What is Long-Term Care Medicaid

Medicaid refers to more than one program, as there are many different eligibility groups within each state’s Medicaid program. Long-term care Medicaid is for the elderly and disabled and it’s what is used to pay for care.

Long-Term Care Medicaid Facts



Medicaid is a jointly funded state and federal health insurance program. Our focus will be on Medicaid Long Term Care for seniors and disabled individuals. Medicaid provides medical care, such as physician visits, and non-medical support services, such as in-home personal care assistance and PACE. Nursing home care and in some states Assisted Living is also covered. If a senior is financially and medically qualified, Medicaid will pay nearly all of his or her long-term care costs.

Medicaid Waivers

Also called Home and Community Based Services (HCBS) Waivers, 1915(c) Waivers, & 1115 Demonstration Waivers, these are state-specific programs that provide long term care and support to individuals outside of nursing homes. Generally, these services are provided at home, in an assisted living facility, in an adult foster care home, or in adult day care. Unlike Medicaid nursing home care and state plan personal care assistance, Medicaid Waivers are not entitlement programs. They have enrollment caps, and once the participant caps have been filled, there are waiting lists.

Self-Directed Care

Is a specific type of Medicaid program available in many states. It’s a program in which the recipients receive funds for care and are given the flexibility to select their own care providers. It can be called “consumer directed care”, “participant directed care”, or “self-directed care”. In many consumer-directed programs, family members can be “hired” as care providers. This means they can be paid for the personal assistance they provide a loved one. In some states, even spouses can be hired and paid to provide care.

Medicaid Benefits and Services

The services covered by Medicaid vary from program to program and from state to state.
 What follows are general Medicaid benefits which are typically available in most states.

Assisted Living / Senior Living Communities

The number of state Medicaid programs helping with assisted living is increasing, and this trend looks like it will continue until assisted living assistance is available nationwide. As of mid 2019, in 44 states and the District of Columbia, Medicaid pays for some assisted living fees, mostly by way of Medicaid Home and Community-Based Services Waivers. To be clear, Medicaid will not pay for room and board or rent in assisted living communities. However, there are other programs open to Medicaid beneficiaries that can help. In addition, there are assisted living-like programs that may not be called assisted living, but provide a very similar experience. Often positioned as an alternative to assisted living or nursing home care, adult foster care is covered by Medicaid in many states.


The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain elderly individuals that live in the community, most of whom are dually eligible for Medicare and Medicaid benefits. An interdisciplinary team of health professionals provides PACE participants with coordinated care. For most participants, the comprehensive service package enables them to remain in the community rather than receive care in a nursing home. Financing for the program is capped, which allows providers to deliver all services participants need rather than only those reimbursable under Medicare and Medicaid fee-for-service plans. PACE is a program under Medicare, and states can elect to provide PACE services to Medicaid beneficiaries as an optional Medicaid benefit. The PACE program becomes the sole source of Medicaid and Medicare benefits for PACE participants.

Nursing Homes / Skilled Nursing

In all states, Medicaid pays for long term nursing home care, provided the facility is Medicaid certified.

Adult Day Care / Adult Day Health Care

Medicaid in all 50 states through Medicaid HCBS Waivers and some regular Medicaid programs will cover adult day care and / or adult day health care for some beneficiaries. Interestingly, some states choose to only cover adult day care and not adult day health (medical) care and other states choose to do the reverse. Still other states elect to cover both options. Specific state policies and waivers.

Home Health Care / Non-Medical Home Care

Medicaid, through HCBS Waivers and some regular Medicaid “personal care assistance” programs, will pay for home health care. Many waivers also offer support for personal care (non-medical home care), as well as a variety of other chore services in and around the home. State vary.

We can help apply for any of these services

Call 973-898-5959