Senior living & memory care

How Medicaid Covers Long-Term Care, State by State

Medicaid pays for nursing home care in every state and for assisted living only where a waiver exists. This guide names each state's program and explains the rules that decide eligibility — income, assets, and the five-year look-back — in terms families can act on.

Last updated: August 2026History

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Three different things called 'long-term care Medicaid'

Institutional Medicaid pays for nursing facility care. It is an entitlement: qualify and the state must cover it.

Home and community-based waivers pay for care outside a facility — at home or, in many states, inside a licensed assisted living residence. Waivers are capped, so slots and waiting lists exist. Where a waiver covers assisted living it pays for the care, not the rent: room and board stays with the resident, paid from their income.

Medicare is not in this picture. It pays for a limited post-hospital skilled nursing stay, not for long-term custodial care.

What Medicaid covers for long-term care by state

Each row is that state's own published summary, naming the waiver or program that operates there. Program names and limits change — confirm with the state agency.

State	What the state's own guide reported
Alabama	Whether Medicaid pays toward assisted living in Alabama is a state decision, not a federal guarantee. Federal law fixes only the floor: Medicare pays nothing toward custodial help with daily activities, and home and community-based coverage is optional, delivered under authorities each state selects for people who would otherwise need institutional care. Alabama's current answer — which waivers exist, who qualifies, what the limits are — is administered by the state Medicaid agency and changes.
Alaska	Medicare pays nothing toward custodial help with daily activities, which is why Alaska families reach Medicaid at all. Whether Medicaid then covers services in assisted living is a state decision, made under federal authorities that let each state choose differently.
Arizona	Yes. Arizona covers assisted living through ALTCS, the Arizona Long Term Care System, and it is one of the few states where that coverage does not sit behind a waiver waiting list.
Arkansas	Yes, through Living Choices Assisted Living, an Arkansas Medicaid waiver built specifically to pay for assisted living services. The constraint is the building: only a facility licensed at Arkansas's Level II can deliver it, which is a much smaller set than the places advertising assisted living. Arkansas also caps income, so a pension slightly over the line blocks eligibility until a qualified income trust is in place.
California	Yes, through the Assisted Living Waiver, but with a caveat that matters more than the answer. The waiver is capped, runs in a limited set of counties, and carries a waiting list, so the barrier in California is usually availability rather than eligibility. California is also not an income-cap state: it uses a share of cost instead, which means no qualified income trust is needed here.
Colorado	Yes. Colorado covers assisted living through what it calls an Alternative Care Facility, funded by the Elderly, Blind and Disabled waiver. The name matters: a building can be a licensed Assisted Living Residence and still not be an ACF, and only an ACF can bill the waiver. Colorado also caps income, so a pension over the line requires an income trust before eligibility begins.
Connecticut	Less than families expect, and the reason is structural. Connecticut does not license assisted living facilities at all. It licenses agencies that deliver services into residential settings, so what Medicaid can buy here is the service, never the apartment. Connecticut also runs no income cap: it uses a spend-down, which means a pension over the limit reduces help rather than ending it.
Delaware	Yes, Delaware Medicaid can pay for care delivered inside an assisted living facility, but not for the rent and meals. Coverage runs through Diamond State Health Plan-Plus, the managed care program that carries nearly all of the state's Medicaid long-term services.
Florida	Yes, but through a health plan and often after a wait. Florida covers assisted living services under its Statewide Medicaid Managed Care Long-Term Care program, paying for care while the resident pays rent and meals.
Georgia	Partly, and the licence type decides it. Georgia Medicaid pays for care in a personal care home through two elderly waivers, CCSP and SOURCE, but never for room and board.
Hawaii	Yes, through QUEST Integration, the single program that carries all of Hawaii's Medicaid. Med-QUEST pays for care services in a licensed residential setting but not for room and board.
Idaho	Yes, through Idaho's Aged and Disabled Waiver, which pays for the care delivered inside a residential assisted living facility but never for the rent and meals. The Idaho-specific trap is financial: Idaho caps income and offers no spend-down behind that cap, so a person even slightly over the limit must route the excess through a qualified income trust before they can qualify at all.
Illinois	Yes, but Illinois routes it through a programme with a different name. The Supportive Living Program pays for care in a supportive living facility, an Illinois category distinct from licensed assisted living, and covers the service package while the resident pays rent from their own income.
