Medicare & Medicaid
Last checked: May 2026
Medicaid long-term care can help pay for nursing home care or long-term help at home. The hard part is that each state runs its own Medicaid program. The forms, income rules, asset rules, and waiting lists can differ by state.
This guide explains where to start, what to ask for, what papers to gather, and what to do if the application is delayed or denied.
Quick answer
To apply for Medicaid long-term care, you usually apply through your state Medicaid agency and ask for long-term services and supports. Medicaid may review both money and care needs. For nursing home care, the nursing home business office often helps with the Medicaid part. For home care, you may need a Medicaid long-term care assessment or a home and community-based services waiver request.
Start with your state Medicaid office on Medicaid.gov. If the person wants to stay at home, also contact the local Area Agency on Aging through the Eldercare Locator. Ask for the exact long-term care Medicaid application path in your state.
Who this helps
This guide is for a family caregiver who needs help paying for long-term care. That may mean care in a nursing home. It may also mean help at home with bathing, dressing, meals, toileting, supervision, or safe movement.
It can help if:
- A parent, spouse, or relative can no longer live safely without daily help.
- A hospital or rehab center says the person cannot go home without more care.
- A nursing home bill is starting, and private pay will not last.
- The person wants to stay at home, but family care is no longer enough.
- You were told to apply for Medicaid, but no one explained which Medicaid path to use.
If you are trying to learn whether a family member can be paid to provide care, read our guide on getting paid as a caregiver. That is related, but it is not the same as applying for Medicaid long-term care for the person who needs help.
What Medicaid long-term care may cover
Medicaid.gov says Medicaid is the primary payer for long-term services and supports in the United States. These services can be provided in an institution, such as a nursing facility, or in home and community settings. See the federal overview of Medicaid long-term services and supports.
For a family, this often means one of two broad paths.
| Care path | What it may help pay for | What to ask for |
|---|---|---|
| Nursing home Medicaid | Long-term care in a Medicaid-certified nursing facility for someone who meets state financial rules and nursing facility level of care rules. | Ask the state Medicaid office and the nursing home business office how to apply for long-term care Medicaid. |
| Home and community-based services | Help at home or in the community. Services vary by state and program. They may include personal care, adult day services, respite, homemaker help, or other supports. | Ask for a long-term care assessment and the home and community-based services waiver or state plan home care path in your state. |
| Managed long-term services and supports | In some states, Medicaid long-term care is delivered through a managed care plan. | Ask whether your state uses a managed long-term care plan and how enrollment works. |
Medicaid-certified nursing facilities provide skilled nursing or medical care, rehabilitation, and long-term care that is needed regularly because of a physical or mental condition. Medicaid.gov explains this on its nursing facilities page.
Home and community-based services can help people receive services in their own home or community instead of an institution. The exact services and waiting lists depend on the state program. Medicaid.gov explains this on its HCBS page.
Medicare is different. Medicare.gov says Medicare does not cover long-term care or custodial care when that is the only care needed. Medicare may still cover hospital care, doctor care, drugs, and some skilled nursing facility care if the person meets Medicare rules. See Medicare.gov long-term care coverage and our guide to what Medicare covers.
The nursing home route is not the same as the home care route
Do not assume one Medicaid application covers every care setting. It might not. Many states have a different process for nursing home coverage, home care, waiver services, adult day care, or managed long-term care.
If the person is already in a nursing home
Ask the business office if the facility accepts Medicaid and whether the person is in a Medicaid-certified bed. Then ask how the facility handles Medicaid pending cases. A nursing home may help collect documents, but the state makes the eligibility decision.
If the person is in the hospital or rehab
Ask the discharge planner for a written care plan and a list of safe discharge options. If Medicaid long-term care may be needed, ask whether a Medicaid application, nursing facility level of care review, or home care assessment should start before discharge. See our guide to hospital discharge rights.
If the person wants to stay at home
Ask the state Medicaid office or local aging agency how to request home and community-based services. Some programs have waiting lists. Some require nursing home level of care. Some allow a family member to be paid under certain rules.
If your state has a waiver program, read our plain guide to Medicaid HCBS waivers. If you are checking whether the person can afford care at home, our care cost calculator can help you list the costs before you call.
Who may qualify
Medicaid long-term care usually has two main tests. The person must meet financial rules. The person must also meet care-needs rules for the type of long-term care requested.
