Medicare assistance program options by state

Reaching the point of eligibility for Medicare is a significant milestone: entry into the largest public health program in the nation – a major source of health coverage for elderly and disabled Americans. It’s a welcome – and popular – “safety net” that has evolved over the decades and covers many medical expenses for its beneficiaries.

But this health coverage can be a source of confusion for Medicare enrollees – many of whom have an expectation that the program will provide long-term nursing home care or in-home care. In fact, Medicare has never covered long-term services and supports (LTSS) – an array of medical and personal “long-term care” services for people who struggle with self-care due to aging, illness or disability. Furthermore, Medicare can leave its enrollees with significant out-of-pocket expenses.

The good news is that Medicaid offers a long list of financial assistance options intended to help Medicare beneficiaries with limited financial resources who are faced with Medicare cost sharing and long-term care expenses. These can include help with Medicare premiums, coverage for dental and vision services, some medical supplies, and long-term care services (at home or in a nursing home).

Where you live affects your financial assistance

But because Medicaid is administered differently by each state, where Medicare enrollees reside has a significant impact on their eligibility for assistance. The pages in this section – including one for every state and the District of Columbia – are designed to help Medicare enrollees easily find the eligibility rules for programs and financial assistance in each state.

You can start by choosing your state from this list.

We’ve tried to make these pages a source of the often hard-to-find information that Medicare enrollees need to get a clear picture of financial assistance they can expect with Medicare and long-term care expenses. At the end of each section, we’ve included a list of resources that can provide further clarification on these topics.

Here’s what’s covered in each state section:

Medicare Savings Programs vary by state

Medicare Savings Programs (MSPs) are Medicaid-administered programs that cover Medicare premiums for eligible enrollees. Each state offers a set of MSP programs, which include the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualified Individuals (QI) programs everywhere other than the District of Columbia. These programs all pay for Part B premiums. One MSP also pays for Medicare Part A and B cost sharing, and covers Part A premiums for enrollees who owe them.

Receiving the MSP means Part B premiums are no longer deducted from an enrollee’s Social Security benefit, which results in an annual benefit increase of over $1,978 for 2023.

Income limits: The income limits for MSPs vary depending on the program and the state. The QMB program is the most robust and has the lowest income limits ($1,153 for a single individual in most states as of 2022). The income limits are higher for the SLMB program, and higher still for the QI program, but still only $1,549 for a single individual in most states as of 2022. However, states can set higher income limits for these programs. Another MSP is the Qualified Disabled Working Individuals (QDWI) program, which pays for Part A premiums for a small number of disabled enrollees who return to work. Very few people choose to enroll in this program.

Asset limits: The minimum asset limit set by the federal government for QMB, SLMB, and QI is $10,590 for individuals and $16,630 for married couples as of 2023 (the minimum asset limit is the same as the asset limit for Full Extra Help). Most states use the asset limit set by the federal government, but there is a trend of some states increasing or removing their limits.

Medicaid for the aged, blind and disabled (ABD)

In every state, Medicaid covers hospital and medical services for people who are aged (65 or older), blind or disabled. This coverage is usually at least as comprehensive as benefits offered by private insurers, and can pay for cost sharing and services Medicare doesn’t cover (including vision and dental care, and some medical supplies).

Medicaid for the aged, blind and disabled has different names in each state. It is sometimes called ABD Medicaid, community Medicaid, traditional Medicaid, or SSI-Related Medicaid.

ABD Medicaid pays after Medicare does for services covered by both programs (Meaning Medicare is primary and Medicaid is secondary). This usually leaves enrollees who are dual eligible – meaning they have both Medicare and Medicaid – with few out-of-pocket expenses.

Medicare beneficiaries don’t have access to dental or vision care through Original Medicare, although some Medicare Advantage plans cover those services. In many states, Medicaid provides comprehensive dental and vision coverage, and may also cover costly items like dentures.

It’s important to note that ABD Medicaid differs from Medicaid expansion. They serve different populations and have different eligibility rules. Medicaid expansion is for adults under the age of 65, and eligibility is based only on income. But once a person turns 65, they’re no longer eligible under Medicaid expansion rules. ABD Medicaid has both income and asset limits. So while a person with low income but significant assets can qualify for Medicaid expansion prior to age 65, they may find that they’re no longer eligible for Medicaid once they turn 65. Here’s more about the transition from Medicaid expansion to Medicare.

Asset limits: In nearly every state, ABD Medicaid eligibility includes an asset limit in addition to an income limit.