Indiana	Yes, through a waiver that Indiana rebuilt from the ground up in July 2024. PathWays for Aging now runs long-term care for Hoosiers 60 and over through managed care plans, and it covers assisted living services while leaving room and board to the resident. Indiana also caps income with no spend-down behind it, so an over-income applicant needs a qualified income trust before applying.
Iowa	Yes, through Iowa's Elderly Waiver, which pays for assisted living services but never for rent and meals. Two Iowa specifics shape everything: the waiver has a hard age floor at 65, so a 63-year-old with the same needs applies somewhere else entirely, and Iowa caps income, requiring what the state calls a medical assistance income trust for anyone above the line.
Kansas	Yes, through the Frail Elderly Waiver, which Kansas runs inside KanCare, its privatised Medicaid programme. The waiver pays for care in four different licensed settings, not just assisted living, and Kansas is unusually blunt that it is not an entitlement: qualifying does not guarantee a service.
Kentucky	No. Kentucky is one of the few states whose Medicaid programme pays nothing toward assisted living, so a certified assisted living community here is private-pay from the first day to the last.
Louisiana	Mostly no. Louisiana never built a broad Medicaid benefit for assisted living, so the state's licensed adult residential care communities are in practice private-pay.
Maine	Yes, though not under that name. MaineCare pays for care in residential settings through a category called the private non-medical institution, or PNMI: the programme pays for the services, the resident pays room and board out of their own income, and a state supplement helps close the gap.
Maryland	Yes. Maryland is one of the states whose Medicaid waiver actually reaches into an assisted living building: the Community Options Waiver pays for the services a resident receives there, while room and board stays with the resident.
Massachusetts	Yes, and Massachusetts does it through a benefit rather than a waiver. Group Adult Foster Care pays for the personal care a resident receives in an assisted living residence, and it sits in MassHealth's regular benefit package. A separate state supplement, SSI-G, helps with the rent.
Michigan	Yes, for people who qualify, through the MI Choice Waiver. But Michigan does not license anything called assisted living. It licenses adult foster care homes and homes for the aged, and MI Choice pays for the care delivered inside them, never for the room.
Minnesota	Yes, through the Elderly Waiver, which pays for a service package Minnesota calls customized living. The waiver does not cover room and board. A separate state program, Housing Support, is what can cover that.
Mississippi	Yes. Mississippi is one of a small number of states that built a Medicaid waiver specifically for assisted living, rather than folding it into a general home-care waiver. The waiver pays for care, never for room and board. The harder gate is financial: Mississippi caps income and offers no spend-down, so an applicant even slightly over the line needs an income trust.
Missouri	Partly, and Missouri's answer is unusual. There is no Medicaid waiver here that pays for assisted living the way most states' waivers do. Missouri instead offers Supplemental Nursing Care, a modest state cash grant to residents of licensed residential care and assisted living facilities, alongside personal care services.
Montana	Yes, through the Big Sky Waiver, which pays for care in a licensed assisted living facility but never for room and board. Montana also runs Community First Choice, a personal care benefit that is an entitlement rather than a capped waiver, so it carries no waiting list.
Nebraska	Nebraska Medicaid does not pay assisted-living rent. It can pay for the care delivered inside an assisted-living community, through the state's Aged and Disabled waiver, for people who meet both a financial test and a nursing-home level-of-care test.
Nevada	Nevada Medicaid can pay for care in an assisted-living setting — which Nevada law calls a residential facility for groups — through the Waiver for the Frail Elderly. It buys the care, not the housing: rent and meals still come out of your parent's income. Qualifying takes a nursing-home level-of-care finding plus a financial test with a hard income ceiling, and the waiver serves a limited number of people at a time.
New Hampshire	New Hampshire Medicaid can pay for care in an assisted-living or residential care setting through Choices for Independence, the state's home and community-based waiver. It pays for services, not for rent — your parent's Social Security and pension still cover room and board. Qualifying requires a nursing-home level-of-care finding and a financial determination, and the waiver serves a limited number of people, so approval and a start date are separate events.
New Jersey	New Jersey Medicaid pays for assisted living through MLTSS — Managed Long Term Services and Supports — which folds nursing home care and home and community care into a managed care plan. It covers the care, not the rent: room and board stays your parent's cost. Qualifying takes a clinical assessment plus a financial one, and income above the state's cap generally requires a qualified income trust.
