Medicare pays for short-term skilled care, not day-in, day-out help with bathing, dressing, or supervision. That’s where Medicaid steps in. Medicaid is the nation’s primary payer for long-term services and supports, funding nursing homes and in-home/community care when you qualify. Here’s how the two programs actually work together in 2025. Medicare Medicaid

Disclaimer: This is general information, not legal or financial advice. Long-term care rules vary by state and change often; always confirm with your state Medicaid agency and a qualified elder-law professional.

Quick answer: Why Medicaid—not Medicare—pays for long-term care

Medicare is hospital/medical insurance; it does not cover custodial long-term care, like ongoing help with ADLs (bathing, dressing, eating). Medicare
Medicaid is means-tested and, for people who meet financial and functional criteria, it covers long-term care in nursing homes and at home/in the community (HCBS). Medicaid
If you have both (a “dual-eligible”), Medicare pays first; Medicaid pays remaining covered costs and LTSS up to state limits. Medicaid

Bottom line: Count on Medicare for short-term skilled care; Medicaid is the workhorse for long-term care if you qualify. Medicare Medicaid

What Medicaid actually covers for LTC

Medicaid covers institutional care and a growing menu of home- and community-based services (HCBS):

Nursing facility services (mandatory state plan benefit): 24/7 nursing and rehab; room and board included. Medicaid+1
HCBS waivers (1915(c)): personal care, homemaker, adult day health, respite, habilitation; states can tailor services to divert from or transition out of institutions. Medicaid
HCBS state plan option (1915(i)): needs-based services in home/community without a waiver slot. Medicaid
Community First Choice (1915(k)): attendant services for ADLs/IADLs as a state plan benefit (with enhanced federal match). Medicaid
PACE (Program of All-Inclusive Care for the Elderly): integrates Medicare + Medicaid; provides all medically necessary care so frail adults can remain in the community. Centers for Medicare & Medicaid Services Medicaid
Many states deliver LTSS via managed care (MLTSS)—coordinated through capitated Medicaid plans. Medicaid

Bottom line: Medicaid can finance full-time nursing home care and robust in-home supports through HCBS, PACE, or MLTSS—depending on your state. Medicaid+1

What Medicare covers—and where it stops

Medicare does not pay for ongoing custodial LTC. It may cover:

Skilled Nursing Facility (SNF) after a qualifying inpatient hospital stay: up to 100 days/benefit period (days 1–20 $0; days 21–100 $209.50/day in 2025). Medicare+1
Home health when intermittent skilled care is medically necessary and you’re homebound. Medicare
Hospice (palliative care for terminal illness). Medicare+1

Bottom line: Medicare coverage is time-limited and skilled-care-focused; it won’t fund long-term custodial care needs. Medicare

Assisted living: what Medicaid can pay (and what it can’t)

Medicaid may cover services delivered in assisted living (e.g., personal care, medication management) via HCBS;
But Medicaid generally does not pay for room & board in assisted living. Some states cap or help with R&B using state-only funds or special policies. KFF

Bottom line: Expect Medicaid to help with care services in assisted living, not the rent/meal package. KFF

Comparison table: Medicare vs. Medicaid for long-term care

Topic	Medicare	Medicaid
Core purpose	Acute/medical insurance	Safety-net coverage incl. LTSS
Long-term custodial care	Not covered	Covered if eligible
Nursing home	Short SNF stays (up to 100 days)	Ongoing nursing facility care
Home care	Intermittent skilled home health	Broad HCBS (personal care, day health, respite)
Assisted living	Generally no (services limited)	Often services via HCBS; room/board no
Who pays first (if dual)	Medicare	Wraps around & pays LTSS

Sources: Medicare.gov; Medicaid.gov (LTSS, benefits, HCBS). Last checked: September 7, 2025. Medicare+1 Medicaid+2Medicaid+2

Bottom line: For ongoing LTC, Medicaid is the payer once you meet financial and functional criteria.

Who qualifies for Medicaid LTC in 2025

You typically must meet both (1) financial rules and (2) a functional “Level of Care” (state-defined need for nursing-facility or comparable HCBS).

