Does Medicaid Pay for Assisted Living? 2026 State Guide

Medicaid does not pay for room and board (rent and meals) in assisted living, but most states will pay for the care services you receive there, such as help with bathing, dressing, medications and supervision. That coverage usually comes through a state waiver program, most often a 1915(c) home and community-based services (HCBS) waiver, and it typically requires you to need a nursing home level of care and meet strict income and asset limits. Many states cap enrollment, so waiting lists are common.

In practice, that means a Medicaid resident in assisted living usually pays a set monthly room and board amount from their own income (often their Social Security), and Medicaid pays the community for the care portion. Below we explain what is and isn’t covered, the 2026 eligibility numbers, real state programs you can look up, how to apply, and what to do if you don’t qualify.

The short answer: what Medicaid pays for in assisted living

Federal rules do not allow Medicaid HCBS waivers to pay for room and board, except in limited situations such as respite care in a facility. So Medicaid can’t pay your rent at an assisted living community. What it can pay for is the care and support you need to live there safely instead of in a nursing home.

According to the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), only a small minority of state Medicaid programs do not cover services in assisted living, and almost 1 in 5 assisted living residents (18%) relies on Medicaid to pay for daily services.

Cost in assisted living	Can Medicaid pay?	Who usually pays
Rent / apartment	No	Resident (income, SSI, family, housing help)
Meals (board)	No, in most programs	Resident, often bundled into a capped room and board rate
Personal care (bathing, dressing, toileting)	Yes, in most states	Medicaid waiver or state plan program
Medication help and administration	Yes, in most states	Medicaid waiver or state plan program
24-hour supervision and staff response	Often	Medicaid waiver
Housekeeping and laundry	Often, as part of the care package	Medicaid waiver
Nursing, therapy, case management	Often	Medicaid waiver and regular Medicaid
Doctor visits, hospital, prescriptions	Yes (regular Medicaid and Medicare)	Medicare first, Medicaid second for dual eligibles
Private room upgrade, extras	No	Resident or family

Sources: AHCA/NCAL; state program pages for Ohio, Texas and California listed below.

For context, the national median cost of assisted living was $6,200 a month ($74,400 a year) in 2025, according to the CareScout Cost of Care Survey. Our guide to how much assisted living costs breaks that down by state and care level.

How Medicaid covers assisted living: the main program types

There’s no single “Medicaid assisted living benefit.” Each state decides whether and how to cover services in assisted living, using one or more federal authorities. The name on the program will be state-specific, but it usually falls into one of these buckets.

1915(c) HCBS waivers

This is the most common route. A 1915(c) waiver lets a state pay for services at home or in community settings for people who would otherwise need a nursing home. States can limit the number of slots and the regions served, which is why waiting lists exist. Ohio’s Assisted Living Waiver and California’s Assisted Living Waiver are both examples.

Managed long-term care (1915(b)/(c) or 1115 programs)

Many states now deliver long-term care through Medicaid managed care plans. You enroll in a health plan, and that plan authorizes assisted living services along with your other Medicaid benefits. Florida’s Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program, Texas STAR+PLUS and Pennsylvania Community HealthChoices work this way.

1915(i) state plan HCBS

The 1915(i) option lets states offer home and community-based services as part of the regular Medicaid state plan, and the functional need threshold can be lower than nursing home level of care. Fewer states use it for assisted living, but it’s worth asking about in your state.

State plan personal care

Some states cover personal care services through their regular Medicaid plan, and those services can be delivered in a licensed residential care setting. Because it’s part of the state plan rather than a waiver, it generally can’t have a waiting list.

State-funded programs and supplements

A few states also run state-funded programs or pay an optional state supplement to SSI recipients living in licensed residential care, which helps with the room and board side. These vary a lot, so check with your state’s Medicaid agency or Area Agency on Aging.

Who qualifies? 2026 eligibility rules

To get Medicaid help in assisted living, you generally have to clear three hurdles: financial eligibility, a functional (care needs) test, and program availability where you live.

Functional eligibility

Most waiver programs require that you need a “nursing facility level of care.” That usually means needing hands-on help with two or more activities of daily living (ADLs), such as bathing, dressing, eating, toileting, transferring or moving around, or needing supervision because of cognitive impairment such as dementia. Each state uses its own assessment tool, done by a nurse or case manager.

