As people age, healthcare needs often grow more complex, and the costs of long-term care can become a significant financial burden. For seniors who require assistance with daily living activities, such as bathing, dressing, and eating, or who need nursing home care, Medicaid can be a critical resource. However, understanding Medicaid for elderly individuals and how it applies to long-term care can be confusing.

This guide breaks down everything you need to know about Medicaid for seniors, including eligibility requirements, the types of services covered, and how to apply. Whether you’re exploring options for yourself, a parent, or a loved one, this article will help you navigate the system and make informed decisions.

What Is Medicaid for Elderly Individuals?

Medicaid is a federal and state program that provides health coverage to low-income individuals, including seniors aged 65 and older. While Medicare is often associated with seniors, it’s important to understand that Medicare does not cover most long-term care services, such as nursing home care or in-home assistance. That’s where Medicaid for elderly individuals comes in.

Medicaid provides essential healthcare services for seniors, including coverage for long-term care in nursing homes, assisted living facilities, and even at home. Unlike Medicare, Medicaid covers the custodial care many elderly individuals require, making it an essential program for seniors with limited financial resources.For more information about Medicaid, visit the official Medicaid.gov website.

Medicaid vs. Medicare: What’s the Difference for Seniors?

Before diving into the details of Medicaid for elderly individuals, it’s important to distinguish between Medicaid and Medicare, as the two programs serve different purposes:

Medicare:

• A federal program primarily for individuals aged 65 and older or those with certain disabilities.
• Covers short-term healthcare needs, such as hospital stays, medical treatments, and some rehabilitation services.
• Does not cover most long-term care services, such as extended nursing home care or assistance with daily living activities.

Medicaid:

• A joint federal and state program that provides health insurance for low-income individuals of all ages, including seniors.
• Covers long-term care services, such as nursing home care, in-home care, and assistance with daily living activities.
• Requires applicants to meet strict income and asset limits to qualify.

Many seniors rely on both Medicare and Medicaid. For example, Medicare may cover a hospital stay or rehabilitation, while Medicaid can step in to cover ongoing long-term care services. This combination can be crucial for seniors with complex healthcare needs.

Medicaid Long-Term Care Services: What’s Covered?

One of the most important aspects of Medicaid for seniors is its coverage for long-term care services. These services are essential for individuals who require assistance with daily living activities due to aging, chronic illness, or disability.

Types of Medicaid Long-Term Care Services

1. Nursing Home Care:
   Medicaid covers the cost of care provided in licensed nursing homes, including room and board, skilled nursing services, and assistance with daily living activities.
2. In-Home Care:
   For seniors who wish to stay in their own homes, Medicaid can cover home health services, such as nursing care, personal care assistance, and therapy.
3. Assisted Living Facilities:
   While not all states cover assisted living under Medicaid, some states offer waivers that include coverage for care provided in assisted living settings.
4. Community-Based Services:
   Medicaid offers programs to help seniors remain in their communities rather than transitioning to a nursing home. These include adult day care, meal delivery services, and transportation to medical appointments. These programs are often referred to as Home and Community-Based Services (HCBS) or waiver programs.
5. Hospice Care:
   Medicaid covers end-of-life care for seniors who qualify for hospice services.

The availability of these services varies by state, so it’s essential to check what your state Medicaid program offers. For more details, visit the Medicaid Long-Term Services and Supports (LTSS) page.

Medicaid Long-Term Care Eligibility: Who Qualifies?

Eligibility for Medicaid long-term care is determined by both income and asset limits, which can vary by state. Additionally, applicants must demonstrate a medical need for long-term care services.

Financial Eligibility

To qualify for Medicaid long-term care, seniors must meet strict income and asset requirements. These limits are set by each state, but here are some general guidelines:

1. Income Limits:
   • In 2025, the monthly income limit for an individual applying for Medicaid long-term care is typically around $2,742. For married couples, the limit is higher.
   • Some states allow applicants to “spend down” their income by deducting medical expenses to meet the income limit.
2. Asset Limits:
   • Most states require individual applicants to have less than $2,000 in countable assets (savings, investments, etc.). For married couples, the limit is higher, often around $3,000.
   • Certain assets, such as a primary home, personal belongings, and a vehicle, are excluded from the asset calculation.

