care is needed	As long as the person remains eligible
Cost	No charge for covered services	Most income above the allowance may go to cost-share in some states

Many people use both: Medicare for skilled visits after an illness, Medicaid for ongoing help.

Common questions

Is there a waitlist? For many waivers, yes. Apply early. Regular Medicaid personal care usually has no waitlist.

Can I choose my aide? In self-directed programs, often yes. In agency programs, you can usually request a change if there are problems.

Will Medicaid pay my daughter to take care of me? In many states, yes, under self-direction or certain waivers. Spouses are excluded in some states.

What if I need more help than Medicaid approves? Ask for a reassessment if needs change. Families often add privately paid hours or adult day care.

Do I have to give up my house? No. The home is usually exempt while you live there. It may face estate recovery after death. See Estate recovery.

Can I get home care if I live with my family? Yes. Some programs consider the help family already gives when setting hours.

Planning tips

Get an assessment early, even before applying, to learn which programs fit.
Apply for a waiver as soon as the person is likely to qualify, because of waitlists.
Look into state plan personal care as a bridge.
Make the home safer: fall prevention, grab bars, lighting.
Talk with a Certified Medicaid Planner (CMP) about the financial side, especially for married couples.

Making the home work

Medicaid help at home works best when the home itself is safe. Common improvements include:

grab bars in the bathroom and a shower chair or tub bench;
removing loose rugs and clutter that cause falls;
better lighting, especially at night;
a ramp or stair lift if steps are a barrier;
a bedroom and bathroom on the main floor.

Some of these can be paid for by a waiver. Others are allowed spend-down purchases for a person working toward the asset limit, because they benefit the applicant and are bought at fair market value. See Allowed spend-down purchases.

Keeping track of hours and care

Once services start, keep a simple record:

the hours aides actually work, compared with the hours approved;
missed visits;
changes in the person’s condition;
any problems with the care.
the names of aides and the agency contact for each shift.
any equipment or supplies that are running low.

This record helps if hours need to be increased, if the agency needs to be changed or if the program asks about the services at renewal.

When home care is no longer enough

Families often reach a point where care at home is not safe, even with Medicaid help. Signs include repeated falls, a caregiver who is exhausted, or needs at night that no one can meet. A move to assisted living or a nursing home does not mean starting over: the person’s Medicaid eligibility and planning carry forward, though the program and rules for what they keep each month change.

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