When people discover Medicare won't pay for long-term care, the next question is usually: then what will? For many families, the answer is Medicaid — the nation's largest payer of long-term care.
Medicaid rules vary a lot by state, so treat the figures here as general benchmarks and check your own state's specifics.
What Medicaid is (and isn't)
Medicaid is a joint federal-and-state program that provides health coverage based on limited income and, often, assets. Unlike Medicare, it does cover long-term care — including custodial nursing-home care — for those who qualify. States run it within federal rules, which is why it goes by different names (Medi-Cal in California, MassHealth in Massachusetts, and so on) and why eligibility and covered services differ from place to place.
Care at home, and paying family
Most states offer Home and Community-Based Services (HCBS) waivers that let people receive long-term care at home or in the community instead of in a facility — though many have waiting lists. And through 'self-directed' or 'consumer-directed' programs, the person receiving care can sometimes choose who is paid to provide it, which in many states can include a family member. The rules vary widely, so ask your state Medicaid office or Area Agency on Aging.
Medicaid generally does NOT pay for room and board in assisted living, but many states use HCBS waivers to cover the care-related services provided there. Nursing-home care, by contrast, can be covered for eligible residents, who then contribute most of their monthly income toward the cost.
- Find your state's program and rules through Medicaid.gov's state directory.
- Gather income and asset documentation before applying.
- If the goal is staying home, ask about HCBS waivers and any waiting list.
- Ask whether your state pays family caregivers through self-directed programs.
- Consult an elder-law attorney for asset, spousal, and estate-recovery questions.
Keep a folder of income statements, bank and asset records, property documents, insurance cards, and IDs — Medicaid applications require detailed proof — plus a dated log of submissions, confirmation numbers, and caseworker contacts.
Frequently asked questions
Does Medicaid pay for a nursing home?
Yes — for eligible enrollees, Medicaid covers care in a certified nursing facility with no set time limit, though the resident contributes nearly all of their monthly income toward the cost.
Does Medicaid pay for assisted living?
Medicaid does not cover room and board in assisted living, but most states use Home and Community-Based Services waivers to help pay for the care-related services provided there. Coverage varies by state.
What is the income limit to qualify for Medicaid long-term care?
A commonly cited 2025 benchmark is about $2,901/month for an individual, but limits vary widely by state, and some states handle nursing-home eligibility differently. Always check your state's rules.
Why is Medicaid different in every state?
Because it's a joint federal-state program — each state sets its own eligibility levels, waiver programs, and covered services within federal guidelines.
Can a family member get paid to provide care through Medicaid?
In many states, yes — through self-directed or consumer-directed programs, the person receiving care can sometimes hire a relative. Rules differ by state, and some exclude spouses or legal guardians, so ask your state Medicaid office.