Overview of Eligibility Requirements for Medicaid Long Term Care

Summary
Medicaid Long Term Care eligibility is complicated because the requirements are updated annually or biannually, and they can change depending on what state you live in, your marital status and the type of Medicaid Long Term Care program. While this page provides an overview of the eligibility requirements, the easiest way to find information specific to your situation is to use our Medicaid Eligibility Requirements Finder tool.

Last Updated: Dec 11, 2024

Medicaid Eligibility Requirements Financial Criteria Medical Criteria Quick Comparison Table: Medicaid Eligibility 2025 Becoming Eligible When Over the Limits

Medicaid Eligibility Requirements

There are three types of Medicaid programs that cover long-term care for seniors: Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. Regardless of the type of Medicaid, all programs consider two major factors: financial need and medical need.

Age as a Qualifying Factor – It is worth noting that age does not impact the dollar limits for Medicaid Long Term Care eligibility, but rather can be a qualifying factor for a specific program. As an example, there will not be different income limits for people over and under 65 years of age, rather a Medicaid program is simply not open to people under 65.

Financial Criteria

Three factors are considered when determining if an applicant is financially qualified for Medicaid Long Term Care; 1) their assets, 2) their income and 3) their home. But how these factors are considered can change depending on the state, the applicant’s marital status and the Medicaid Long Term Care program.

Asset Rules
In most states in 2025, the individual asset limit for all three Medicaid Long Term Care programs is $2,000. The following assets are typically counted toward this limit:

Bank accounts
Retirement accounts
Stocks
Bonds
Certificates of deposit
Cash
Any other liquid assets that can be easily converted to cash

Not all assets count toward the limit, however. Some assets are exempt, including the applicant’s primary home in many cases (more on this below), as well as their primary vehicle, clothing, essential household appliances and furniture, and personal items like wedding rings.

The asset limit for a married couple with both spouses applying is either $3,000 or $4,000 for all three Medicaid Long Term Care programs in most states in 2025. Medicaid considers the assets of married applicants to be jointly owned. However, when only one spouse in a couple is applying for Nursing Home Medicaid or HCBS Waivers, the non-applicant spouse is allowed to keep up to $157,920 in assets thanks to the Community Spouse Resource Allowance (CSRA). The CSRA does not apply to ABD Medicaid.

As mentioned, these asset limits do vary by state. In New York, for example, the 2025 asset limits for all three programs are $31,175 for an individual and $42,312 for a married couple, and in California there are no asset limits.

To find the asset limit for your specific situation, use our Medicaid Eligibility Requirements Finder.

Income Rules
In most states in 2025, the individual income limit for Nursing Home Medicaid and HCBS Waivers is $2,901/month. For ABD Medicaid, the 2025 income limits range from $967/month to $1,795/month, depending on the state. Almost all income us counted toward these limits, including:

Social Security benefits
Pension payments
Retirement account distributions
Salary
Wages
Alimony
Property income

For married couples with both spouses applying for Nursing Home Medicaid or HCBS Waivers, the 2025 income limit in most states is $2,901/month per spouse. When only one spouse is applying for either of those two programs, the income of the non-applicant spouse is not counted. And if that non-applicant spouse does not have much income of their own, the applicant spouse is allowed to transfer some of their income to the spouse without penalty. Plus, that transferred income will not count against the applicant’s income limit. This is known as the Monthly Maintenance Needs Allowance (MMNA), and it ranges from $2,555/month to $3,948/month in 2025 depending on the state and the situation.

The ABD Medicaid income limit for married couples in 2025 ranges from $1,450/month to $2,658/month, depending on the state. This is for couples with both spouses applying and just one spouse applying, because the income of the non-applicant spouse is counted when it comes to ABD Medicaid. And the Monthly Maintenance Needs Allowance does not apply to ABD Medicaid either.

Caution: Applicants are not allowed to give away their financial resources in order to qualify for Medicaid. To make sure they don’t, Medicaid uses the Look-Back Period. In most states, the Look-Back Period is 60 months (five years), which means the state will look back into the applicant’s financial history for the 60 months prior to their application date to make sure they have not given away any assets or sold them at less than fair market value. If they have, their application will be denied and they will face a penalty period of ineligibility.

Home Ownership Rules
An applicant’s primary home is exempt from the asset limit in several situation. First, it’s exempt if the applicant will continue to live there after enrolling in Medicaid Long Term Care and they are under their state’s home equity interest limit. Home equity interest is the percentage of the home the applicant owns minus any outstanding debt, like a mortgage. In most states in 2025, the home equity interest limit is either $730,000 or $1,097,000, depending on the average real estate prices in the state.

The home can also be exempt if the applicant’s spouse, minor child or blind or disabled child of any age is living there, regardless of the applicant’s home equity interest or where they live. If not one lives in the home, it can still be exempt for a period of time if the applicant meets the state’s home equity interest limit and files an intent to return home statement with the state Medicaid offices.