New Mexico	New Mexico Medicaid can pay for care in an assisted-living setting through Turquoise Care, the managed care program that replaced Centennial Care in 2024.
New York	Yes, through the Assisted Living Program, but New York's answer is unusual. The ALP is not a waiver. It is a fixed pool of state-authorized beds inside licensed adult care facilities, and Medicaid pays for the care while the resident's own income covers room and board.
North Carolina	Not through a waiver, and North Carolina has no assisted living licence. It licenses adult care homes and family care homes. Medicaid Personal Care Services pays for hands-on help inside them, and a separate cash program, State-County Special Assistance, helps with room and board.
North Dakota	Mostly no, and North Dakota's answer needs its own vocabulary. The state licenses basic care facilities and assisted living facilities as two different things. Medicaid does not pay for either directly.
Ohio	Yes, through the Assisted Living Waiver, which is one of the few state programs actually named after the thing families search for. It pays for care inside a licensed residential care facility that holds a Medicaid agreement. Room and board stay with the resident, paid from their income.
Oklahoma	Sometimes, through the ADvantage Waiver, which does list assisted living services as a covered benefit. The catch is participation: a residence has to hold that contract, and few do. Oklahoma is unusual in genuinely licensing assisted living centers, so the phrase means something here.
Oregon	Oregon Medicaid can pay for the care you receive in an assisted living facility, a residential care facility, or an adult foster home — but never for the rent and meals. Those you cover from your own monthly income, minus a small personal-needs allowance.
Pennsylvania	Mostly no — and Pennsylvania is unusual in how plainly it says so. Medical Assistance, the state's Medicaid program, does not generally pay for a personal care home or an assisted living residence.
Rhode Island	Unusually, yes. Rhode Island is one of the states whose Medicaid program pays for the care delivered in a licensed assisted living residence, and it goes further than most: a state supplement helps with the room and board that Medicaid itself cannot cover.
South Carolina	No, not for the care in a community residential care facility — South Carolina's name for assisted living. Healthy Connections, the state's Medicaid program, pays for nursing facility care and for services at home through its waivers.
South Dakota	Yes. South Dakota is one of the states whose Medicaid program pays for care delivered in a licensed assisted living center, through the HOPE waiver. Room and board still comes out of the resident's own income — no state's Medicaid pays rent. The harder question here is rarely eligibility.
Tennessee	Tennessee Medicaid pays for assisted living, but not the way most families expect. TennCare covers the care services delivered inside an assisted-living residence through its CHOICES program: bathing, dressing, medication help, nursing oversight.
Texas	Texas Medicaid can pay for assisted living, through the STAR+PLUS Home and Community Based Services program. It covers the care delivered inside the residence, not the room and board.
Utah	Utah Medicaid can pay for the care delivered inside an assisted living residence, though never for room and board. The main route is the New Choices Waiver, and its design is unusual: it was built to move people out of nursing facilities, so it generally opens to someone already receiving care in one.
Vermont	Vermont Medicaid pays for long-term care through one program, Choices for Care, and it covers three settings: a nursing facility, care at home, or enhanced residential care inside a licensed residential care home or assisted living residence. Services are covered; room and board is not.
Virginia	In Virginia, Medicaid generally does not pay for assisted living. A separate program does: the Auxiliary Grant, a state and locally funded supplement for people with very low income, which pays a set rate toward room, board and care in a licensed assisted living facility or an approved adult foster care home.
Washington	Washington Medicaid pays for the care a person receives in an assisted living facility or adult family home, but never for the room and board — that rent-and-meals share stays a private bill.
West Virginia	In West Virginia, Medicaid rarely pays the rent-and-meals part of assisted living. Its help comes mostly through the Aged and Disabled Waiver, which funds personal care and support in a person's own home, and through coverage of nursing-facility care for those who qualify. To get it, a person must meet both West Virginia's medical level-of-care test and its income and asset limits.
Wisconsin	Wisconsin answers the assisted-living question differently from most states. Through its managed long-term care programs — Family Care and the self-directed IRIS option — Medicaid can pay for the care a person receives in an assisted-living setting, though never the room and board.
Wyoming	Wyoming pays for long-term care through Medicaid mainly by way of the Community Choices Waiver, which can fund care at home or in some assisted-living settings — but never the room and board.

