Senior Care & Long-Term Planning by State

Medicaid LTC covers nursing home care and home- and community-based services (HCBS) for seniors and people with disabilities who meet both medical need and financial eligibility criteria. To qualify financially, most states limit income to 300% of the SSI Federal Benefit Rate — $2,901/month in 2026 for income-cap states — and assets to $2,000 for an individual ($157,920 for the spouse who remains at home, under the Community Spouse Resource Allowance). Medically needy states allow applicants to 'spend down' excess income on care costs until they reach the state's threshold.

In the 28 income-cap states, Medicaid LTC requires gross monthly income at or below the income cap ($2,901/month in 2026). If income exceeds the cap by one dollar, the applicant does not qualify unless a Miller Trust (Qualified Income Trust) diverts the excess. In the 23 medically needy states (plus DC), there is no hard income cap — applicants can 'spend down' income on care costs until reaching the state's medically needy standard, making these states more accessible for middle-income seniors with high care costs.

PACE is a federal and state Medicare/Medicaid program providing all-inclusive medical, social, and long-term care services for adults 55+ who need nursing-home-level care but prefer to live at home or in the community. PACE participants receive comprehensive services at a day center — primary care, specialists, nursing, therapy, medications, meals, and transportation — covered jointly by Medicare and Medicaid. As of 2026, approximately 35 states operate PACE programs.

Federal law requires all states to seek repayment from a deceased Medicaid recipient's estate for long-term care services received after age 55. States can file a claim against the recipient's home, bank accounts, and other probate assets after death to recover Medicaid payments. All 50 states have estate recovery programs. Common strategies to consider (with an elder law attorney): irrevocable trusts, caregiver-child exemptions, sibling exemptions, and hardship waivers. Community spouse protections apply during lifetime but estate recovery can apply after both spouses pass.

Nursing home costs vary dramatically. The national median for a private room in a skilled nursing facility is approximately $9,584/month ($115,000/year) as of 2026 — but Alaska exceeds $30,000/month while Oklahoma is closer to $5,750/month. Assisted living averages around $4,500/month nationally, though Connecticut, New Jersey, and Massachusetts exceed $7,000/month. Long-term care insurance, Medicaid, and VA benefits are the primary funding sources for extended care.