Long-Term Care Medicaid in Minnesota: 2026 Guide

In Minnesota, Medicaid is called Medical Assistance (MA). It is run by the Minnesota Department of Human Services (DHS), and eligibility is decided by your county or Tribal Nation human services agency. Long-Term Care Medicaid can pay for nursing home care and for care at home or in assisted living through the Elderly Waiver. Minnesota does not use an income cap for nursing home care, and its asset limit is a little higher than in many states. This guide explains the 2026 rules in plain language.

At a glance: Minnesota 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the Minnesota Department of Human Services before relying on them.

What Long-Term Care Medicaid covers in Minnesota

Nursing home care. Medical Assistance pays for care in a certified nursing facility. You pay most of your income toward the cost each month (your “spenddown” or monthly contribution), and MA pays the rest.

Elderly Waiver (EW). This home and community-based program is for people 65 and older who need a nursing facility level of care and qualify for MA. It can pay for services such as homemaker and personal care help, home-delivered meals, adult day services, respite, home changes, caregiver support and customized living services in assisted living. Most people on the Elderly Waiver get it through a managed care plan.

Managed care for older adults. Most MA members 65 and older are enrolled in Minnesota Senior Health Options (MSHO), which combines Medicare and MA in one plan, or Minnesota Senior Care Plus (MSC+). The plan’s care coordinator arranges long-term services.

Alternative Care (AC). A state-funded program for people 65 and older who need a nursing facility level of care and would qualify for MA within 135 days of entering a nursing home. It is not Medicaid, and it has its own fees and rules; ask your county about it.

Assisted living. MA does not pay room and board. The Elderly Waiver can pay for customized living services in assisted living; you pay room and board from your income.

How Medicare fits in. Medicare Part A covers skilled nursing facility care only for a limited time. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first (time under observation or in the emergency room does not count), and you must need daily skilled nursing or therapy. In 2026, Medicare charges nothing for days 1 to 20 after the Part A deductible ($1,736) is met, $217 a day for days 21 to 100, and nothing after day 100, when you pay all costs. Medicare limits this coverage to 100 days in each benefit period. Medicaid can be a way to pay for long-term nursing home care after Medicare coverage ends.

Who qualifies

A person generally must:

• be 65 or older, or blind or disabled;
• live in Minnesota and be a U.S. citizen or qualified non-citizen;
• need a nursing facility level of care. Minnesota uses the MnCHOICES assessment, done by your county, Tribal Nation or managed care plan;
• meet the income and asset rules below, as decided by the county or Tribal Nation.

Income rules

Minnesota does not use a 300% income cap for nursing home MA. The income standard for MA for people 65 and older is $1,330 a month for one person in 2026 (100% of the federal poverty guideline). If your income is higher, you have a spenddown: income above the standard goes toward medical costs, including nursing home care, before MA pays.

For the Elderly Waiver, a special income standard of $2,982 a month applies in 2026. Ask your county how your income is counted for the waiver.

Once you are on MA in a nursing home, most of your income goes to the facility. You keep $132 a month for clothing and personal needs, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have up to $3,000 in countable assets, and a household of two $6,000.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within DHS rules

Spousal protections

• Assets: The spouse at home can keep a share of the couple’s countable assets, up to $162,660 in 2026, plus the home, one car and belongings. Ask DHS or your county how the share is worked out, including any minimum.
• Income: The spouse at home keeps their own income. If it is below $2,705 a month (from July 1, 2026), part of the applicant’s income can go to them, plus extra for high housing costs, up to $4,066.50 a month.

Look-back and penalties

When you apply, Minnesota looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($11,869 a month).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $11,869 is about 4.2 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Minnesota

Minnesota’s estate recovery program is run by DHS.

• What is recovered: MA paid for long-term care and related services received at age 55 or older, and Alternative Care costs.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: DHS can waive or put off recovery in some situations. Ask DHS for the current rules.
• Family members and personal representatives can contact DHS Estate Recovery with questions.

How to apply

• Online: MNbenefits, Minnesota’s benefits website
• On paper: the DHS application for people 65 and older, blind or disabled, returned to your county or Tribal Nation
• In person: at your county or Tribal Nation human services office
• For the Elderly Waiver: ask your county, Tribal Nation or health plan for a MnCHOICES assessment.

After you apply. Your county or Tribal Nation will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Minnesota

• DHS and your county or Tribal Nation: MA applications and eligibility.
• Senior LinkAge Line: the Minnesota Board on Aging’s free information line, which is also Minnesota’s SHIP for Medicare counseling.
• Area Agencies on Aging: local information on long-term care options.
• Office of Ombudsman for Long-Term Care: free advocates for residents of nursing homes and assisted living, and for people receiving home care.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Minnesota:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Minnesota’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Minnesota’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Minnesota Elderly Waiver (EW) and Consumer Directed Community Supports (CDCS)
• Minnesota Community First Services and Supports (CFSS), Replacing PCA
• Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+)

Frequently asked questions

Is there an income limit for nursing home MA in Minnesota? Not a hard cap. The standard is $1,330 a month in 2026, and income above it is used toward your care through a spenddown.

What is the Elderly Waiver? It is Minnesota’s MA program for people 65 and older who need a nursing home level of care but want to stay at home or in assisted living.

What is the asset limit? $3,000 for one person and $6,000 for a household of two in 2026. The home, one car and personal belongings are usually not counted.

How much can my spouse keep? Up to $162,660 in assets, plus the home, a car and belongings, and income of at least $2,705 a month.

How long is the penalty for a gift? Divide the gift by $11,869 to get the number of months. A $20,000 gift would mean about 1.7 months without MA payment for long-term care.

Will the state take my home after I die? DHS can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the Minnesota Department of Human Services before relying on them.

Sources

• DHS, Health Care Programs Income and Asset Guidelines (DHS-3461A)
• DHS, Eligibility Policy Manual, Appendix F
• MNbenefits
• Medicare.gov, Skilled nursing facility care
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

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