Clear Money Guide
What this guide covers
A quick view of the questions and evidence developed below.
Comparison tables scroll horizontally on smaller screens.
Updated August 4, 2026. Quick answer: this is the asymmetry nobody explains at the hospital discharge meeting. If your parent qualifies for Medicaid and needs a nursing home, the nursing home is covered — there is no queue. If they want the same level of care at home, that runs through a waiver, and waivers are capped by number. Same person, same needs, same programme. One route is an entitlement and the other is a waiting list.
Why home care has a queue and the nursing home does not
Home and community-based services exist because a state asked the Secretary to waive ordinary Medicaid rules. The authority is what creates the asymmetry:
The Secretary may by waiver provide that a State plan approved under this subchapter may include as “medical assistance” under such plan payment for part or all of the cost of home or community-based services (other than room and board) approved by the Secretary which are provided pursuant to a written plan of care to individuals with respect to whom there has been a determination that but for the provision of such services the individuals would require the level of care provided in a hospital or a nursing facility
— 42 U.S.C. §1396n(c)(1) — Social Security Act §1915(c)
Read the eligibility test: the person must need the level of care a nursing facility provides. So the waiver population is, by definition, people who could walk into a nursing home tomorrow and be covered. That is the whole point — and it is why being on a waiting list is not evidence that someone is not sick enough.
The cap is not an administrative habit. It is written into the statute, in the provision that describes what happens when a capped waiver has a vacancy:
In the case of any waiver under this subsection which contains a limit on the number of individuals who shall receive home or community-based services, the State may substitute additional individuals to receive such services to replace any individuals who die or become ineligible for services under the State plan.
— 42 U.S.C. §1396n(c)(9)
That is the waiting list, described in federal law. A slot opens when somebody dies or becomes ineligible. It is a grim sentence to read about your own parent, and it is the honest mechanism — which is why “how long is the list” is often the wrong question and “how does this list actually move” is the right one. The same waivers pay for home modifications, which is the one route that regularly funds a stairlift.
One floor exists: the Secretary “shall not limit to fewer than 200” the number of people a state may serve under a waiver (§1396n(c)(10)). That is a minimum imposed on the federal side, not a ceiling on the state — states routinely run waivers far larger, and routinely run them full.
The two routes, side by side
| Nursing facility care | A state-plan benefit. If the person is eligible and needs the care, it is covered. No slot limit, no list. |
|---|---|
| The same care at home, under a §1915(c) waiver | Requires a waiver, and the waiver may limit the number of individuals. Slots free up when someone dies or loses eligibility. |
| Self-directed personal assistance (§1915(j)) | A state may limit the population eligible and limit the number of persons served — capped in the same way. |
| Personal care services under the state plan (no waiver) | Available in states that elect it, but with the family-member restriction below. |
Can Medicaid pay a family member to provide the care?
This is where the two routes diverge again, and the answer turns on a phrase most people never see. Under the ordinary state-plan personal care benefit:
The regulation lists three requirements for the service to count. The second is the one that matters here:
Provided by an individual who is qualified to provide such services and who is not a member of the individual’s family
— 42 CFR §440.167(a)(2)
That looks like a flat bar on paying family. It is not, because the regulation defines the term in the very next subsection:
For purposes of this section, family member means a legally responsible relative.
— 42 CFR §440.167(b)
“Family member” means legally responsible relative. A spouse is one. An adult son or daughter is generally not. So under the state-plan personal care benefit, the daughter who gave up her job to provide the care is frequently payable and the husband doing the identical work is not.
And the regulation opens with the clause that undoes even that:
Unless defined differently by a State agency for purposes of a waiver granted under part 441, subpart G of this chapter—
— 42 CFR §440.167, opening words
A waiver can define it differently — which is the route by which some states do pay spouses. So the answer to “can Medicaid pay me to care for my husband?” is not yes or no. It is: not under the state-plan benefit, possibly under your state’s waiver, and that is a question for your state Medicaid agency about that specific waiver.
⚠️ This is not the caregiver-child exemption
These two get conflated constantly and they solve completely different problems. The caregiver-child exemption is about transferring the house — an adult child who lived there and provided care for two years can receive the home without triggering a transfer penalty. It pays nobody. What is on this page is about Medicaid paying for care, which is a different question with different rules and does not require anyone to move in or transfer anything. A family can need both, one, or neither.
What to actually ask, and who to ask
- Ask for the waiver by name. States run several, each with its own population, services and list. “Am I on the Medicaid waiting list” is not a question anyone can answer.