If the home is not exempt, or the applicant does not meet the asset or income limits for some other reasons, there are still planning strategies they can use to qualify. These strategies tend to be complicated, and we recommend consulting with a professional like a Certified Medicaid Planner, Elder Law Attorney or Public Benefits Counselor before attempting them on your own.

Medical Criteria

The medical eligibility for Medicaid Long Term Care depends on the state and the program – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind and Disabled (ABD) Medicaid.

Basics: Nursing Home Medicaid and HCBS Waivers both require a Nursing Facility Level of Care, while ABD Medicaid does not have a level of care requirement.

In every state, Nursing Home Medicaid applicants must require a Nursing Facility Level of Care (NFLOC). How a NFLOC is defined and measured can vary by state, but in general it means the type of constant care and supervision associated with nursing home. States will evaluate applicants to assess if they require a NFLOC. A central part of most evaluations is an assessment of the individual’s ability to independently complete the Activities of Daily Living: mobility, bathing, dressing, eating and toileting. In some states, an inability to perform two of these activities might equal a NFLOC, in some states it might be three. Most assessments will also include communication with the applicant’s primary care providers.

Cognitive and behavioral issues are also considered when determining if a NFLOC is needed. A diagnosis of Alzheimer’s disease or other dementias will certainly impact the evaluation, but it does not guarantee a NFLOC designation.

The only functional requirements to receive basic healthcare coverage – physician’s visits, prescription medication, emergency room visits and short-term hospital stays – through ABD Medicaid are being aged (65 or over), blind, or disabled. For ABD Medicaid applicants who require long-term care services and supports, the state will conduct an evaluation to see if they need those specific long-term care benefits.

2025 Medicaid Long Term Care Eligibility Criteria Table

The table below provides general dollar values for the three types of Medicaid. These are not state-specific. This table should be used for comparative purposes. For accurate eligibility criteria, use our personalized Medicaid Eligibility Requirements Finder tool.

Medicaid Eligibility Requirement by Type of Medicaid Long Term Care Program
Type of Medicaid	Marital Status / # of Applicants	Monthly Income Limit	Countable Asset Limits	Home Equity Limit	Medical Criteria
Nursing Home Medicaid	Single	Approximately $2,900	$2,000	$730,000 or $1,097,000	Nursing Facility Level of Care
	Married w/1 Applicant	Approximately $2,900 for the applicant	$2,000 for the applicant. Up to $157,920 for the non-applicant.	$730,000, $1,097,000 or exempt if owner-occupied	Nursing Facility Level of Care
	Married w/2 Applicants	Approximately $5,800	$3,000 – $4,000	$730,000 or $1,097,000	Nursing Facility Level of Care
HCBS Waivers	Single	Approximately $2,900	$2,000	$730,000, $1,097,000 or exempt if owner-occupied	Nursing Facility Level of Care
	Married w/1 Applicant	Approximately $2,900 for the applicant	$2,000 for the applicant. Up to $157,920 for the non-applicant.	$730,000, $1,097,000 or exempt if owner-occupied	Nursing Facility Level of Care
	Married w/2 Applicants	Approximately $5,800	$3,000 – $4,000	$730,000, $1,097,000 or exempt if owner-occupied	Nursing Facility Level of Care
ABD Medicaid	Single	Approximately $960 – $1,800	$2,000	Exempt	Must show need for long-term care benefits
	Married w/1 Applicant	Approximately $1,450 – $2,600	$3,000	Exempt	Must show need for long-term care benefits
	Married w/2 Applicants	Approximately $1,450 – $2,600	$3,000	Exempt	Must show need for long-term care benefits

Ways to Become Medicaid Eligible When Exceeding the Limits

If you meet Medicaid’s medical criteria, but your income and/or assets exceed Medicaid’s financial limits, there may be other ways you can qualify for Medicaid Long Term Care.

For those with high medical costs that exceed their income, you may be deemed Medicaid-eligible if your state offers a Medically Needy Pathway. About 60% of states offer this program. If you spend a lot of your income on healthcare, Medicaid can deduct those costs from your income. If the remaining income is at or below your state’s income limit, you’re considered financially eligible, regardless of your income.

In states that don’t offer a Medically Needy Pathway, applicants with too much income can use a a Qualified Income Trust (QIT) to qualify for Medicaid. They simply deposit their excess income (the amount over their state’s income limit) into the QIT every month to become and maintain eligibility. The money in the QIT must be controlled by a trustee, not the Medicaid applicant. QIT funds can only be spent for medical expenses, Medicare premiums or other healthcare that is not covered by Medicaid.

Applicants who are over the asset limit can spend down their excess assets until they meet the limit. This is a common strategy, but you must follow the rules when it comes to spending down. For examples, you can’t just give away your assets, spend them on other people or sell them at less then fair market value. To learn more about spend down, click here.

Working with a Medicaid planning professional like a Certified Medicaid Planner can help with the above approaches and many other strategies to become Medicaid eligible.

More on alternative pathways to Medicaid eligibility.