Medical Eligibility

In addition to financial criteria, seniors must demonstrate a medical need for long-term care. This is typically assessed through a functional needs evaluation conducted by a healthcare professional. The evaluation determines whether the applicant requires assistance with daily living activities, such as:

• Bathing
• Dressing
• Eating
• Mobility
• Medication management

If the applicant meets both the financial and medical requirements, they may qualify for Medicaid long-term care services. For more information on eligibility requirements, visit the Medicaid Eligibility page.

How to Apply for Medicaid for Elderly Long-Term Care

The process of applying for Medicaid long-term care can be complex, but understanding the steps involved can make it more manageable.

Step 1: Check Eligibility

Before applying, ensure you meet the financial and medical eligibility criteria for Medicaid long-term care in your state. Use the eligibility tool on Medicaid.gov or contact your state’s Medicaid office for guidance.

Step 2: Gather Necessary Documents

You’ll need to provide documentation to verify your eligibility. Commonly required documents include:

• Proof of income (e.g., pay stubs, Social Security statements)
• Proof of assets (e.g., bank statements, property deeds)
• Medical records or a physician’s statement confirming the need for long-term care
• Proof of citizenship or legal residency
• Identification (e.g., driver’s license or state ID)

Step 3: Submit Your Application

You can apply for Medicaid long-term care in several ways:

• Online: Many states allow you to apply through their Medicaid website or the federal HealthCare.gov portal.
• In Person: Visit your local Medicaid office or Department of Social Services.
• By Mail: Request a paper application from your state Medicaid office and return it by mail.
• By Phone: Some states allow telephone applications.

Step 4: Wait for Approval

After submitting your application, your state’s Medicaid office will review it to determine your eligibility. This process can take a few weeks to a few months, depending on your state.For additional assistance, contact your state Medicaid agency. You can find their contact information on the State Overviews page.

Frequently Asked Questions About Medicaid for Elderly

Here are some of the most commonly asked questions about Medicaid for seniors and long-term care:

1. Does Medicare cover long-term care?

No, Medicare does not cover most long-term care services, such as nursing home care or in-home assistance. However, Medicare may cover short-term care following a hospital stay or rehabilitation services.

2. Can seniors qualify for both Medicare and Medicaid?

Yes, many seniors qualify for both programs. Medicare covers short-term medical needs, while Medicaid provides coverage for long-term care services and additional healthcare needs not covered by Medicare.

3. What is the difference between Medicaid long-term care and private long-term care insurance?

Medicaid long-term care is a government program for low-income individuals that provides free or low-cost care. Private long-term care insurance is purchased through an insurance company and requires paying premiums, but it may offer more flexibility in coverage.

4. How can I protect my assets and still qualify for Medicaid?

Medicaid has strict asset limits, but some individuals use Medicaid planning strategies, such as irrevocable trusts or spousal impoverishment protections, to protect their assets while qualifying for benefits. Consult an elder law attorney for guidance.

5. Does Medicaid cover in-home care for seniors?

Yes, Medicaid provides coverage for in-home care for eligible seniors through programs like Home and Community-Based Services (HCBS). These services help seniors remain in their homes rather than transitioning to a nursing home.

Need Help?

Navigating Medicaid for elderly individuals and long-term care can be overwhelming, but you don’t have to do it alone. The Southern Tier Independence Center (STIC) Navigator program provides free assistance to seniors and their families applying for Medicaid or renewing their coverage.

Whether you’re exploring eligibility, completing an application, or seeking help with Medicaid long-term care services, the STIC Navigators are here to guide you every step of the way. Their team of trained professionals ensures that you understand the requirements, gather the necessary documentation, and submit your application with confidence.

Contact STIC Navigator Today!

Don’t wait to secure the care and support you or your loved one deserves. Visit STIC’s website or call their office to get personalized assistance with Medicaid for elderly individuals. Let STIC help you access long-term care services and the healthcare benefits you need today!