- Ask whether the state has a personal care benefit outside the waiver — if it does, it has no slot cap, though it has the family-member restriction.
- Ask how the list is ordered. Some states run first-come, some run by assessed need. It changes what waiting means.
- Ask whether accepting nursing-home placement forfeits the list position. Families are often told to take the bed and sort it out later.
- Your Area Agency on Aging and your state’s protection-and-advocacy organisation are free, and they do this every day.
Related
If the house is the worry: can Medicaid take your house, estate recovery by state, and the lady bird deed. Paying a relative under a written arrangement: the family caregiver agreement. Whether a trust helps: a living trust does not protect the house.
Honest gaps
We have not published any state’s waiver names, waiting-list lengths, income or asset limits, or payment rates — they vary by state and by waiver, and we have no verified corpus for them. We have not covered the §1915(i) or §1915(k) options, managed long-term care, or how a level-of-care determination is actually made. The provisions quoted here are federal; what your state elected to do inside them is the part that decides your case, and only your state Medicaid agency can tell you.
Statutory and regulatory text read at Cornell LII (42 U.S.C. §1396n; 42 CFR §440.167). General information, not legal or benefits advice. Medicaid is administered state by state and the federal text above is the floor, not the answer. We sell nothing on this page and earn nothing from it.
A waiting list is the slow path. When a placement has already happened and the money is running out, the work shifts to crisis planning, and its cost is a different figure.
The remaining 25 jurisdictions’ waiver names, added September 4, 2026
A prior update closed this gap for the first 26 states. This second update finishes the family at all 50 states plus DC, each researched at the jurisdiction’s own Medicaid agency.
| State | Waiver / state plan option | Covers assisted living? |
|---|---|---|
| Nebraska | Nebraska Medicaid Aged and Disabled (AD) Waiver, Supported Residential Living service | Yes |
| Nevada | Home and Community Based Services (HCBS) Waiver for the Frail Elderly (FE) | Yes |
| New Hampshire | Choices for Independence (CFI) Waiver, administered by the NH DHHS Bureau of Elderly and Adult Services | Yes |
| New Jersey | NJ FamilyCare Managed Long Term Services and Supports (MLTSS) | Yes |
| New Mexico | Turquoise Care Community Benefit, Agency-Based Community Benefit (ABCB) | Yes |
| New York | Assisted Living Program (ALP) | Yes |
| North Carolina | State Plan Personal Care Services (PCS) Provided in Congregate Settings (Clinical Coverage Policy No. 3L-1) | Yes |
| North Dakota | Home and Community-Based Services (HCBS) Waiver, 1915(c) [ND.0273.R06.07]: “Adult Residential Care” service | Yes |
| Ohio | Assisted Living (HCBS) Waiver, administered by the Ohio Department of Aging under OAC Chapter 5160-33 | Yes |
| Oklahoma | ADvantage Waiver (Medicaid HCBS 1915(c)): Assisted Living service option, OAC 317:35-17-3(e)(17) | Yes |
| Oregon | Community First Choice State Plan Option (“K Plan”), 1915(k) Medicaid State Plan benefit | Yes |
| Pennsylvania | Community HealthChoices (CHC) 1915(c) HCBS Waiver (PA.0386.R05.01) | Yes |
| Rhode Island | RI Comprehensive Section 1115 Demonstration: Office of Healthy Aging Assisted Living Program (Medicaid LTSS Assisted Living benefit) | Yes |
| South Carolina | Community Choices (CC) Waiver, SC.0405 / Draft SC.016.05.00 renewal | Yes |
| South Dakota | HOPE Waiver: Home and Community Based Options and Person-Centered Excellence (SD.0189) | Yes |
| Tennessee | TennCare CHOICES in Long-Term Services and Supports: Assisted Care Living Facility (HCBS-ACLF) service, Groups 2/3 | Yes |
| Texas | STAR+PLUS Home and Community Based Services (HCBS) program: Assisted Living Services | Yes |
| Utah | New Choices Waiver (NCW): Adult Residential Services-Assisted Living | Yes |
| Vermont | Choices for Care (CFC): Enhanced Residential Care (ERC) option | Yes |
| Virginia | Commonwealth Coordinated Care Plus (CCC Plus) Waiver [1915(c), 12VAC30-120-900 et seq.] | No |
| Washington | Community Options Program Entry System (COPES): 1915(c) waiver | Yes |
| West Virginia | Aged and Disabled Waiver (ADW): 1915(c) waiver | No |
| Wisconsin | Family Care (Wisconsin’s managed long-term care program combining 1915(b)/(c) authority) | Yes |
| Wyoming | Community Choices Waiver (CCW): 1915(c) waiver, Wyoming Medicaid Rules Chapter 34 | Yes |
| District of Columbia | Elderly and Persons with Physical Disabilities (EPD) Waiver: 1915(c) waiver | Yes |
The Medicaid nursing-facility income limit, by state (23 states with a figure or mechanism worth stating on its own)
The tables above are about home- and community-based waiver eligibility mechanics, a different question. The income figure itself is genuinely different from state to state, and in some states is not a fixed dollar cap at all. Each row below is that state’s own quick answer, excerpted from its own detail page.