Most states’ asset limits for ABD Medicaid also are based on the SSI program, where resource limits haven’t increased since that program took effect in 1973, and are $2,000 for individuals and $3,000 for spouses.

ABD Medicaid uses the same asset limit as SSI in most states. ABD Medicaid’s asset limits are highest in Arizona (no asset limit), California ($130,000 for a single individual, and no asset limit as of 2024), and New York ($30,180 for single applicants and $40,820 for couples).

Income limits: The income limits for Medicaid ABD are closely related to Supplemental Security Income (SSI), which provides income support to elderly, blind and disabled Americans. In 2023, SSI’s income limit is $914 a month for individuals and $1,371 a month for spouses, who receive cash payments that usually increase their income until it reaches this limit.

Most SSI enrollees automatically receive Medicaid benefits, but in some states they have to apply for Medicaid themselves.

Medicaid ‘spend down’ programs

Many states allow enrollees with incomes above the eligibility limit for Medicaid ABD to enroll in a Medicaid spend-down program, which allows medical expenses to be subtracted from income that is counted toward the Medicaid eligibility limit.

In some states, enrollees can also pay their “spend-down” amount to Medicaid directly, but other states require the submission of medical bills to receive spend-down benefits.

The Medicaid spend-down covers long-term services and supports (LTSS) in some states, but it does not cover those services in others.

Medicaid nursing home coverage

Many Medicare enrollees may ultimately need help with long-term services and supports (LTSS) or “long-term care.” In previous decades, individuals mostly received those services in a nursing home or another “institutional” setting. This is why Medicaid covers nursing home care for an unlimited number of enrollees in each state, but there can be limits on home-based care.

Medicare can cover up to 100 days in a skilled nursing facility for certain enrollees who meet medical and level of care criteria. However, Medicare’s coverage is limited, and does not apply if a person needs only custodial care (as opposed to skilled nursing care). So enrollees often end up needing to seek coverage for nursing homes or other long-term care services through Medicaid.

A few Americans finance their long-term care by purchasing private long-term care insurance (LTCI) or paying out-of-pocket. But LTCI policies are unaffordable for most middle-income families, and must be purchased while an applicant is relatively young. In 2023 , nursing home care cost an average of $8,341 a month, which could rapidly deplete most couples’ savings. Medicare enrollees who need ongoing nursing home care often have to apply for Medicaid.

Although ABD Medicaid has low asset limits in most states, a primary home is not counted if the applicant or their spouse continues to live in the home. And Congress passed the Medicare Catastrophic Coverage Act (MCCA) in 1988 to reduce impoverishment of people whose spouses needed Medicaid-funded long-term care (referred to as “community spouses” as they continue to live in the community, without long-term care assistance).

That legislation allows community spouses of nursing home recipients to keep an allowance from income received by their nursing home spouse. In 2022, this “spousal allowance” was between $2,288.75 and $3,435 each month (these limits are updated each year in July).

MCCA also allows these community spouses to keep as much as $137,400 in assets, although several states have a lower spousal resource limit.

Income limits for nursing home care higher than for other Medicaid programs

Because of the enormous cost of long-term care, the income limit in many states for Medicaid nursing home benefits is higher than for ABD Medicaid.

Income limits for nursing home care vary significantly from state-to-state, and can be found in our individual state guides.

Once someone enters a nursing home, they usually have to pay most of their income to the home — including the amount below their state’s income limit for nursing coverage. Enrollees are allowed to keep a personal needs allowance that varies by state and is discussed on our individual state pages.

Medicaid Home and Community Based Services (HCBS) waivers

All states have chosen to cover community-based long-term care services, which are provided to enrollees in their home, adult day care center, adult living facility, or another community location.

Medicaid programs offering this type of care are known as Home and Community Based Services (HCBS) waiver programs. Enrollees can receive long-term care services through these programs without entering a nursing home.

Although states must cover Medicaid nursing home benefits for an unlimited number enrollees, they don’t have to cover HCBS. Because these HCBS benefits are costly, most states use waiting lists for at least some of these programs. (656,000 enrollees in 37 states were on waiting lists for HCBS waivers in 2021.)

These pages explain the eligibility limits and services covered by HCBS waiver programs in each state.

Rules about transferring assets

Long-term care can be very expensive, which is why Medicare enrollees sometimes feel the need to reduce their assets to help themselves qualify for Medicaid. This process can involve giving away or transferring assets for less than they are worth.

