Medicaid Eligibility: Who Qualifies?

To qualify for Medicaid long-term care you have to pass two separate tests: a medical one showing you need that level of care, and a financial one covering income and assets. Most families only think about the money. The medical test is what decides whether the money test even applies.

The two financial tests have their own pages, because the rules are genuinely different: income limits and asset limits. This page is the map of how the whole thing fits together.

Figures shown are 2026 amounts, last verified July 17, 2026. Source: CMS, Center for Medicaid and CHIP Services; Social Security Administration.

What are the two tests?

The medical test asks whether you need the level of care you're applying for. The financial test asks whether your income and assets are low enough. You must pass both. Failing either one means no coverage, and they're assessed by different people using different rules.

Families usually discover the medical test late, after weeks spent worrying about savings. Ask about it first, because a parent who doesn't yet meet the care standard cannot qualify no matter how little money they have.

How does the medical test work?

States call it a level-of-care determination or a functional assessment. A nurse or assessor reviews how much help the person needs with daily activities: bathing, dressing, eating, using the toilet, moving from a bed to a chair, and managing medication.

Cognitive decline counts too. Someone physically capable but unsafe alone because of dementia can meet a nursing-home level of care. If an assessment came back negative and the person's condition has since worsened, you can ask for a reassessment.

How does the financial test work?

Income and assets are counted separately, and being fine on one says nothing about the other. Income is the money arriving each month. Assets are what you own and could convert to cash.

In most states, a single applicant can have income up to $2,982 a month and around $2,000 in countable assets. About half the states use no income cap and instead let you spend income down against your care costs, and several states allow far higher asset limits.

Your home usually isn't counted while you or your spouse lives in it and the equity sits under your state's ceiling, which falls between $752,000 and $1,130,000.

Which kind of Medicaid are you applying for?

This matters more than most people realize, because the rules and the waiting differ:

• Nursing-home Medicaid. An entitlement. If you qualify, the state must cover it; there's no waiting list.
• Home and community-based waivers. Care delivered at home or in the community instead. Same idea, but these are capped programs, so a waiting list is common.
• Aged, blind and disabled Medicaid. Regular health coverage for people who qualify on age or disability, with stricter income rules and no long-term care attached.

Most families reading this want the first or second. Getting the name right when you call the agency saves a wasted conversation.

Does being married change eligibility?

Substantially, and in your favor. When one spouse needs care and the other stays home, the at-home spouse keeps a protected share of the couple's savings, between $32,532 and $162,660, plus the house and a car.

They can also keep a minimum monthly income, at least $2,705 and in some cases up to $4,066.50, drawn from the applicant's income if their own falls short. The rules exist so the healthy spouse isn't left destitute.

How do I check where we stand?

Work through it in this order, because each step decides whether the next one matters:

1. Ask the doctor or the facility whether the person meets a nursing-home level of care.
2. Add up monthly income from every source: Social Security, pensions, annuities, VA benefits, rent, dividends.
3. List countable assets for both spouses, leaving out the home, one car and personal belongings.
4. Compare those against your own state's figures, not the national ones.
5. Call your state agency and apply, even if you think you're slightly over. Being over is often fixable, and the application date matters.

Common questions

Can I qualify for Medicaid if I own a home?

Usually yes. The home is generally exempt while you or your spouse lives there and your equity is under the state ceiling. Owning a home rarely blocks eligibility by itself, though estate recovery may apply later.

How long does a Medicaid application take?

Commonly 45 to 90 days, and longer when a disability determination or missing documents are involved. Apply as soon as care starts rather than waiting until paperwork is perfect, because the application date drives what gets covered.

Does Medicaid check your bank accounts?

Yes. Expect to provide several months of statements for every account, and for the look-back review, records going back five years in most states. Large or unexplained withdrawals will be asked about.

Can I qualify if my income is too high?

Often, yes. In states with a hard cap, a qualified income trust holds the excess. In spend-down states, income above the threshold goes toward your care and you still qualify. Being over the limit is not automatically a no.

Sources

• Centers for Medicare and Medicaid Services, "Updated 2026 SSI and Spousal Impoverishment Standards," CMCS Informational Bulletin, April 27, 2026.
• Centers for Medicare and Medicaid Services, "2026 SSI, Spousal Impoverishment, and Medicare Savings Program Resource Standards," CMCS Informational Bulletin, December 9, 2025.
• Social Security Administration, "SSI Federal Payment Amounts for 2026."
• Justice in Aging, "H.R. 1 Reduces Medicaid Retroactive Eligibility Starting in 2027," April 9, 2026.

Written and reviewed by Owen Hastings. Last reviewed July 30, 2026. Read our editorial policy for how we source and check these figures.