| State | Medicaid nursing-facility income limit |
|---|---|
| California | California runs no income ceiling at all for Medi-Cal nursing-home eligibility. Instead it uses a share-of-cost model: California Code of Regulations, Title 22, §50605 sets the resident’s own personal-and-incidental-needs allowance at “Thirty-five dollars for personal and incidental needs, when the beneficiary will remain in long-term care for the entire calendar month.” Every dollar of countable income above that (after allowed deductions) goes to the facility as the applicant’s share of cost. A high income does not disqualify anyone; it just raises the monthly bill Medi-Cal expects the applicant to pay before it covers the rest. |
| Delaware | Delaware’s long-term-care Medicaid income limit is $2,485 a month for a single applicant, effective 2026, and it is not the 300%-of-SSI figure nearly every other income-cap state uses. Delaware Health and Social Services’ own income-limits table sets it at 250% of the SSI standard: “250% Individual $2,485.” A page or advisor quoting the generic $2,982 national figure for Delaware is quoting the wrong state’s math. |
| Florida | Florida’s standard Institutional Care Program (ICP) income cap is $2,982/month in 2026, the plain federal default. But Florida also runs a second, lower institutional-eligibility pathway most other states do not name separately: MEDS-AD, capped at $1,182/month (88% of the federal poverty level), plus a true Medically Needy track with no income limit at all once an applicant’s share of cost is met. |
| Hawaii | Hawaii sets no income ceiling at all for an aged, blind, or disabled applicant, including someone applying for nursing-facility Medicaid. Its own administrative rule states countable income is “unlimited” before spend-down; eligibility instead runs through the state’s medically needy spend-down process against allowable medical expenses. |
| Idaho | Idaho’s own published long-term-facility-care income limit is $3,002 a month for a single applicant, effective January 2026, not the plain $2,982 that 300% of the 2026 federal SSI benefit rate would otherwise produce. Idaho Health and Welfare’s income-limits table folds its own $20 general income disregard into the headline number rather than listing it separately, so the figure a reader sees is $20 higher than the bare 300% cap most other states quote. |
| Illinois | Illinois has no institutional income cap at all; it is a medically-needy spend-down state, and the standard someone spends down to is $1,330 a month for a household of one in 2026. The Illinois Department of Human Services’ own program-standards desk aid lists this AABD Medically Needy income standard as equal to 100% of the federal poverty level, which means the figure moves every year with the federal poverty guideline rather than waiting on a specific state rule change. |
| Kentucky | Kentucky runs the standard 300%-of-SSI income cap for nursing-home Medicaid, but its own current regulations also keep alive a separate, much lower medically-needy “basic maintenance” standard of $235 a month for a household of one. Most secondary sources describe Kentucky purely as a cap-and-trust state; 907 KAR 20:020 shows a second, still-active pathway most write-ups leave out. |
| Louisiana | Louisiana’s Special Income Level (SIL) is three times the SSI federal benefit rate, the same $2,982 figure most states use in 2026. But Louisiana’s own eligibility manual guarantees every institutionalized applicant over that line a medically needy spend-down pathway with no upper income limit at all, so the SIL is a routing point, not a hard cutoff. |
| Maryland | Maryland’s own current regulation makes the 300%-of-SSI income cap, not a low medically-needy figure, the primary standard for institutional Medicaid: COMAR 10.09.24.10 states “A person is categorically needy if his total income before deductions does not exceed 300 percent of the current SSI payment standard.” Several secondary Medicaid-planning sites characterize Maryland purely as a low-dollar medically-needy state; Maryland’s own codified rule runs the cap first. |
| Massachusetts | The $2,982 (300%-of-FBR) figure often quoted for Massachusetts actually governs only its Home and Community-Based Services waivers (Frail Elder Waiver, PACE, and similar programs). True nursing-facility MassHealth has no income ceiling at all: countable income above a small personal-needs allowance and allowed deductions goes toward the cost of care. |
| Michigan | Michigan does not test institutional Medicaid income against 300% of the SSI federal benefit rate at all. It tests net income against the lower “Group 2” needs standard used for its aged, blind, and disabled category, with a mandatory medically-needy spend-down for any excess. |
| Minnesota | Minnesota is often filed as a flat 300%-cap state; it is not. The Department of Human Services’ own training material shows the $2,982-a-month figure (2026) is a “Special Income Standard” that gates a waiver/institutional level-of-care determination, not the eligibility ceiling itself. Someone above it does not simply lose eligibility the way they would in a pure income-cap state; a separate, lower spend-down obligation for ongoing long-term-care Medicaid applies underneath it. |
