What Long-Term Care Medicaid Covers: An Overview

Families often ask a simple question: “If Mom qualifies for Medicaid, what will it actually pay for?” The answer depends on the setting (nursing home, assisted living or home), the program (regular state plan Medicaid or a waiver) and the state. This guide gives the big picture of what Long-Term Care Medicaid covers, what it does not, and how coverage differs by setting.

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

The short version

Nursing home care is a mandatory Medicaid benefit. Once someone qualifies and needs that level of care, Medicaid pays for the nursing home, minus the person’s share of cost from their income.
Home and community-based services (HCBS), such as personal care at home, adult day care and assisted living services, are covered in every state, but many are offered through waivers with limited slots.
Medicaid also covers medical care in general: doctor visits, hospital care, prescriptions (mostly through Medicare Part D for people with Medicare), equipment and more.
Medicaid generally does not pay room and board outside a nursing home.
For people who also have Medicare, Medicare pays first for medical care, and Medicaid fills gaps.

How “long-term care” differs from medical care

Long-term care means help with everyday living over a long period, rather than treating an illness. It includes help with activities of daily living (bathing, dressing, eating, toileting, moving around and continence) and instrumental activities such as cooking, cleaning, shopping, managing medications and paying bills. See Activities of daily living.

Medicare and most private health insurance pay little for this kind of ongoing custodial care. Medicaid is the largest payer of long-term care in the United States.

Coverage by setting

Nursing homes

Federal law requires every state’s Medicaid program to cover nursing facility services for people 21 and older who need them (Social Security Act section 1905(a)(4)(A)). For a resident on Medicaid, the nursing home’s daily rate covers:

a semi-private room and meals;
24-hour nursing care and supervision;
help with daily activities;
routine personal hygiene items and supplies;
medically related social services;
an activities program;
rehabilitation therapy as needed;
basic laundry.

The resident pays most of their monthly income to the nursing home as their patient liability, keeping a small personal needs allowance, and Medicaid pays the rest. See What nursing home Medicaid covers.

Home and community-based services

Every state offers some long-term care services outside nursing homes. These may include:

personal care (help with bathing, dressing and similar tasks);
homemaker and chore services (cleaning, laundry, meal preparation);
home health aide and skilled nursing visits;
adult day care or adult day health;
respite care for family caregivers;
home-delivered meals;
personal emergency response systems (medical alert buttons);
home modifications, such as ramps and grab bars;
medical equipment and supplies;
transportation to medical appointments and sometimes community activities;
case management;
assisted living services (but not the rent and meals);
consumer-directed care, which lets the person hire and manage their own caregivers, often including family members.

Many of these services are offered through 1915(c) waivers or other programs that states choose to provide. Waivers can cap enrollment, so there may be a waiting list. Some services are part of the regular state plan, which means everyone who qualifies can get them. See Home and community-based services (HCBS) waivers.

Assisted living

Medicaid can pay for services in assisted living, such as personal care, medication help and supervision, in most states, usually through a waiver. It does not pay the rent and meals, which the resident pays from income, sometimes with help from a state supplement. See Will Medicaid pay for assisted living? and Room and board in assisted living.

Hospice

All states cover hospice care through Medicaid. For a nursing home resident who elects hospice and has both Medicare and Medicaid, Medicare pays for hospice care while Medicaid generally continues to pay for the room and board. See Hospice under Medicaid.

PACE

The Program of All-Inclusive Care for the Elderly (PACE) provides all medical and long-term care services through one organization, mostly at a PACE center, for people 55 and older who need a nursing-home level of care and live in a PACE service area. See PACE programs.

What Medicaid generally does not cover

Room and board outside a nursing home, such as rent in assisted living or at home.
A private room in a nursing home, unless medically necessary. See Private rooms on Medicaid.
Services above the person’s assessed need. A waiver may approve, say, 20 hours a week of personal care, not round-the-clock care.
Non-covered personal items, such as a personal phone, television, salon services beyond basic grooming and personal clothing. Residents may use their personal needs allowance for these.
Care from providers who do not accept Medicaid.

Medicare and Medicaid together

Most older adults on Long-Term Care Medicaid also have Medicare, making them “dual eligible.” In general:

Medicare pays first for hospital care, doctor visits, short-term skilled nursing and rehabilitation, hospice, and prescription drugs (through Part D).
Medicaid pays for long-term custodial care, and for Medicare premiums, deductibles and coinsurance through Medicare Savings Programs for those who qualify.
After a qualifying hospital stay of at least three days as an inpatient, Medicare can cover up to 100 days in a skilled nursing facility per benefit period: the first 20 days in full, then days 21 to 100 with a daily coinsurance of $217 in 2026, which Medicaid may pay for dual eligibles. After day 100, Medicare stops paying.

See Dual eligibility and Medicaid vs. Medicare for long-term care.

Managed care

In many states, long-term care services are delivered through managed long-term services and supports (MLTSS) plans. The state pays a health plan to arrange and pay for care, and the person chooses a plan and uses its network of providers. Covered services are the same in principle, but the plan handles approvals and care coordination. See Managed long-term services and supports.

How much care Medicaid will pay for

For home and community services, a state or plan assessment decides how many hours and which services are approved, based on the person’s needs. The amount can be less than families expect, especially for people who need round-the-clock supervision. If the approved services seem too low, the person can ask for a reassessment or appeal through a fair hearing.

A simple example

Rose, 84, has Parkinson’s disease and needs help with bathing, dressing and medications. She qualifies for Long-Term Care Medicaid in her state.

If she stays at home, a waiver may pay for a personal care aide for about 25 hours a week, adult day care twice a week, a medical alert system and grab bars in the bathroom, once a waiver slot is available. She pays her own rent, food and utilities.
If she moves into assisted living that accepts Medicaid, the waiver pays for her care services, and she pays the room and board from her Social Security.
If she moves into a nursing home, Medicaid pays the full daily rate, and she pays most of her income toward it as her share of cost, keeping her personal needs allowance.

Getting help

The mix of programs in each state can be confusing, and choosing the right program can make a large difference to both care and cost. Each state guide lists that state’s main programs. A Certified Medicaid Planner can help match needs with programs and handle the eligibility side, so the family can focus on care.

Frequently asked questions

Does Medicaid pay for 24-hour home care? Rarely. Most programs cap hours based on assessed need and cost. Some states allow higher hours for people who would otherwise need a nursing home.

Does Medicaid pay for memory care? Medicaid can pay for care services in a memory care unit through some waivers, but not the room and board. In a nursing home with a dementia unit, Medicaid pays the full rate.

Does Medicaid cover dental, vision and hearing? It depends on the state. Adult dental and vision coverage varies widely. Nursing homes must help residents get needed dental services.

Can a person switch from home care to a nursing home? Yes, if their needs change. The reverse is also possible; see Money Follows the Person.

Key terms

State plan services: benefits every eligible person in the state can receive, with no enrollment cap.
Waiver services: extra home and community services a state offers under a federal waiver, often with limited slots.
Level of care: the state’s measure of how much help a person needs, which decides whether they qualify for nursing home or waiver services.
Patient liability (share of cost): the part of a person’s income that goes toward the cost of care.

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