Medicaid is a joint federal and state health insurance program designed for low-income individuals that can help cover some of the costs associated with long-term care, including assisted living.
But who qualifies, and how much does Medicaid cover? We’ll examine the ins and outs of Medicaid options for assisted living so you can budget accordingly in case you need to move into one of these senior care facilities in the future.
[READ: Medicare vs. Medicaid: Key Differences, Eligibility & Coverage]
Does Medicaid Pay for Assisted Living?
Medicaid may pay for some aspects of assisted living, but not all. For instance, the National Council on Aging reports that Medicaid does not cover room and board, two significant contributors to the price tag of assisted living communities.
The median monthly cost of an assisted living facility is $5,900, according to Genworth and CareScout. NCOA notes that nearly 1 in 6 assisted living residents depends on Medicaid to pay for daily care services.
Medicaid home and community-based services waivers
However, most states have Medicaid waiver programs to help cover other costs associated with assisted living
. Technically referred to as home and community-based services (HCBS) waivers or 1915(c) Medicaid waivers, these programs help cover some of the services and supports that older adults and some people with certain disabilities need but cannot otherwise afford.
Currently there are 636 Medicaid state waiver programs across the country. Who’s eligible, which services covered and which program are available vary by state and the individual waiver program. This makes it difficult to generalize what and who is covered, so you’ll have to do some investigation about the options in your state. Here are just a few examples that show the complexity and localized nature of these programs:
— In Florida, HCBS waivers have been eliminated, and assisted living is covered through the Statewide Managed Medicaid Care Long-Term Care program.
— In Louisiana, Medicaid does not currently pay for assisted living costs, but the Community Choices Waiver benefit does cover monitored in-home caregiving, which is similar to adult foster care.
— In Maryland, the Community Options Waiver supports eligible individuals who need assisted living care but don’t yet need nursing home care.
— In New York, the Assisted Living Program provides about 4,200 assisted living units statewide, but these units are not restricted to Medicaid participants.
— In Texas, the Star Plus program will cover the cost of services provided in an assisted living community, but room and board are not included.
Medicaid beneficiaries who are enrolled in their state’s HCBS waiver program often receive long-term care services and support in their own homes rather than in an institutional setting. Providing care in the person’s house or in an assisted living facility is usually less expensive than providing the same care in a nursing home.
Medicaid.gov provides a list of all state waiver programs with more information about which programs are available in each state, what’s covered and how to find out more about qualifying and applying.
[Read: Medicaid Coverage for Nursing Home Care.]
Assisted Living Costs Covered by Medicaid
Medicaid, or more specifically HCBS waivers, may cover some or all of the following senior care services for those who are unable to pay:
— Activities of daily living, such as toileting and personal hygiene
— Nursing care
— Medical supplies and equipment
— Medication management
— Medical assessments and exams, such as preventive care, checkups and diagnostic tests
— Case management services (coordination with medical providers)
— Respite care for a primary caregiver
— Mental health services
— Access to senior centers or adult day care services
— Transportation services, particularly to and from medical appointments
[Read: Assisted Living Costs: A Guide to Expenses and Payment Options]
These waivers can provide a lifeline for many older adults in assisted living situations. However, NCOA notes that these programs have limited enrollment because some states cap the number of waivers that are available at any one time as a means of controlling costs. That means some people who meet all the requirements will end up on a waiting list until a slot becomes available.
These waiting lists can be lengthy, and placement is prioritized based on level of care needed — they are not first come, first served. According to 2024 data from independent health policy research organization KFF, more than 710,000 people were on HCBS waiting lists in 2024.
If you find yourself on an HCBS waiver waiting list, you may be able to access other Medicaid services in the meantime. But because each state administers waivers and Medicaid benefits differently, you’ll have to inquire with your state’s Medicaid agency or department of health and human services for what services you may qualify for while you wait.
Assisted Living Costs Not Covered by Medicaid
As noted above, while Medicaid covers most of your nursing and medical care while you’re living in an assisted living community, it won’t pay for your room and board.
Your state agency can help you determine your eligibility for any supplemental assistance programs, explain what exactly is covered and tell you how to enroll. The Medicaid.gov website lists numerous resources for assistance with paying for assisted living expenses.
Do All Assisted Living Facilities Accept Medicaid?
No, not all assisted living facilities accept Medicaid. The facilities that do may cap the number of beds available to residents who rely on Medicaid.
However, facilities that don’t accept Medicaid may still allow service providers into the facility to care for Medicaid-funded residents. It can be complicated, so be sure to ask any facility you’re considering moving into about their Medicaid coverage policies.
Your local Area Agency on Aging can also help you figure out which communities near you accept Medicaid and how to find the right place for your needs.
How to Qualify for Medicaid
According to the Centers for Medicare & Medicaid Services, to qualify for Medicaid, you must meet several criteria:
— Your income must be below your state’s Medicaid income limit, or your medical-related care expenses must exceed your income.
— Your “countable assets” (cash, stocks, bonds, investments, bank accounts and real estate holdings that are not your primary residence) must fall within a certain range.
— You must be a citizen of the U.S. or a permanent resident.
— You must reside in the same state where you’re seeking benefits.
— You must have a qualifying medical need.
Medicaid spend down process
Some individuals have incomes that are too high to qualify for Medicaid but too low to afford long-term care out of pocket. These individuals may need to navigate a complex Medicaid spend down process
, where they reduce countable income or assets to meet eligibility requirements. Income eligibility limits vary by state and by waiver program.
For example, in Alabama, a single person can’t have an income of more than $2,901 per month to qualify for Medicaid waivers and HCBS. In California, however, the qualifying income limit for these programs is even lower, at $1,801 per month.