| Missouri | Missouri’s “Vendor Care” program (its nursing-facility Medicaid category) lists no income-limit dollar figure at all in the state’s own eligibility-standards table, unlike every other program on the same page. Eligibility instead runs on a post-eligibility surplus computation with no hard ceiling. |
| Montana | Montana’s own current Table of Standards puts the monthly categorically-needy income standard for an institutionalized individual at just $30, with a separate $525 medically-needy income level, effective January 1, 2026. Neither number functions as a real ceiling the way other states’ figures do: the same document states plainly that “Otherwise eligible institutionalized individuals and spouses are income-eligible for nursing home coverage so long as their monthly nursing home costs equal or exceed their monthly income.” The real test in Montana is cost of care, not a dollar limit. |
| New York | New York sets no single dollar income ceiling for nursing-facility Medicaid. Once eligible under the state’s Medically Needy income standard, a resident enters “chronic care budgeting,” under which essentially all income above narrow deductions is applied to the cost of care as NAMI (Net Available Monthly Income), with no upper bound. |
| North Carolina | North Carolina does not test nursing-facility Medicaid income against a statewide percentage of the SSI federal benefit rate. It compares an applicant’s net income against the specific nursing facility’s own Medicaid reimbursement rate or private-pay rate, so the effective ceiling varies by which facility the applicant is in. |
| North Dakota | North Dakota’s medically needy income level is $1,197 a month for one person, effective April 1, 2026, and it is not tied to the SSI benefit rate at all. North Dakota is a Section 209(b) state, and its own policy manual sets the figure at 90% of the federal poverty level, updated each April rather than each January the way SSI-linked cap states update. |
| Oklahoma | Oklahoma’s Medicaid income limit for nursing-facility care is $2,982 a month; 300 percent of the 2026 SSI federal benefit rate of $994; as published in the state’s own standards form, Appendix C-1, effective July 1, 2026. Oklahoma’s public online eligibility popup still shows $2,205, which is 300 percent of the 2017 benefit rate of $735; it was still showing $2,205 when it was re-read on September 7, 2026. The effective-dated form is the one to use. |
| Rhode Island | Rhode Island runs the standard 300%-of-SSI income cap, currently about $2,982 a month, as an initial eligibility gate for its Elders and Adults with Disabilities institutional group, per its own current regulation. Unlike a pure income-cap state, Rhode Island’s rule also automatically evaluates every long-term-services applicant for the medically-needy spend-down pathway, so someone over the cap is not automatically locked out the way they would be in a state that requires a Qualified Income Trust as the only cure. |
| Utah | Utah’s own official long-term-care figures table lists a $2,982-a-month, 300%-of-SSI income line for its HCBS waiver programs, but no corresponding income-ceiling entry for plain nursing-facility (“Institutional Long Term Stay”) Medicaid at all, only a $45 personal needs allowance. That structure is consistent with the commonly repeated claim that Utah applies no hard income cap to straight nursing-home Medicaid, with income above the personal-needs allowance instead going toward the cost of care. |
| Virginia | Virginia runs three separate regional medically-needy income limits rather than one statewide figure. For a household of one, Virginia’s own administrative code sets Group I at $2,691.00 a month, Group II at $3,105.00, and Group III at $4,036.50, depending on where in the state the applicant lives, a genuinely unusual structure compared to the single flat figure most states use. |
| Washington | Washington uses the standard 300%-of-SSI Special Income Level as its institutional Medicaid gate, currently about $2,982 a month, but its own administrative code then offers a direct medically-needy spend-down eligibility route for income above that level, without requiring a Qualified Income Trust the way many other income-cap states do. |
| Wisconsin | Wisconsin is frequently described in secondary Medicaid-planning material as a medically-needy spend-down state; its own current Eligibility Handbook shows nursing-home Medicaid actually runs on a plain 300%-of-SSI income cap, $2,982 a month for one person, effective 2026. The much lower $1,330 figure often cited for Wisconsin applies to a separate, non-institutional coverage group, not to the nursing-facility category itself. |
Coverage, stated honestly: 23 states researched this way. Every other state’s own leaf page, if published, follows the same sourcing standard.