Financial pathways (vary by state)

SSI-linked (ABD): If you receive SSI, you’re usually financially eligible (states may supplement/expand). 2025 SSI FBR: $967 (individual) / $1,450 (couple). Social Security
Special Income Rule (up to 300% of SSI): Many states cover people needing an institutional level of care (in nursing homes and often HCBS) with income up to 300% of SSI ($2,901/month in 2025). KFF Medicaid
Medically Needy/Spend-down: Some states allow high medical expenses to spend down income to eligibility levels. Medicaid

Assets/resources & home equity (2025): States follow federal ranges. For married couples, spousal impoverishment protections apply (see next section). Home equity can bar eligibility if over a federal limit; 2025 range: $730,000–$1,097,000 (state-set within this band). Medicaid

Bottom line: In many states, needing nursing-home-level care + income ≤ $2,901/mo (2025) (and assets within limits) gets you through the financial door—but you still need to meet your state’s Level of Care criteria. KFF Medicaid

Spousal protections, home equity limits & personal needs rules (2025)

Spousal impoverishment protections (2025 federal ranges):

Community Spouse Resource Allowance (CSRA): $31,584–$157,920.
Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,643.75 (effective July 1, 2025; higher in AK/HI); maximum $3,948 (Jan 1–Dec 31, 2025).
Home equity limit: $730,000–$1,097,000 (state-set within federal range).
Source: CMS/CMCS May 28, 2025 bulletin; last checked: September 7, 2025. Medicaid

Personal needs allowance (PNA): In nursing homes, residents contribute most income to their cost of care but keep a small PNA plus certain deductions (spousal support, medical expenses). The PNA is at least $30 by federal rule; states can set higher amounts. eCFR Medicaid

Bottom line: 2025 rules protect a portion of the at-home spouse’s income/assets and set home equity limits; nursing home residents keep a small PNA while Medicaid pays the rest. Medicaid eCFR

Look-back & estate recovery—plain-English guide

Look-back: States examine asset transfers in the 60 months before applying for Medicaid LTC. Gifts/transfers for less than fair market value can trigger a penalty period (a delay of coverage), calculated by the amount transferred ÷ state’s average nursing-home cost. Legal Information Institute
Estate recovery: States must seek recovery for Medicaid LTSS paid after age 55 (and for permanently institutionalized individuals at any age), with hardship waivers and exceptions (e.g., surviving spouse, certain children). Medicaid

Bottom line: Don’t gift assets within 5 years of a Medicaid LTC application without expert guidance, and know that estate recovery is required by federal law (subject to protections). Legal Information Institute Medicaid

Your application checklist (print & use)

Proof of identity & citizenship/immigration (IDs, SSNs).
Income: Social Security/retirement statements; pensions; annuities.
Assets: Bank statements, life insurance cash values, deeds/titles; home equity estimate.
Medical need: Doctor notes; functional assessments; list of ADL/IADL needs.
Care setting: Nursing home admission paperwork or HCBS service plan request.
Health coverage: Medicare cards; Medigap/MA; Part D.
Spousal info (if married): spouse income/assets for CSRA/MMMNA.
Transfers (past 5 years): gifts, property transfers, trusts—bring documentation.
Authorized representative form (if someone helps apply).
(State agency will also schedule a Level of Care assessment.)

Where to start: Apply with your state Medicaid agency; if you’re a dual-eligible, remember Medicare pays first and Medicaid can cover the rest, including LTSS. Medicaid

QIT/Miller Trust (for “income-cap” states): If your gross income exceeds your state’s cap (often 300% of SSI), some states let you qualify by depositing income into a Qualified Income Trust (QIT)—an irrevocable trust that routes income toward your care; any remainder typically goes to the state upon death up to what Medicaid paid. Check your state’s rules. Delaware Health and Social Services

Bottom line: Gather paperwork, expect a financial and functional review, and ask the caseworker whether your state uses a QIT for over-income applicants. Delaware Health and Social Services

Case examples & quick math (for orientation only)

Example A — Nursing home, single applicant (income below cap):

Gross income $2,200/mo (below $2,901 cap). After Medicaid approval, you pay most income to the facility each month minus your PNA (state-set, at least $30) and any health insurance premiums; Medicaid pays the rest. Medicaid eCFR
Bottom line: Expect to contribute most of your monthly income, while Medicaid covers the balance.

Example B — Married applicant; community spouse at home:

Couple has $80,000 in countable, non-exempt assets. Under 2025 rules, the community spouse can keep between $31,584 and $157,920 (state-specific). If the community spouse’s income is low, an income allowance may raise it up to $2,643.75–$3,948/mo (federal min/max ranges) with adjustments for housing. Medicaid
Bottom line: Spousal rules help the at-home spouse keep essential income and assets while the applicant qualifies.

Example C — Assisted living with HCBS waiver:

Medicaid may cover personal care and supports in the residence; you still pay room & board. If you don’t have a waiver slot, you might be waitlisted or need state plan HCBS. KFF
Bottom line: In assisted living, plan to self-pay housing/food even if Medicaid covers services.