Income, assets, and the look-back

Long-term care Medicaid applies its own financial tests, distinct from ordinary Medicaid. Income above the limit does not automatically disqualify: many states allow a qualified income trust or a medical spend-down. Assets are counted with important exclusions — typically a home within an equity limit while a spouse or dependent lives there, one vehicle, and personal belongings.

Spousal impoverishment rules exist specifically so the spouse remaining at home keeps a share of income and assets. And transfers made in the five years before applying are reviewed: gifts inside that window can create a penalty period during which Medicaid will not pay.

Before you spend anything down

Find your state's program, then get a benefits check-up before spending down anything. The look-back makes well-meant gifts expensive, and the spousal rules are more protective than most families assume. Your Area Agency on Aging can usually point you to free counseling.

Common questions

Only where the state runs a waiver that covers it, and then only for the care portion — room and board is paid by the resident from their income.

When you apply, the state reviews asset transfers made in the preceding five years. Gifts within that window can trigger a penalty period of ineligibility.

The home is often an excluded asset while a spouse or dependent lives there. Estate recovery after death is a separate rule and varies by state.

Senior living & memory care
How Medicaid Covers Long-Term Care in the District of Columbia
Senior living & memory care
How Medicaid Covers Nursing Home Care
Senior living & memory care
Medicaid Waivers for Senior Care, State by State

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When to Get Help Before Applying

—A planned gift or property transfer within the last five years
—A spouse remaining at home whose income depends on the applicant's
—A denial letter — appeals have deadlines measured in days

A fall with a head strike, sudden confusion, one-sided weakness or facial droop, chest pain, or trouble breathing is an emergency: call 911. A Medicaid application is never the reason to wait — the eligibility and coverage questions keep until afterward.

This article describes Medicaid long-term care coverage by state. It is general information, not legal or financial advice; rules change and are applied individually, so confirm with your state Medicaid agency or an elder law attorney.

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References

1.Centers for Medicare & Medicaid Services (2025). Spousal Impoverishment. Medicaid.gov (U.S. Centers for Medicare & Medicaid Services). linkSource carried forward from the state pages consolidated here; it is cited by 43 of them.
2.Administration for Community Living (HHS) (2025). Long-Term Care Ombudsman Program. ACL.gov (HHS Administration for Community Living). link ✓Source carried forward from the state pages consolidated here; it is cited by 42 of them.
3.Centers for Medicare & Medicaid Services (2025). Home & Community-Based Services 1915(c). Medicaid.gov (U.S. Centers for Medicare & Medicaid Services). linkSource carried forward from the state pages consolidated here; it is cited by 42 of them.
4.Centers for Medicare & Medicaid Services (2026). Long-term care coverage. Medicare.gov (U.S. Centers for Medicare & Medicaid Services). link ✓Source carried forward from the state pages consolidated here; it is cited by 38 of them.
5.Centers for Medicare & Medicaid Services (2025). Home & Community Based Services Authorities. Medicaid.gov (U.S. Centers for Medicare & Medicaid Services). linkSource carried forward from the state pages consolidated here; it is cited by 34 of them.
6.U.S. Government Accountability Office (2018). Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare is Needed. U.S. Government Accountability Office (GAO-18-179). linkSource carried forward from the state pages consolidated here; it is cited by 28 of them.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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