Income limits

Many states use the “special income level” for long-term care, which is 300% of the SSI federal benefit rate. Others use different standards, and some let you “spend down” excess income on care costs.

2026 figure	Amount	What it’s used for
SSI federal benefit rate (individual)	$994 / month	Base for many income tests and room and board caps
SSI federal benefit rate (couple)	$1,491 / month	Couples where both receive SSI
300% special income limit	$2,982 / month	Common income cap for waivers and nursing home Medicaid
SSI resource (asset) standard	$2,000 individual / $3,000 couple	Typical Medicaid asset limit for the applicant
Community spouse resource allowance	$32,532 min / $162,660 max	Assets a spouse at home can keep (state choice within range)
Maximum monthly maintenance needs allowance	$4,066.50 / month	Cap on income a spouse at home can keep
Home equity limit	$752,000 to $1,130,000	Home equity cap; states choose within range

Source: CMS Informational Bulletin, 2026 SSI and Spousal Impoverishment Standards (updated April 27, 2026).

If your income is above the cap in a state that uses one, you may still qualify by placing the excess in a Qualified Income Trust (often called a Miller trust). If your state uses a medically needy or spend-down approach instead, your excess income goes toward your care before Medicaid pays.

Asset limits

The typical asset limit for a single applicant is $2,000, though some states set it higher. Pennsylvania, for example, allows an extra $6,000 disregard for people with income at or below the 300% limit, and California, after dropping its asset test in 2024, set new Medi-Cal limits of $130,000 for an individual starting January 1, 2026. Assets that usually don’t count include:

• Your home, if your equity is under the state limit and you, your spouse or a dependent relative lives there or you intend to return
• One vehicle
• Household goods and personal belongings
• Burial plots and a limited burial fund or prepaid funeral plan
• Life insurance with a small face value (rules vary by state)

The 5-year look-back

Medicaid long-term care programs, including assisted living waivers, review asset transfers made in the 60 months before you apply. If you gave money or property away for less than fair market value, you can face a penalty period during which Medicaid won’t pay for long-term care. Washington’s COPES program, for example, applies the 5-year look-back to waiver applicants. Talk to an elder law attorney before moving assets.

Married couples

If only one spouse needs care, spousal impoverishment protections let the spouse at home keep a share of the couple’s assets (between $32,532 and $162,660 in 2026, depending on the state) and part of the applicant’s income. Federal law requires these protections for nursing homes and HCBS waivers.

Rules vary by state. Always confirm current limits with your state Medicaid agency before you apply.

Waiting lists: the catch most families hit

Because waiver programs can cap enrollment, being eligible doesn’t guarantee a slot. KFF’s survey found that in 2024 over 710,000 people were on Medicaid HCBS waiting or interest lists across 40 states, with an average wait of 40 months among the states that reported it. Seniors and adults with physical disabilities made up about 24% of waiver waiting lists (people with intellectual and developmental disabilities make up most of the rest).

A real example: California’s Assisted Living Waiver had 14,831 people enrolled and 15,910 on its waitlist as of March 2026, according to the state’s enrollment dashboard.

Tips for waiting lists:

• Get on the list early. In most states your place is set by your screening date or priority score, not your move-in date.
• Ask about priority categories. Some states give priority to people leaving a nursing home, so a short nursing home stay can sometimes speed access (ask your state how this works before relying on it).
• Update your screening if needs change. In Florida, for example, your priority score decides whether you’re placed on the waitlist at all.
• Look at other programs while you wait. State plan personal care, PACE, or home care may fill the gap.

State examples: Medicaid programs that cover assisted living

The table below shows real programs in several large states. Names, rules and availability change, so use it as a starting point and confirm details with the agency listed.

