Medicaid and long-term care: eligibility, coverage and the look-back

Medicaid is a joint federal and state program, and it is the main payer for long-term care in the United States. Each state runs its own Medicaid program and sets its own rules, so who qualifies, what is covered and how long you wait depends on your state.

This page gives the federal picture. For your exact limits and forms, use your state Medicaid agency. Carevo does not assess eligibility.

How Medicaid pays for long-term care

Medicaid.gov says Medicaid is the primary payer across the nation for long-term care services, and that it covers them in settings from institutional care to community-based services. Medicare.gov says Medicaid also covers some services Medicare does not, such as nursing home and personal care. That includes the custodial help with bathing, dressing and daily tasks that Medicare leaves out. See Medicare vs Medicaid for the side-by-side.

Two broad routes exist:

• Nursing facility care. The state Medicaid program pays a nursing home for covered residents who qualify. Browse nursing homes.
• Home and community-based services (HCBS). These help people who qualify get care at home or in the community instead of an institution.

Home and community-based services

Medicaid.gov describes HCBS as services that let enrollees receive care in their own homes or communities. States create them under several federal authorities. The best known is the 1915(c) waiver. Nearly every state runs at least one.

For a 1915(c) waiver, you generally must meet an institutional level of care, have an assessed need for waiver services, belong to the group the waiver targets, be financially eligible, and choose to be served through the waiver. The state chooses the maximum number of people the waiver serves. Waiver services can include personal care, home health aide, homemaker, adult day health and respite care. State names for these programs vary, for example IHSS in California and CDPAP in New York.

Some states let the person receiving care choose and hire their own workers, including in some cases a family member. See how to get paid to care for a family member.

To browse state programs, go to state Medicaid programs. For care at home, see home care, personal care and adult day care.

Medicaid eligibility and income limits

Medicaid.gov says federal law requires states to cover certain groups, such as low-income families and people who receive SSI. States can cover more. Besides income, states look at residency and citizenship or qualified immigration status. For long-term care they also look at resources, as the look-back and spousal rules below show.

For long-term care, three points matter most:

• People 65 or older, or who are blind or disabled, are generally evaluated with SSI income methods.
• Some states use a "spend-down" for people with high medical costs, which lets you qualify after subtracting medical expenses from income.
• Waiver and nursing facility coverage also require a need for that level of care.

There is no one national income limit for long-term care. Limits depend on your state and the eligibility group. The state table on Medicaid.gov covers children, pregnant women, parents and expansion adults, and does not cover long-term care. For long-term care limits, ask your state agency.

Medicare Savings Programs, which help with Medicare costs, have their own limits. See Medicare Savings Programs.

Does Medicaid pay for assisted living?

It can pay for some services, depending on the state. It generally does not pay for rent and meals.

The federal rule on waiver spending says federal funding is not available for the cost of room and board, with two exceptions: respite care in a state-approved facility that is not a private residence, and a share of rent and food for an unrelated live-in caregiver where the waiver allows it. In practice, a state assisted living program may pay for the care services and leave the resident to cover room and board from income.

Ask your state Medicaid agency which assisted living services it covers, whether there is a waiting list and how residents pay for room and board. Compare local options under assisted living and memory care.

The 60-month look-back rule

When you apply for long-term care coverage, the state reviews transfers of assets. Federal law sets a look-back of 60 months before the date you apply. If you gave away assets or sold them for less than fair market value in that window, you can be ineligible for nursing facility and some home care coverage for a period.

The length of that period comes from a formula: the total value transferred, divided by the average monthly cost of nursing facility care for a private patient in your state. The period starts on the later of the transfer date or the date you would otherwise be eligible and receiving institutional care.

The statute lists exceptions, including transfers of the home to a spouse, to a child under 21 or to a blind or disabled child, and to a child who lived in the home for at least two years and provided care that kept the person at home. It also lets a state waive the penalty for undue hardship.

Use the Medicaid look-back calculator to see how the formula works. It cannot tell you what your state will decide.

Protections for a married couple

When one spouse needs long-term care, the spousal impoverishment rules protect the spouse who stays home. Medicaid.gov says a portion of the couple's combined resources and some of the institutionalized spouse's income can be set aside for the spouse in the community.

The 2026 federal standards, from the CMS bulletin of April 27, 2026:

• Community spouse resources: minimum $32,532, maximum $162,660
• Monthly maintenance needs allowance: minimum $2,705.00 (effective July 1, 2026; higher in Alaska and Hawaii), maximum $4,066.50
• Community spouse monthly housing allowance: $811.50 outside Alaska and Hawaii
• Home equity limits: $752,000 to $1,130,000

Your state agency applies these to your couple. The spousal protection calculator shows how the numbers interact.

Estate recovery

The statute says states must seek recovery from the estate of a Medicaid enrollee age 55 or older for nursing facility services, home and community-based services and related hospital and prescription drug costs. Recovery can happen only after the death of a surviving spouse and only if no child under 21, or blind or permanently and totally disabled child, survives. States must have hardship waiver procedures. Ask your state agency what counts as the estate in your state.

Before you move any assets

Do not transfer, retitle or spend down assets to qualify for Medicaid until you have spoken to your state Medicaid agency or a qualified elder law attorney. A transfer made with good intentions can trigger a penalty period, and rules differ by state. Carevo is a connection platform and does not give legal or financial advice.

How to apply

Apply through your State Medical Assistance (Medicaid) office. Medicare.gov points people to Medicaid.gov to find their state office. If you are weighing options, compare Medicare, VA benefits, long-term care insurance and private pay, or tell us what care you need.