The financial review
The state may review income, assets, bank accounts, retirement accounts, life insurance, property, vehicles, trusts, transfers, and other items. The exact rules depend on the state and the Medicaid category. Medicaid is run by states under federal rules, as explained by Medicaid.gov.
If income is too high, there may still be a path in some states. Some states have spend-down or medically needy rules. Some states use income trusts for certain long-term care cases. Do not guess. Ask the state Medicaid office what path applies. You can also read our guide to Medicaid spend-down.
The care-needs review
The state may assess whether the person needs a nursing facility level of care or another level of long-term support. The review may look at help needed with bathing, dressing, eating, toileting, getting in and out of bed, walking, medication support, memory problems, behavior risks, and supervision needs.
For home care programs, the state may send a nurse, case manager, or assessor. For nursing home care, the facility and state may complete level-of-care paperwork. Keep hospital notes, therapy notes, discharge papers, and doctor statements because they can help show the care need.
If the person is married
Do not assume the at-home spouse must spend everything. Federal Medicaid spousal impoverishment rules protect a certain amount of income and resources for the spouse who remains in the community. The protected amounts change and state treatment can differ. Review the Medicaid.gov page on spousal impoverishment and ask your state Medicaid office for the current state numbers.
Where to start first
Start with the care setting. The right first call depends on where the person is right now.
- If the person is in a nursing home: call the nursing home business office and ask for the Medicaid long-term care application packet and Medicaid pending policy.
- If the person is in a hospital or rehab: ask the discharge planner for the safest care options and whether a Medicaid long-term care application or assessment should start now.
- If the person is at home: use Medicaid.gov’s state Medicaid finder to reach your state office. Also contact the Eldercare Locator to find the local Area Agency on Aging.
- If the person is a veteran: check whether VA long-term care or Aid and Attendance may also help. VA says some long-term care services may be covered for enrolled veterans, and Aid and Attendance may add money to a VA pension for qualified veterans and survivors who need help with daily activities. See VA long-term care, VA Aid and Attendance, and our guide to VA Aid and Attendance.
Phone script for the first call
Use this when calling the state Medicaid office, local aging agency, or nursing home business office.
Script: “Hi. I am helping my [mother/father/spouse/relative] apply for Medicaid long-term care. They need help with [bathing, dressing, toileting, meals, supervision, nursing home care]. I need to know the correct application path in this state. Should we apply for nursing home Medicaid, home and community-based services, a waiver, or managed long-term care? What forms and documents do you need, and how do we request the care-needs assessment?”
Before you hang up, ask for the person’s name, the date, the case number if there is one, and the next deadline.
Documents that may be needed
States differ, but many Medicaid long-term care applications ask for proof of identity, residence, income, assets, insurance, and care needs. Start a folder before you apply.
- Photo ID or other proof of identity
- Social Security card or Social Security number
- Medicare card, Medicaid card, and other insurance cards
- Proof of citizenship or qualified immigration status, if requested
- Marriage certificate, divorce papers, or spouse information, if married or recently married
- Power of attorney, guardianship papers, representative form, or signed permission to speak with the agency
- Bank statements for the months or years requested by the state
- Proof of Social Security, pension, annuity, wages, rental income, or other income
- Retirement account statements
- Life insurance policy information
- Deeds, property tax bills, mortgage statements, or home value information
- Vehicle titles or registration
- Trust documents, if any
- Funeral or burial contract information, if any
- Medical bills, unpaid care bills, and nursing home bills
- Hospital discharge papers, rehab notes, doctor letters, medication lists, therapy notes, and care plans
If you need help getting legal authority to apply or speak for a parent, see our guide to power of attorney for an aging parent. Keep copies of everything you send. If you upload papers online, save the confirmation page.
Do not give away money or property before asking
Medicaid long-term care has transfer-of-asset rules. Federal Medicaid guidance explains that the look-back period for certain transfers was extended to 60 months. Another CMS letter explains that the 60-month look-back can apply when a person has applied for Medicaid and is an institutionalized individual, including some home and community-based waiver cases. See CMS guidance on transfer-of-asset changes and HCBS waiver transfer rules.
In plain English: if the person gave away money, sold property for less than fair value, added someone to an account, moved assets into a trust, or made large gifts, the state may ask questions. A transfer can delay Medicaid payment for long-term care.