“Source” stamps for sensitive figures

Medicare SNF limit (100 days) & 2025 coinsurance ($209.50/day for days 21–100): Source: Medicare.gov, last checked: September 7, 2025. Medicare+1
Medicaid is the primary payer of LTSS; LTSS settings: Source: Medicaid.gov, last checked: September 7, 2025. Medicaid
2025 SSI & spousal standards (MMMNA/CSRA, 300% cap, home equity limits): Source: CMS/CMCS Bulletin (May 28, 2025), last checked: September 7, 2025. Medicaid
Assisted living room & board not covered: Source: KFF (2025), last checked: September 7, 2025. KFF
Estate recovery & 60-month look-back: Source: Medicaid.gov & 42 U.S.C. §1396p, last checked: September 7, 2025. Medicaid Legal Information Institute

Key takeaways

Medicare won’t cover custodial long-term care; Medicaid is the primary payer for LTSS if you qualify. Medicare Medicaid
2025 spousal rules protect the at-home spouse (CSRA $31,584–$157,920; MMMNA min $2,643.75/max $3,948). Medicaid
Many states use the 300% of SSI income standard ($2,901/mo in 2025) for institutional/HCBS eligibility. KFF Medicaid
Assisted living: Medicaid may cover services, not room & board. KFF
Watch for 60-month look-back and estate recovery rules. Legal Information Institute Medicaid

Next steps

Call your state Medicaid LTSS line to confirm Level of Care and which HCBS/waivers exist. Medicaid
Gather the checklist documents and schedule your functional assessment.
If over income in an “income-cap” state, ask about a QIT/Miller Trust. Delaware Health and Social Services

FAQs

Q: Does Medicaid cover long-term care that Medicare doesn’t?

Yes. Medicaid can pay for nursing homes and home- and community-based services (HCBS) if you meet financial and functional eligibility rules; Medicare generally does not cover custodial long-term care.

Q: How long will Medicare pay for a nursing home?

Up to 100 days per benefit period after a qualifying inpatient stay. In 2025, there is no coinsurance for days 1–20; days 21–100 generally require a daily coinsurance.

Q: What are the 2025 spousal protection numbers (MMMNA/CSRA)?

Federal ranges for 2025: the Minimum Monthly Maintenance Needs Allowance (MMMNA) minimum is $2,643.75 (from July 1, 2025) with a maximum of $3,948, and the Community Spouse Resource Allowance (CSRA) ranges from $31,584 to $157,920. States set exact amounts within these ranges.

Q: Does Medicaid pay for assisted-living rent?

Generally no. Medicaid may cover services delivered in assisted living (such as personal care) through HCBS, but room and board are typically not covered.

Q: What is the Medicaid look-back period?

States review asset transfers made in the 60 months before applying for long-term care Medicaid. Gifts or transfers for less than fair market value can create a penalty period that delays coverage.

Q: Will the state take the house after death?

States must pursue estate recovery for Medicaid long-term care benefits paid after age 55 (and for permanently institutionalized individuals), with exemptions and hardship waivers in certain situations.

Q: I’m over the income cap—can I still qualify?

In income-cap states, a Qualified Income Trust (Miller Trust) may allow eligibility by directing income toward care costs according to state rules.

Q: What’s the fastest way to start?

Contact your state Medicaid long-term services and supports office, ask about HCBS waivers, and schedule a Level of Care assessment. Apply even if some documentation is pending.

1) Does Medicaid cover long-term care that Medicare doesn’t?
Yes. Medicaid can pay for nursing homes and HCBS if you meet financial and functional rules; Medicare generally does not cover custodial LTC. Medicaid Medicare

2) How long will Medicare pay for a nursing home?
Up to 100 days per benefit period after a qualifying inpatient stay; in 2025, you owe $209.50/day for days 21–100 unless other coverage applies. Medicare+1

3) What are the 2025 spousal protection numbers (MMMNA/CSRA)?
Federal ranges: MMMNA minimum $2,643.75 (from July 1, 2025) and maximum $3,948; CSRA $31,584–$157,920. States set final amounts within these ranges. Medicaid

4) Does Medicaid pay for assisted-living rent?
Generally no. Medicaid may cover services in assisted living (personal care, etc.), but not room & board. KFF

5) What is the Medicaid “look-back” period?
States review transfers for the 60 months before applying for LTC Medicaid. Gifts can trigger a penalty delaying coverage. Legal Information Institute

6) Will the state take the house after death?
States must pursue estate recovery for LTSS paid after age 55 (and for permanently institutionalized persons), with exemptions and hardship waivers. Medicaid

7) I’m over the income cap—can I still qualify?
In “income-cap” states, a Qualified Income Trust (QIT) may allow eligibility by routing income to care costs. Rules are state-specific. Delaware Health and Social Services

8) What’s the fastest way to start?
Call your state Medicaid LTSS office, ask about HCBS waivers, and schedule a Level of Care assessment; apply even if documentation is still in progress. Medicaid

Medicaid vs. Medicare: Who Pays for Long-Term Care?