Medicaid is the main payer for long-term care in the U.S. (Medicaid.gov). It covers medical care and some long-term care for people with limited income who meet other requirements, and who is eligible varies by state (National Institute on Aging). Federal rules add a look-back on gifts, protections for a spouse at home, and recovery from the estate after death.
The main federal rules
| Rule | What it means |
|---|---|
| Eligibility | Set within federal limits by each state. Income, assets and level of care all count (National Institute on Aging) |
| 60-month look-back | For nursing home applicants, assets given away or sold for less than fair market value within the 60 months before applying can lead to a period of ineligibility (Legal Information Institute, Cornell Law School) |
| Spouse at home | A certain amount of the couple's resources is protected for the spouse living in the community. CMS publishes the yearly minimum and maximum (Medicaid.gov) |
| Income after approval | A post-eligibility calculation decides how much of their own income a resident contributes to the cost of care (Medicaid.gov) |
| Estate recovery | For people 55 or older, states must seek recovery from the estate for nursing facility care, home- and community-based services and related costs (Medicaid.gov) |
Where the care happens
- Institutional care. In a nursing facility, Medicaid's comprehensive care includes room and board (Medicaid.gov).
- Home- and community-based services. States can pay for services at home or in the community, often through waivers (Medicaid.gov). Other Medicaid services are prohibited from including room and board, which is why these programs generally do not pay rent (Medicaid.gov).
- PACE. Some states offer the Program of All-Inclusive Care for the Elderly, a combined Medicare and Medicaid program that helps most participants keep living at home. There may be a monthly charge (National Institute on Aging).
Protections around estate recovery
- States may not recover from the estate of someone survived by a spouse, a child under age 21, or a blind or disabled child of any age (Medicaid.gov).
- States must have procedures to waive recovery when it would cause undue hardship.
- A lien on a home during life is not allowed while certain relatives live there, including a spouse, a child under 21, a blind or disabled child, or a sibling with an equity interest.
Where to apply and get help
- Find your state's program through Medicaid State Overviews.
- Call your State Health Insurance Assistance Program for free counseling at 877-839-2675 (National Institute on Aging).
- The Eldercare Locator (800-677-1116) can connect you with local help (U.S. Administration for Community Living).
- Rules on assets and transfers are complicated. An elder law attorney can advise on your parent's own situation before they apply.
Common questions
Can Medicaid take my parent's house?
States must seek recovery from the estates of people age 55 or older for certain long-term care. They may not recover from the estate of someone survived by a spouse, a child under 21, or a blind or disabled child of any age, and must have procedures for hardship waivers. Ask an elder law attorney how this applies.
Can my parent give money to family to qualify?
Gifts or sales below fair market value made during the look-back period can lead to a period of ineligibility. Talk to an elder law attorney before moving any assets.
What happens to a spouse who stays at home?
Federal spousal impoverishment rules protect a certain amount of the couple's resources, and possibly income, for the spouse living in the community.
Related guides
Does Medicaid pay for assisted living?
Medicaid can pay for some care services in assisted living in some states, but not for room and board. Here is how it works.
Does Medicare pay for a nursing home?
Medicare covers up to 100 days of skilled nursing care after a qualifying hospital stay, not long-term custodial care. See the 2026 copays and run the day calculator.
How to pay for assisted living
The ways families pay for assisted living, from personal funds to Medicaid, VA benefits and long-term care insurance, side by side.
Sources
- Long Term Services & Supports, Medicaid.gov. Checked November 8, 2026.
- Institutional Long Term Care, Medicaid.gov. Checked November 8, 2026.
- Home & Community-Based Services, Medicaid.gov. Checked November 7, 2026.
- 42 U.S. Code § 1396p: Liens, adjustments and recoveries, and transfers of assets, Legal Information Institute, Cornell Law School. Checked November 8, 2026.
- Spousal Impoverishment, Medicaid.gov. Checked November 8, 2026.
- Estate Recovery, Medicaid.gov. Checked November 8, 2026.
- Paying for Long-Term Care, National Institute on Aging (NIH). Checked November 8, 2026.
- Eldercare Locator, U.S. Administration for Community Living. Checked November 7, 2026.
This guide explains general rules. It is not medical, legal or financial advice for your situation. Program rules and amounts change, usually each January (Medicare and Medicaid) and each October (VA). Confirm details with the agency or a qualified professional before you decide. See our editorial policy.