There are exceptions and state details. Do not try to fix a problem by moving more money. Ask the state Medicaid office, a qualified elder law attorney, or a legal aid office before making transfers. For more, read our guide to the Medicaid look-back period.
What happens after you apply
After you apply, the state may ask for more documents. It may also schedule a care-needs assessment. If the person is in a nursing home, the facility may help with parts of the process, but you should still track the case yourself.
Federal rules say Medicaid eligibility decisions must be made promptly and without undue delay. The federal time limit is generally 45 days, or 90 days when eligibility is based on disability, with exceptions allowed in some cases. See 42 CFR 435.912. Long-term care cases can still take time because the state may need bank records, transfer answers, medical records, or level-of-care paperwork.
Medicaid pending in a nursing home
Some nursing homes accept a resident while the Medicaid application is pending. This is often called Medicaid pending. It does not mean the state has approved payment. It means the facility is waiting for a Medicaid decision.
Ask the facility these questions in writing:
- Do you accept Medicaid pending residents?
- Is this bed Medicaid-certified?
- What happens if Medicaid is denied?
- Who sends documents to the state?
- What monthly amount must be paid while the case is pending?
Do not rely only on a verbal answer. Ask for the admission agreement, payment terms, and Medicaid pending policy.
If home care is approved
The state or managed care plan may create a care plan. It may list the number of approved hours, services, provider agency, start date, and review date. If the approved help is too low or does not meet the person’s needs, ask how to request a reassessment or appeal.
If your state allows family caregivers to be paid through a program, the rules may include background checks, training, live-in rules, agency enrollment, or limits on spouses or legal representatives. Start with our guide to structured family caregiving and the paid caregiver quiz, but confirm your state’s rules.
What usually goes wrong
Many Medicaid long-term care problems are not caused by one big mistake. They happen because no one tells the family what the state needs.
- The family applies for regular Medicaid only. Ask if there is a separate long-term care, nursing home, HCBS waiver, or managed long-term care application.
- The state asks for old bank statements. Request them early. Banks may take time.
- The caregiver has no authority to speak. Ask the agency what representative form, power of attorney, or guardianship document it accepts.
- The nursing home says it is handled, but the state still needs papers. Keep your own checklist and call the caseworker.
- The person is over the income limit. Ask about spend-down, medically needy rules, income trusts, or other state-specific paths. Do not assume there is no path.
- There was a gift or transfer. Answer honestly. Ask how the state calculates any penalty and whether an exception or hardship rule applies.
- Home care has a waiting list. Ask if there is another state plan service, adult day program, respite option, PACE program, or urgent risk process.
- The care assessment misses real needs. Keep notes for three days. List falls, night care, wandering, incontinence, transfers, medication help, and unsafe time alone.
What to do if the first path does not work
If Medicaid long-term care is denied, delayed, or not enough, do not stop at the first answer. Ask for the reason in writing. Then match the next step to the problem.
If income or assets are the issue
Ask about spend-down, medically needy rules, spousal protection, income trusts, and which assets count. Rules differ by state. Our Medicaid spend-down guide can help you prepare questions.
If care needs were denied
Ask for the assessment result. Gather doctor notes, hospital records, fall history, dementia safety notes, and caregiver logs. Ask how to request a new assessment or appeal.
If home care has a waiting list
Ask the local aging agency about respite, adult day services, meals, transportation, caregiver support, or emergency options. See our guide to respite care for caregivers.
If Medicare denied a short-term service
Medicare is not the main payer for long-term custodial care, but it may cover some skilled care. If a Medicare service was denied, read our guide on how to appeal a Medicare denial.
If the answer is no, ask about appeal rights
A Medicaid denial should come with a notice. Read the notice carefully. It should explain why the state denied, reduced, delayed, or ended coverage and how to request a fair hearing or appeal. Medicaid.gov has application and fair hearing resources. Its fair hearing factsheet explains that federal Medicaid fair hearing rules apply in all states, but some state practices vary.
Do these steps right away:
- Find the appeal deadline on the notice.
- Request the appeal before the deadline.
- Ask for the full case record or reason for denial.
- Send missing documents with proof of delivery.
- Ask whether benefits can continue during the appeal, if the person was already receiving services.
- Contact legal aid, an elder law attorney, or a Medicaid rights group if the case involves a home, spouse, transfer penalty, or loss of care.