State	Program	How it works	Where to start
Florida	Statewide Medicaid Managed Care Long-Term Care (SMMC LTC)	Managed care plan covers assisted living services for people needing nursing facility level of care. Not an entitlement; enrollment is through a priority-based waitlist.	Local Aging and Disability Resource Center; Elder Helpline 1-800-963-5337
Texas	STAR+PLUS HCBS	Covers assisted living services (personal care, meds, supervision, meals) in contracted facilities. Room and board is set at the SSI rate minus an $85 personal needs allowance, which works out to about $909 a month in 2026.	Texas HHS; your STAR+PLUS health plan
California	Assisted Living Waiver (ALW)	Age 21+, full-scope Medi-Cal with no share of cost, nursing facility level of care. Available in 15 counties including Los Angeles, San Diego, Orange and Sacramento. Resident pays room and board directly. Has a waitlist.	A Care Coordination Agency in your county (listed by DHCS)
New York	Assisted Living Program (ALP)	For people medically eligible for nursing home placement who don’t need continual nursing care. Statewide capacity is capped (the state lists 4,200 residents, about 85% on Medicaid). Medicaid applicants need approval from their local social services district.	Contact an ALP directly and your Local Department of Social Services
Illinois	Supportive Living Program (SLP)	Medicaid waiver pays for personal care, homemaking, laundry, medication help and 24-hour staff in certified supportive living facilities. The resident pays room and board.	Illinois HFS supportive living facility locator
Ohio	Assisted Living Waiver	Age 21+, needs hands-on help with daily activities, assets of $2,000 or less and income up to 300% of SSI ($2,982 in 2026). Resident pays a state-set room and board amount; may owe a monthly share toward services.	Area Agency on Aging, 1-866-243-5678
Pennsylvania	Community HealthChoices (CHC) Assisted Living Residence option	Covers services only in licensed Assisted Living Residences, not personal care homes. As of 2026, only 18 of the state’s 64 ALRs contract with at least one CHC plan.	Your CHC plan; PA Department of Human Services
Washington	COPES	Covers care in assisted living, adult family homes and at home for people needing extensive help with 2+ daily activities. Income up to $2,982, assets $2,000. In assisted living you keep a $108.74 personal needs allowance; the rest goes to care, room and board.	Washington Connection online or a local DSHS office

Sources: Florida AHCA; Texas HHS STAR+PLUS Handbook; California DHCS; New York State Department of Health; Illinois HFS; Ohio Department of Aging; Pennsylvania Health Law Project (May 2026); WashingtonLawHelp.org.

How to apply for Medicaid assisted living help: step by step

1. Find your state’s program. Search your state Medicaid agency’s website for “assisted living waiver” or “home and community-based services,” or call your local Area Agency on Aging (find it through the Eldercare Locator at 1-800-677-1116).
2. Request a screening or assessment. Most states start with a phone screening, then an in-person functional assessment to confirm nursing facility level of care.
3. Get on the waitlist if there is one. Ask how priority is set and how you’ll be contacted when a slot opens.
4. Gather financial documents. Typically 60 months of bank statements, income proof (Social Security, pensions), property deeds, life insurance policies, vehicle titles, and ID and proof of citizenship or immigration status.
5. Submit the Medicaid application. Apply online, by mail or at your county office. The financial review is done by your state or county eligibility agency.
6. Choose a participating community. Not every assisted living accepts Medicaid. You’ll often pick from a list of contracted providers.
7. Agree on your care plan and costs. A case manager or health plan sets your service plan. You’ll be told your monthly room and board amount and any share of cost.
8. Keep up with renewals. Medicaid must be renewed, usually yearly. Report changes in income, assets or address promptly.

How to find an assisted living community that accepts Medicaid

Even with an approved waiver slot, you still need a community that participates. Supply is the bottleneck in many areas, because Medicaid rates are often lower than private-pay rates.

• Ask the program for its provider list. Care Coordination Agencies, health plans and Area Agencies on Aging keep lists of contracted communities.
• Ask communities the right question. Don’t just ask “Do you take Medicaid?” Ask “Are you contracted with [program name] and do you have a Medicaid bed or apartment available?”
• Ask about “spend down” policies. Some communities let private-pay residents stay after converting to Medicaid, often after a set period of private pay (for example, one or two years). Get this in writing.
• Check room type. Medicaid residents may be offered shared rooms. Ask what’s included in the room and board amount.
• Consider smaller settings. Adult family homes and residential care homes are sometimes more likely to accept Medicaid than large communities.

You can start by browsing our assisted living directory, or look at all care types in your state on our senior living by state page. If dementia is part of the picture, ask whether the program covers secure memory care units too; some state waivers do.

What if you don’t qualify for Medicaid?

