What Is Long-Term Care Medicaid?

Long-Term Care Medicaid is the part of Medicaid that pays for ongoing help for people who are elderly, blind or disabled and need care over a long period, in a nursing home, at home or in another community setting. It is the single most important source of payment for long-term care in the United States, because Medicare and most health insurance cover very little of it. This guide explains what the program is, how it is run and what it pays for, in plain language.

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

Medicaid in one paragraph

Medicaid is a health coverage program created in 1965 under Title XIX of the Social Security Act. It is paid for jointly by the federal government and the states, and each state runs its own program within federal rules. Medicaid covers many groups, including children, parents, pregnant women and lower-income adults. Long-Term Care Medicaid is the shorthand used on this site for the Medicaid coverage that pays for nursing home care and home and community-based care for older adults and people with disabilities. It has its own, stricter financial rules.

Who runs it

The federal agency in charge is the Centers for Medicare & Medicaid Services (CMS). CMS approves each state’s Medicaid plan and its waivers, and publishes some figures that apply nationally, such as the spousal protection amounts and the home equity limits.

Each state decides many details, including:

the asset limit, within federal rules;
which income limit or pathway it uses;
how much a nursing home resident keeps as a personal needs allowance (at least $30 a month under federal law);
which home and community-based services it offers, and how many people it can serve;
how it runs estate recovery.

The application usually goes to a state or county agency, often called the Department of Social Services, Human Services or Health. Because the details vary so much, this site has a state guide for each state.

What it pays for

Nursing home care

Nursing facility services are a mandatory Medicaid benefit for adults: every state must cover them for people who qualify. When Medicaid pays, it covers the nursing home’s daily rate, which includes the room, meals, nursing care, help with daily activities and most supplies. The resident contributes most of their own income toward the cost (the patient liability), and Medicaid pays the rest.

Care at home and in the community

Most people would rather stay at home. Federal law lets states offer home and community-based services (HCBS), mainly through waivers approved by CMS. Depending on the state, these can include:

personal care aides who help with bathing, dressing and eating;
adult day programs;
home-delivered meals;
respite care to give family caregivers a break;
home modifications such as ramps or grab bars;
care management;
services in assisted living (the care, not usually the room and board).

Unlike nursing home care, many waiver programs have limited slots and may have waiting lists.

Regular Medicaid services

People who qualify also get regular Medicaid coverage, such as doctor visits, hospital care and prescriptions not covered by Medicare. For people who also have Medicare, Medicaid usually pays the Medicare premiums and cost-sharing. See Dual eligibility.

What it usually does not pay for

Room and board in assisted living. Medicaid can pay for care services in assisted living in many states, but rent and meals are usually the resident’s responsibility, sometimes with help from a state supplement.
Care that is not medically needed at the required level. A person who needs only occasional help may not meet the medical test.
A private room, unless it is medically necessary.
Care from a provider that does not accept Medicaid. Not every nursing home or home care agency participates.

Who qualifies, in brief

Every applicant must pass three tests. The Eligibility overview explains each in detail.

The money test. Countable assets must be under the state’s limit, often $2,000 for a single person in 2026, and income must be under the state’s limit or handled through another pathway.
The care test. The person must need the level of care the program provides, often called nursing home level of care.
The residency and citizenship test. The person must live in the state and be a U.S. citizen or qualifying non-citizen.

There is also a five-year look-back: gifts and transfers for less than fair market value in the 60 months before applying can delay coverage. See The five-year look-back.

Why it is different from regular Medicaid

Many people know someone who has Medicaid through a job loss or low wages. That coverage, for children and working-age adults, usually looks only at income. Long-Term Care Medicaid for people who are 65 or older, blind or disabled looks at both income and assets, has a medical test and has the look-back. It also has special rules for married couples so that the spouse at home is not impoverished. See Married couples and Medicaid.

A short example

Helen is 84 and a widow. After a fall and a hospital stay, she moved to a nursing home for rehab. Medicare paid for part of her rehab stay, but she now needs long-term care and will not be able to go home. The nursing home costs far more each month than her Social Security and small pension combined.

Helen has $48,000 in savings and owns a small house. Her family learns that in her state:

the asset limit is $2,000, so her savings must come down before she qualifies;
her home can be exempt while she intends to return, or under other rules, though it may face estate recovery after her death;
most of her income will go toward her nursing home bill each month, and she will keep a small personal needs allowance.

With help from a Certified Medicaid Planner (CMP), the family plans allowed ways to spend her savings, such as prepaying her funeral and paying the nursing home, and applies in the month she qualifies.

Common questions

Is Medicaid the same as welfare? No. It is health coverage. Millions of middle-class families rely on it for nursing home care after savings are used up.

Do I have to be poor to get it? The asset and income limits are low, but many people who once had substantial savings qualify after spending on care or through legal planning. Married couples can keep much more than single people.

Will Medicaid take my house? Not while you are alive in most cases. The home is often exempt for eligibility. After death, the state may seek estate recovery, with important protections for spouses and certain children.

Can I choose my nursing home? You can choose among facilities that accept Medicaid and have a bed available. Not every facility accepts Medicaid, and some limit how many Medicaid residents they take.

Does Medicaid pay for 24-hour care at home? Rarely. Home care programs usually provide a set number of hours. Families often fill the gaps.

Is there an age limit? Long-Term Care Medicaid serves people 65 and older, and people of any age who are blind or disabled.

How to get started

Read the Eligibility overview to see where you stand.
Make a list of income and assets, using What counts as an asset? and What counts as income?.
Look up your state in the state guides.
Before giving away money, changing a deed or cashing out accounts, talk with a Certified Medicaid Planner (CMP). Mistakes made in a hurry can delay coverage for months.
When ready, see How to apply.

Key terms

Term	Meaning
CMS	The federal agency that oversees Medicaid and Medicare
Countable assets	Savings and property that count toward the asset limit
Exempt assets	Property that does not count, such as the home in many cases and one car
HCBS	Home and community-based services
Waiver	A CMS-approved program that lets a state offer HCBS
Level of care	The medical need a person must show to qualify
Look-back	The 60-month review of gifts and transfers
Patient liability	The part of income a nursing home resident pays toward care
Estate recovery	The state’s claim against an estate after death

Where the money comes from

Each state’s Medicaid costs are shared with the federal government. The federal share differs by state and is at least half of most costs, so Medicaid is one of the largest items in every state budget. This is part of why states review applications closely and check the look-back period.

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