Appeal phone script
“Hi. I received a Medicaid long-term care notice dated [date]. It says [denied/reduced/delayed]. I want to understand the reason and the deadline to appeal. Please tell me how to request a fair hearing, where to send documents, and how to get a copy of the case record.”
Ask about estate recovery before you sign
Medicaid estate recovery can surprise families later. Medicaid.gov says states must seek recovery from the estate of some Medicaid enrollees age 55 or older for nursing facility services, home and community-based services, and related hospital and prescription drug services. States may also have their own details. Read Medicaid.gov’s estate recovery page and ask your state what applies.
This does not mean every family will lose a home. There are protections, deferrals, exceptions, and state rules. But families should know the rule before they apply. If a home, spouse, disabled child, caregiver child, trust, or probate issue is involved, get state-specific legal help.
Official sources used for this update
For this May 2026 update, we checked these sources:
- Medicaid.gov long-term services and supports
- Medicaid.gov home and community-based services
- Medicaid.gov nursing facilities
- Medicaid.gov state Medicaid office finder
- Medicare.gov long-term care coverage
- 42 CFR 435.912 on timely Medicaid decisions
- Medicaid.gov application and fair hearing resources
- Medicaid.gov spousal impoverishment rules
- Medicaid.gov estate recovery
- ACL Eldercare Locator
- VA long-term care services
State Medicaid rules change. Before you act, confirm the current rule with your state Medicaid agency or a qualified local adviser.
Resumen en espanol
Medicaid puede ayudar a pagar cuidado a largo plazo en un hogar de ancianos o ayuda en casa. Las reglas cambian por estado. Llame a la oficina de Medicaid de su estado y pregunte por la solicitud correcta para cuidado a largo plazo. Si la persona quiere quedarse en casa, pregunte por servicios en el hogar y la comunidad.
Prepare documentos de identidad, ingresos, cuentas bancarias, seguro medico, propiedad, facturas medicas y notas del medico. No regale dinero ni propiedad antes de preguntar, porque Medicaid puede revisar transferencias hechas en los ultimos 60 meses. Si le niegan la solicitud, pida la razon por escrito y pregunte como apelar.
About This Guide
CaregiverBenefits.org writes for family caregivers who need clear benefit steps, not policy talk. This guide explains the national Medicaid long-term care process and points you to state and local offices because the final rules are state-specific.
Plain disclaimer
This guide is general information. It is not legal, financial, medical, or benefits advice. Medicaid rules can change and can differ by state. Always confirm your case with your state Medicaid agency, local aging agency, or a qualified adviser.
FAQ
Does Medicaid pay for long-term care?
Yes, Medicaid can pay for long-term services and supports for people who meet state financial rules and care-needs rules. It may cover nursing home care or certain home and community-based services, depending on the state and program.
Is Medicaid long-term care the same as regular Medicaid?
Not always. A person may have Medicaid health coverage but still need a separate long-term care assessment, waiver request, nursing home approval, or managed long-term care enrollment. Ask your state Medicaid office which path applies.
Does Medicare pay for nursing home care?
Medicare may cover limited skilled nursing facility care when Medicare rules are met. Medicare does not cover long-term custodial care when that is the only care needed. Medicaid is often the main public program families look at for long-term care payment.
Can I apply before the person runs out of money?
Often, yes. Timing matters. The person may not be eligible until financial and care-needs rules are met, but waiting too long can cause unpaid bills or rushed decisions. Ask the state Medicaid office or nursing home when to file.
What is Medicaid pending?
Medicaid pending usually means a Medicaid application has been filed and a nursing home or provider is waiting for a decision. It is not an approval. Ask what happens if the state denies the application.
What if my parent gave money away?
Tell the truth on the application. Medicaid long-term care has transfer rules and a look-back period. A gift or transfer for less than fair value can delay payment. Ask for state-specific help before moving any more money.
Can a spouse keep any money?
There are spousal impoverishment protections for some married applicants. These rules can protect income and resources for the spouse who remains at home. The amounts change, and state treatment can differ.
What should I do if Medicaid denies long-term care?
Read the notice. Find the appeal deadline. Ask for the reason in writing. Request a fair hearing or appeal before the deadline. Send missing records and ask for legal help if the issue involves a home, spouse, transfer, or loss of care.