In short, it gets complicated quickly, and there are strict rules for the spend down process that vary by state. Contact Medicaid for details about what documentation you’ll need and how to initiate the spend down process to meet Medicaid eligibility standards.
Kate Granigan, CEO of LifeCare Advocates in Newton, Massachusetts, and president of the board of directors with the Aging Life Care Association, recommends working with an elder law attorney who specializes in Medicaid. They can help ensure you meet the strict criteria and avoid “unknowingly disqualifying yourself by making financial gifts” or stumbling into other pitfalls that could affect your qualification status.
She also notes that senior living facilities that accept Medicaid often have someone on staff who can help you navigate the process of applying.
Early planning for senior care expenses
Medicaid may not become an option until you’ve spent down your assets to meet the qualifying financial threshold, so it’s best to plan ahead to finance care using other resources, such as long-term care insurance policies, for as long as possible, says Stephanie Pogue, a St. Louis-based certified Medicare insurance planner and the CEO of St. Louis Insurance Group.
Such policies can help pay for assisted living communities, “but the policy must be in place for a period of time prior to using the services, and you must be healthy enough to qualify for it initially,” Pogue says.
If you don’t have such a policy, you may be in for a bumpy ride until you have used up your reserves enough to qualify for Medicaid.
“People must pay out of pocket until their assets are depleted and the state’s Medicaid program steps in,” Pogue explains.
How to Qualify for Medicaid Payments for Assisted Living
To qualify for a Medicaid HCBS waiver for assisted living, you must meet certain financial and functional requirements set by the state where you live. While these criteria vary by state, many states set the income limit at no more than of 300% of the Federal Benefit Rate — the maximum monthly federal payment for individuals who qualify for Supplemental Security Income.
The 2025 Federal Benefit Rate is $967 for a single individual and $1,450 for an eligible couple. So, if you’re taking in more than $2,901 per month as an individual or $4,350 as a married couple, Medicaid won’t be able to help you.
The Federal Benefit Rate is adjusted annually in accordance with the Social Security Cost of Living Adjustment rate. In some years, the increase is 0%, as occurred in 2016; however, in others, it may be significantly higher — in 2023, the COLA was 8.7%. The COLA for 2026 is 2.8%.
Also worth noting: If you qualify for Social Security Insurance benefits, you’ll also qualify for Medicaid benefits in some states, the American Council on Aging reports.
How to Apply for Medicaid
Using Medicaid benefits to cover some of the costs of assisted living will require you to apply for and receive an HCBS waiver, and that’s not guaranteed because each state has caps on program enrollment.
The application process for these waivers also varies by state, but no matter what, you’ll have to apply for Medicaid if you aren’t already enrolled.
You can contact your state Medicaid agency for advice on how to apply. As mentioned, the Medicaid.gov website is also a great resource for understanding your options and accessing this benefit. You can also find more information on the Medicaid application information site.
Other Ways to Cover Assisted Living Costs
Many people assume that Medicare will cover senior care expenses, but this can be an expensive miscalculation, says Diane J. Omdahl, Wisconsin-based president and co-founder of the Medicare consulting firm 65 Incorporated.
“It’s worth noting that Medicare, often mistaken for covering long-term care, actually does not provide such coverage,” she explains. “In fact, 56% of middle-income baby boomers believe that Medicare will pay for their ongoing long-term care.”
Instead, Omdahl recommends looking to other programs and products for help in paying for senior living expenses.
“There are several options available to help older adults cover the costs of assisted living, especially if they require assistance with daily activities,” she says.
These options include:
— Traditional long-term care insurance
— Deferred long-term care annuities
— Combination insurance products
— Reverse mortgages
— Charitable remainder trusts
You may also need to consider these options if you have qualified for but anticipate losing Medicaid coverage as a result of the passage of the One Big Beautiful Bill Act in July 2025.
Medicare vs. Medicaid
It’s also worth noting Medicare focuses on short-term rehabilitative care rather than the longer-term custodial care that Medicaid provides coverage for. Medicare is a federal health insurance program that pays for up to 100 days in a skilled nursing facility if the patient requires medically necessary post-hospital care. For the first 20 days Medicare pays in full, and then Medicare pays a portion of the cost of days 21 to 100. The patient must continue making improvements in health or physical function for Medicare to continue coverage.
On the other hand Medicaid kicks in when someone needs long-term care that’s not focused on regaining function but is rather maintaining the status quo and supporting the activities of daily living rather than health improvement.
Start Today by Exploring Top-Rated Assisted Living Facilities With U.S. News
Paying for senior care needs can get expensive, and for many seniors who haven’t been able to set aside enough funds for assisted living, Medicaid might help offset some of the costs.
You can start your search for the best assisted living community for your needs, whether you’ll be relying on Medicaid or not, with U.S. News’ Best Assisted Living Communities 2025 ratings, which include more than 3,800 communities across the country. These facilities have been listed based on more than 450,000 survey responses from residents and families who’ve benefited from the services and support these communities provide.
New this year, each community was considered for accolades covering areas such as activities and enrichment, care, home-like feel, food and dining, and management and staff. U.S. News selected these categories of service because they are important differentiators for many consumers. Accolade-earning communities’ U.S. News profiles highlight that they are, for example, “High Performing in Food & Dining.”
Start your search today to get a jump on future needs and access the best care near you.
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Does Medicaid Pay for Assisted Living? What You Need to Know originally appeared on usnews.com
Correction 01/09/26: This story was previously published at an earlier date and has been updated with new information.
