What is the difference between Medicaid and community Medicaid?

What is the difference between Medicaid and community Medicaid?

Short answer: “Community Medicaid” is the term some states use for Medicaid coverage for people living at home rather than in a nursing home, including home care services.

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

“Medicaid” is the overall program. Within it, some states, notably New York, use the term community Medicaid for coverage of people who live in the community (at home, with family or in some residential settings), as opposed to institutional or nursing home Medicaid for people living in a nursing facility.

The differences usually include:

  • Services. Community Medicaid can include home care, personal care, adult day programs and other services that help people stay at home, along with regular medical care.
  • Income rules. People living at home keep more of their income for rent, food and utilities. Some states use a lower income limit with a spend-down or pooled trust for people above it.
  • Asset rules. Asset limits may be the same or different from nursing home rules, depending on the state.
  • The look-back. Some states apply the look-back to community long-term care services; the rules vary.

Other states use different names, such as “home and community-based services,” “waiver services” or a program name. Our community Medicaid guide explains the idea in more detail, and each state guide uses the state’s own terms.

Getting help

Every situation is different, and small facts can change the answer. If this question affects a real decision, especially with a spouse at home, a home, gifts or a trust, a Certified Medicaid Planner can apply your state’s rules to your situation. As a rough guide, published fees for help with an application range from about $500 to $6,000, and hourly help from about $150 to $600.

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

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