Does Medicaid Cover Long-Term Care?

No matter how healthy and active you are today, the reality is that seven out of ten people who reach age 65 will need some form of long-term care (LTC) services. Whether it’s because of aging, a chronic illness, or a disability, long-term care services provide support when you or your loved one can no longer manage everyday tasks, like bathing, dressing, eating, or moving around safely.

These services can be expensive, so it’s no surprise that many seniors ask, “Does Medicaid cover long-term care?” It’s one of the most common questions families face when planning for the future. The good news is the answer to the question, “Does Medicaid cover long-term care?” is yes!

Does Medicaid Cover Long-Term Care?

As long as certain financial and medical criteria are met, Medicaid covers long-term care through a Medicaid LTC program. Medicaid LTC is a government-funded program within Medicaid that helps people who need assistance performing Activities of Daily Living (ADLs) due to disabilities, chronic illness, or aging. It covers non-medical and medical support services for ADLs, such as:

• Bathing

• Dressing

• Eating

• Using the bathroom

• Getting in and out of bed or a chair

In addition to ADLs, Medicaid LTC may assist with services like meal delivery, transportation, housekeeping, and specific modifications to one’s home.

What Are the Categories of Medicaid LTC?

Medicaid offers three LTC programs:

Nursing Home Medicaid

This program covers the full cost of care associated with a Medicaid-certified nursing home, including:

• Room and board

• Personal care

• Medical services

• Supervision

Nursing Home Medicaid is ideal for individuals with complex medical needs, severe mobility issues, or late-stage dementia. However, not all facilities accept Medicaid, so availability may be limited.

Home and Community-Based Services (HCBS) Waivers

HCBS Waivers allow eligible individuals to receive long-term care services at home or in a community setting rather than a nursing facility. This option is especially helpful if your loved one prefers to age in place or needs care in an assisted living community or adult day care.

Services may include personal care aides, meal preparation, transportation, and home modifications. However, there may be waiting lists or enrollment caps because these waivers are not entitlements.

Aged, Blind, and Disabled (ABD) Medicaid

ABD Medicaid supports individuals who are older than 65, blind, or disabled. This program provides long-term care services like personal assistance, case management, and medical transportation.

For example, imagine if a loved one is 80 years old, lives alone, and suffers from mobility issues due to a stroke. ABD Medicaid could cover regular visits from a personal care aide who helps them with bathing and dressing, escorts them to appointments, and even coordinates therapies. This type of support allows each person to continue living independently at home with dignity and safety.

ABD Medicaid services may be provided in various settings.

At-a-Glance Comparison of Medicaid LTC Programs

Program	Level of Coverage	Setting	Eligibility Criteria	Limitations
Nursing Home Medicaid	Most comprehensive	Medicaid-certified facility	Low income + nursing facility level of care	Limited facility options, must be Medicaid certified
HCBS Waivers	Moderate to high	Home or community	Same as nursing home	Not guaranteed; may have waitlists
ABD Medicaid	Varies by state	Flexible (home, community, facility)	Age 65+, blind, or disabled; income/assets limit	More limited services in some states

What Services Are Covered by Medicaid LTC?

While coverage varies by program and state, Medicaid LTC typically covers or helps pay for:

• Nursing care

• Assistance with ADLs

• Room and board in a facility

• Adult day health programs

• Personal care aides

• Transportation to medical appointments

• Case management

• Medical equipment and supplies

Some states even provide caregiver respite support through Medicaid HCBS. Check with your state’s Medicaid program for specific details.

Who Qualifies for Medicaid Long-Term Care Coverage?

To qualify for Medicaid LTC, you or your loved one must display the medical need for services and meet financial eligibility requirements.

1. Medical need: The person must require assistance with at least two ADLs or meet their state’s definition of nursing facility level of care.

2. Financial eligibility: Medicaid is a needs-based program, so your assets and income must fall below state-specific limits. Most states set the asset limit at $2,000 for individuals. Some assets, like a primary residence, one vehicle, or personal belongings, are exempt.

If you are relatively healthy and aging but need light help around the house, you likely won’t qualify for Medicaid LTC. However, you may become eligible if you need daily hands-on help or supervision due to a decline in physical or cognitive abilities.

Tips for Finding a Long-Term Care Facility That Accepts Medicaid

Locating a suitable long-term care facility for a loved one and navigating Medicaid can be overwhelming. Use the following practical tips to avoid common roadblocks:

• Start your search early. Not all nursing homes or assisted living facilities accept Medicaid, so it’s wise to begin your search early.

• Ask direct questions. When contacting a facility, ask if they accept Medicaid, if they have Medicaid-certified beds, and whether there’s a waiting list.

• Use online tools. Your state Medicaid website, eldercare locator tools, or services like A Place for Mom can help narrow your options.

• Check with your employer. More employers are starting to offer caregiver support through services as a benefit. Services like Wellthy can help you manage logistics and connect with vetted providers.

• Talk with a social worker. Hospital discharge planners or social workers are often familiar with local facilities and can offer guidance.

How Much Does Medicaid Cover for Long-Term Care?

Medicaid typically covers the full cost of long-term care for those who qualify, including room and board, personal care, medical treatment, and other supportive services. However, recipients are usually expected to contribute most of their income toward the cost of their care, which is known as patient liability.

States allow small deductions for things like a personal needs allowance, dependents, or maintaining a home for a spouse. For example, Georgia’s Personal Needs Allowance is $70 monthly.

Can Someone Have Long-Term Care Insurance and Medicaid LTC?

Yes! You’re allowed to have long-term care insurance and Medicaid LTC. Using long-term care insurance and Medicaid can be a smart combination. Some people use long-term care insurance to pay for services while “spending down” their assets. They can apply for Medicaid LTC when their policy ends or resources fall below Medicaid limits. Some states even have LTC Partnership Programs that let you keep more assets if you have qualifying insurance.

For more, check out our blog, Preserving Wealth and Dignity: Long-Term Care Planning for Seniors.

How Long Can Someone Receive Medicaid Long-Term Care?

There’s no hard time limit on how long someone can receive Medicaid LTC benefits. The coverage doesn’t run out or lapse. However, eligibility is periodically reviewed to ensure the individual remains qualified.

Key Takeaways

• Medicaid LTC provides benefits through Nursing Home Medicaid, HCBS Waivers, and ABD Medicaid to those who meet the financial and medical criteria.

• You can receive services at home, in a facility, or through community-based organizations.

• Having private long-term care insurance doesn’t disqualify someone from Medicaid. In fact, it may supplement and offer valuable support.

• Coverage continues as long as the individual remains eligible.

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