If your income or assets are too high, or the waitlist is long, there are other ways to cover the cost. We cover these in depth in our guide on how to pay for assisted living with no money, but the main options are:

Option	Who it helps	What to know
VA Aid and Attendance	Wartime veterans and surviving spouses	Monthly pension add-on that can be used for assisted living. See our VA Aid and Attendance guide.
Long-term care insurance	People who bought a policy	Most policies cover assisted living once you need help with 2+ ADLs or have cognitive impairment.
Spend down to Medicaid	People slightly over the asset limit	Pay privately for care, home repairs or a prepaid funeral until you qualify. Avoid gifts that trigger the look-back penalty.
Home sale, reverse mortgage or life insurance conversion	Homeowners or policyholders	Can fund several years of care; get independent advice first.
PACE	Age 55+, nursing home level of care, in a PACE service area	Covers medical and long-term care services; ask your local PACE program whether it serves people living in assisted living.
Home care or adult day	People who can stay home with help	Often cheaper than assisted living for lighter needs. Our home care directory lists local agencies.
Subsidized senior housing	Low-income older adults who need less care	HUD housing plus outside services. Ask your local housing authority about senior housing waitlists.

One thing that won’t help much: Medicare. Medicare does not pay for assisted living rent or long-term personal care. We explain the limited exceptions in does Medicare pay for assisted living for dementia.

Assisted living vs nursing home: how Medicaid treats each

The biggest difference is that nursing home care is a mandatory Medicaid benefit, while assisted living coverage is optional for states. That has real consequences.

	Assisted living	Nursing home
Required federal benefit?	No, state option	Yes, for eligible adults 21+
Room and board covered?	No	Yes, Medicaid pays the full daily rate minus your income contribution
Waiting lists?	Common	No program waitlist (bed availability can still be an issue)
Money you keep	Room and board payment plus a personal needs allowance set by the state	Personal needs allowance only (federal minimum $30 a month)
Level of care needed	Usually nursing facility level of care	Nursing facility level of care

If your loved one’s needs are growing, read when to move from assisted living to a nursing home and our full guide to whether Medicaid pays for nursing home care.

FAQs

Does Medicaid cover assisted living in every state?

No. Covering services in assisted living is optional for states. According to AHCA/NCAL, only a small minority of states don’t cover any assisted living services, but the scope, regions served and number of slots vary widely. Check with your state Medicaid agency.

Will Medicaid pay for assisted living rent?

No. Medicaid can’t pay room and board in assisted living. Residents typically pay a set room and board amount from their income, and Medicaid pays for the care services. Some states add a small state supplement for SSI recipients that helps with housing costs.

How much do Medicaid residents pay for room and board?

It depends on the state. Many states tie it to the SSI benefit. In Texas STAR+PLUS, for example, room and board is the SSI rate minus an $85 personal needs allowance, about $909 a month in 2026. Other states set their own rate.

What is the income limit for Medicaid assisted living in 2026?

Many states use 300% of the SSI federal benefit rate, which is $2,982 a month in 2026. Some states use lower limits or medically needy spend-down rules, and income above a cap can sometimes be placed in a Miller trust.

Can I keep my house and still get Medicaid for assisted living?

Often, yes. Your home is usually an exempt asset if your equity is below your state’s limit ($752,000 to $1,130,000 in 2026) and a spouse or dependent lives there or you intend to return. Estate recovery may apply after death, so ask how your state handles it.

Does Medicaid pay for memory care in assisted living?

In many states, waiver programs cover services in licensed memory care units the same way they cover assisted living, but room and board still isn’t covered. Some states pay a higher service rate for dementia care. Availability of Medicaid memory care beds is often limited.

How long is the waiting list for Medicaid assisted living?

It ranges from no wait to several years. KFF found an average wait of 40 months across all HCBS waiver waiting lists in 2024, though times for seniors vary by state. California’s Assisted Living Waiver had 15,910 people waiting as of March 2026.

Can I move into assisted living as private pay and switch to Medicaid later?

Sometimes. You’ll need a community that participates in your state’s program and agrees to keep residents who convert. Ask for the community’s Medicaid conversion policy in writing before you move in.

Does Medicare pay for assisted living if Medicaid won’t?

No. Medicare doesn’t pay for long-term custodial care or assisted living rent. It does keep covering doctor visits, hospital care, hospice and some home health care while you live in assisted living.

Who can help me apply?

Your local Area Agency on Aging or Aging and Disability Resource Center can explain programs for free. For complex finances, a home, or a married couple, an elder law attorney can help you avoid look-back penalties.

Find senior living near you

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Related guides

• How to pay for assisted living with little or no money
• VA Aid and Attendance for assisted living
• How much does assisted living cost?