States are required to penalize applicants who apply for Medicaid nursing home benefits if they gave away or transferred assets during the “lookback period” prior to filing their application (or before they entered a nursing home in some states). As of 2023, every state but California and New York also have an asset transfer penalty for HCBS. (New York plans to implement an asset transfer lookback period for HCBS applicants starting in 2024.)

Qualifying for Medicaid, nursing home care, or HCBS with income above the eligibility limit

When a Medicare enrollee’s income is too high to qualify for Medicaid nursing home benefits or HCBS, their options for qualifying for those services depend on their state.

Some states have Medicaid spend-down programs that allow applicants to subtract medical expenses (and often long-term care costs) from income counted toward the Medicaid eligibility limit. Medicaid spend-down programs cover long-term care in some states, but not in others.

States that don’t allow enrollees to pay what they can afford toward their long-term care, and have Medicaid pay the rest are called income cap states. Fortunately, federal rules allow applicants in these states to qualify for Medicaid long-term care benefits by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”

Most states that permit Miller Trusts allow applicants to use them to qualify for either nursing home benefits or HCBS.

Some states offer Medicaid spend-down and Miller Trust options. In other states, applicants are not able to use a Miller Trust, but can use a “pooled trust” to qualify for Medicaid (and for LTSS benefits).

Estate recovery for Medicaid benefits

States are required to recover from the estates of enrollees who received Medicaid-funded long-term care beginning at the age of 55. The law requires states to recover the cost of LTSS (and related medical and prescription drug costs), but states can also recover what they paid for other Medicaid benefits for enrollees age 55 or older. States also have the option to recoup Medicaid costs for younger enrollees if they lived in an institution permanently.

This process of recouping money from a Medicaid enrollee’s estate is called “estate recovery.”

Some states that previously used estate recovery for all Medicaid-funded services after a person was 55 have changed their rules to prevent estate recovery from applying to people who qualified for Medicaid expansion between the ages of 55 and 64 (but for whom Medicaid-funded LTSS were not provided). But the rules around this still vary considerably from state to state, and it’s important for Medicaid expansion enrollees age 55+ to understand how it works in their state.

Some states only recover from assets subject to a will (known as the “probate estate”), but other states will recover assets that pass outside of probate.

Medicaid prescription drug benefits / State Pharmaceutical Assistance Programs

Before the Medicare Part D prescription drug benefit took effect in 2006, low-income Medicare beneficiaries received prescription drug benefits through Medicaid.

To keep prescription drug costs affordable, Medicare enrollees who also have Medicaid, an MSP, or SSI are automatically enrolled in Extra Help. This federal program lowers prescription drug expenses under Part D to prices similar to those paid under Medicaid. However, Part D plans are not allowed to cover certain medications that Medicaid covers – including over-the-counter drugs, prescription vitamins, most non-FDA approved drugs, and some cough medicines. A few states provide a limited Medicaid prescription drug benefit that covers these drugs for eligible Medicare beneficiaries.

Some states also operate State Pharmaceutical Assistance Programs (SPAPs), which provide assistance to Medicare Part D enrollees with low and moderate incomes. These programs can help pay for Part D premiums and copays, and may cover drugs that aren’t covered by Part D. SPAP enrollees also receive a once-yearly special enrollment period (SEP) to select or change Medicare Advantage and Part D plans.

How do I apply for Medicaid benefits or an MSP in my state?

The way you apply for ABD Medicaid, MSP and long-term care benefits varies in each state. Some states allow you to apply for ABD Medicaid or MSP benefits online – or to begin your long-term care application. In other states, you have to submit a paper application at a Medicaid or social services office – or send this by mail or fax.

We have included information about applying for Medicaid at the end of each state page. When available, we included a link to the state’s online Medicaid application. We also listed the state agency in charge of eligibility.

If you’re applying for MSP or ABD Medicaid, your state should try to confirm information about your identity, income and assets without asking you to provide records. You would only need to provide Medicaid with identification documents, a Social Security award letter, pay stubs, or bank account statements if information couldn’t be verified electronically, or if electronic records don’t match what was listed on your application.

But eligibility for Medicaid long-term care benefits can’t be determined without your financial records. You’ll usually have to share 60 months of checking, savings, and retirement account statements when applying for those services.

Medicaid will meet with you and your family if you apply for long-term care benefits. You would also be evaluated for whether you require a certain level of assistance with needs and activities, which could affect your eligibility.