Medicaid Long Term Care Eligibility Requirements by Type of Program / Care Location

Summary
All states have three types of Medicaid Long Term Care relevant to seniors – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers, and Aged, Blind, and Disabled (ABD) Medicaid. The eligibility requirements vary by state, program and the applicant’s marital status. To find the eligibility criteria specific to your situation, use our Medicaid Eligibility Requirements Finder tool.

 

Nursing Home Medicaid

As the name implies, Nursing Home Medicaid covers the cost of long-term care in nursing homes. This includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

The financial eligibility requirements for Nursing Home Medicaid are an asset limit and an income limit. As of 2024, the asset limit for an individual in most states is $2,000, and the income limit is $2,829/month. These limits can vary by state and marital status. They are also updated every year, although the asset limit tends to remain the same while the income limit increases. For example, the income limit for Nursing Home Medicaid went from $2,523/month in 2022 to $2,742/month in 2023 to $2,829/month in 2024, while the asset limit stayed at $2,000 for those three years. However, it should be noted that Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help pay for the cost of the nursing home. They are allowed to keep a “personal needs allowance” that ranges from $30 to $200/month depending on the state, and they can keep enough to make Medicare premium payments if they are “dual eligible,” and enough to make Medicaid-approved spousal income allowance payments.

The functional, or medical, requirement for Nursing Home Medicaid is requiring a Nursing Facility Level of Care (NFLOC). This means the applicant requires the kind of full-time care that is normally associated with a nursing home. The exact definition of NFLOC, and how it is assessed, varies by state. In general, states evaluate how much help applicants need with the Activities of Daily Living – mobility, bathing, dressing, eating, toileting. Cognitive and behavioral issues can also be taken into consideration, and the applicant’s physician and other attending medical personnel may be asked for input.

Nursing Home Medicaid is an entitlement. This means that eligible applicants are guaranteed by law, aka “entitled,” to receive Nursing Home Medicaid benefits once their application has been approved. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Nursing Home Medicaid will only cover long-term care expenses in Medicaid-approved nursing homes with licensing and certifications that meet federal standards. Nursing Home Medicaid applicants can use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country, to help them find a Medicaid-approved nursing home near them.

 Home Ownership’s Impact on Eligibility: Homes are generally considered exempt from countable assets. However, this depends on the type of Medicaid, where the applicant lives and, if they are married, where their spouse resides. More details.

 

Home and Community Based Services Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help seniors remain living in the community instead of moving into a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care benefits for seniors who reside in their own home, the home of a loved or another setting in the community, like an assisted living facility. The type of long-term care benefits and where they can be provided vary by state and HCBS Waiver program (many states have multiple HCBS Waiver programs). While HCBS Waivers will cover services and supports in various settings, they will not pay for room and board in those settings with only a few rare exceptions.

Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for an HCBS Waiver program, they are not guaranteed by law to receive the benefits. Instead, there will be a limited number of enrollment spots. Once those spots are full, additional eligible applicants will be placed on a waitlist.

The financial eligibility requirements for HCBS Waivers are an asset limit and an income limit. As of 2024, the asset limit for an individual in most states is $2,000, and the income limit is $2,829/month. These limits can vary by state and marital status. Unlike Nursing Home Medicaid beneficiaries, most HCBS Waiver beneficiaries are allowed to keep all of their income. There are some HCBS Waivers that help cover the cost of living in an assisted living residence or a memory care facility, and beneficiaries of those type of Waivers are often required to give some or most of their income to the state to help cover those costs.

The functional, or medical, requirement for most HCBS Waivers in most states is requiring a Nursing Facility Level of Care (NFLOC). This means that even though the applicant is not going to a nursing home, they do require the kind of full-time care that is normally provided in a nursing home. The exact definition of NFLOC, and how it is assessed, varies by state. In general, states evaluate how much help applicants need with the Activities of Daily Living – mobility, bathing, dressing, eating, toileting. Cognitive and behavioral issues can also be taken into consideration, and the applicant’s physician and other relevant healthcare providers may be asked for input.

However, some HCBS Waiver programs have less restrictive functional requirements, like being at risk of requiring a NFLOC. And some of them base the services offered on the level of care required, so applicants can have a range of care needs and still qualify for the same Waiver. But for the most part, the functional requirement for an HCBS Waiver program is needing a NFLOC.

 

Aged, Blind, and Disabled Medicaid

Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care benefits to financially limited individuals who are aged (65 and older), blind or disabled and live in their own home, the home of a loved one or somewhere else in the community, like an assisted living facility. While ABD Medicaid will cover benefits in multiple settings, it will not pay for room and board costs, with only a few rare exceptions. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages.

ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

ABD Medicaid’s long-term care benefits can adult day care, home modifications, Personal Emergency Response Systems (PERS), and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). ABD Medicaid beneficiaries qualify for these benefits and services one at a time, which is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, ABD Medicaid recipients will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

The financial eligibility requirements for ABD Medicaid are an asset limit and an income limit. As of 2024, the asset limit for an individual in most states is $2,000, and the income limit ranges from $943/month to $1,677/month. These limits can vary by state and marital status.

The only functional requirement for receiving basic healthcare coverage through ABD Medicaid is being age 65 or over, blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, the state will conduct an assessment of their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry), as well as their cognitive abilities and social interaction issues, to determine the kind of long-term care the state will cover.