Waiver eligibility runs on the same resource tests as institutional Medicaid, and for a single applicant the house is only exempt below a state-set equity ceiling. The published figure by state: Texas, Utah, Oregon, Pennsylvania, Rhode Island, Michigan, Illinois, Indiana, Louisiana, South Carolina, Tennessee, Iowa, Kentucky, Delaware, Georgia, North Dakota, Oklahoma, Minnesota, Mississippi, Montana, North Carolina, Virginia, West Virginia, Wisconsin, Idaho, Maine, Nevada, Washington, California.
26 states’ waiver names, added September 3, 2026
This page said we had not published any state’s waiver names, waiting-list status or payment rates. That gap is now closed for the first 26 states below, each researched at the state’s own Medicaid agency; the remaining 25 states and DC follow in a later tranche.
| State | Waiver / state plan option | Covers assisted living? |
|---|---|---|
| Colorado | Alternative Care Facilities (ACF) benefit under the Elderly, Blind and Disabled (EBD) waiver | Yes |
| Florida | Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) Program | Yes |
| Connecticut | Connecticut Home Care Program for Elders (CHCPE), funded by CMS 1915(c) waiver 0140.R08.00 | Yes |
| Missouri | None currently: Missouri’s dedicated MO Assisted Living Waiver (0649.R00.00) was terminated March 3, 2012, and its remaining HCBS waivers exclude ALF/RCF residents | No |
| Montana | Big Sky Waiver (BSW) | Yes |
| Hawaii | QUEST Integration (Section 1115 demonstration), HCBS benefit package: Hawaii folded its former standalone 1915(c) waivers into managed care effective February 1, 2009 | Partial |
| Idaho | Aged and Disabled Waiver (CMS waiver ID ID.1076.R07.00) | Yes |
| Illinois | Supportive Living Program (SLP), IL Supportive Living Program Waiver (0326.R05.00) | Yes |
| Indiana | PathWays for Aging (Assisted Living Waiver, age 60+) and the Health and Wellness Waiver (under 60), governed by 455 IAC 3-1 | Yes |
| Alabama | Medicaid Waiver for the Elderly and Disabled (E&D Waiver) | Unclear |
| Alaska | Alaskans Living Independently (ALI) Waiver | Yes |
| Arizona | Arizona Long Term Care System (ALTCS), operated by AHCCCS under a Section 1115 demonstration (no separate 1915(c) waiver name) | Yes |
| Arkansas | Living Choices Assisted Living Waiver (LCAL) | Yes |
| California | Assisted Living Waiver (ALW) | Yes |
| Georgia | Elderly and Disabled Waiver Program (EDWP, formerly CCSP) and SOURCE (Service Options Using Resources in a Community Environment) | Yes |
| Delaware | Long Term Care Community Services (LTCCS), under the Diamond State Health Plan (DSHP) 1115 Demonstration, drawing on HCBS authorities of Sections 1915(c) and 1915(i) | Yes |
| Maryland | Home and Community-Based Options Waiver (HCBOW), also known as the Community Options (CO) Waiver | Yes |
| Iowa | Elderly Waiver (part of the Hope and Opportunity in Many Environments, or HOME, redesign) | Yes |
| Kansas | Frail Elderly (FE) HCBS waiver | Partial |
| Kentucky | Home and Community Based Waiver (HCB Waiver), CMS control number KY.0144.R08.00 | No |
| Louisiana | Community Choices Waiver (CCW), home-based only; the prior Adult Residential Care (ARC) Waiver, which would have covered assisted-living-type settings, was repealed January 10, 2022 for lack of CMS approval | No |
| Maine | Elderly and Adults with Disabilities Waiver (MaineCare Benefits Manual Section 19), CMS control number ME.0276 | Yes |
| Massachusetts | MA Frail Elder Waiver (CMS waiver 0059.R08.00); whether this or Group Adult Foster Care (a separate state-plan option) is the program that actually pays for assisted-living-setting care could not be confirmed this session | Unclear |
| Michigan | MI Choice Waiver (CMS waiver MI.0233.R06.00) | Yes |
| Minnesota | Elderly Waiver (EW) | Yes |
| Mississippi | Assisted Living Waiver (CMS waiver 0355.R05.00) | Yes |