Medicaid for Seniors Guide

Medicaid is a joint federal-state program that provides free or low-cost health coverage to eligible low-income Americans. Each state administers Medicaid, so the type and levels of coverage vary depending on where you live. Drawing Social Security might affect your eligibility for Medicaid waivers.

In 2025, uncertainty exists around Medicaid. The Trump administration’s Department of Government Efficiency staffing reductions at the Centers for Medicare and  Medicaid Services can affect administrative processes for individuals applying for coverage or seeking assistance, though the U.S. Department of Health and Human Services states these changes will not impact Medicaid services.

In addition, House Republicans unveiled a bill in May that included roughly $880 billion in proposed cuts to Medicaid. As these stories continue to unfold, the facts around Medicaid may change rapidly in the coming months.

Medicaid is a joint federal-state program that provides free or low-cost health coverage to eligible Americans with low income and limited resources, including those who qualify based on disability or financial need. According to KFF, 10% of Medicaid's 71 million+ enrollees are over the age of 65 — at least as of 2021. 

Don’t confuse Medicaid with Medicare, the U.S. federal health insurance program specifically for people aged 65 and over, regardless of their financial situation. Medicare has premiums, copays, and other costs, while Medicaid is usually free for low-income Americans. Medicaid is an important player in American health care. In 2022, the program paid for more than half the long-term services and supports claims in the U.S. — more than $200 billion worth.

Since each state administers Medicaid, the type and levels of coverage vary depending on where you live. Many states offer waiver programs, which increase the program's functionality to meet specific needs.
 

​These waiver programs, however, may have eligibility affected by certain Social Security benefits, as these are often counted as income depending on state specific Medicaid rules. Long-term, institutional care is a particular focus of Medicaid for older adults, which you can explore in this guide.

Medicaid for seniors varies based on your location. States can impose cost-sharing measures, such as deductibles, and your annual income may determine these costs. 

Some seniors, including 11% of the respondents in the 2025 Caring mental health poll, may dually enroll in both Medicaid and Medicare, which can help lower costs. In addition, Medicaid may pay for prescription medications that aren't covered by Medicare Part C (Medicare Advantage) or Part D.  

Your Medicaid coverage may operate through a state-run entity, or your state may contract with a managed care organization (MCO), which handles costs, utilization, and quality of care. The MCO may operate as a health maintenance organization or preferred provider organization (PPO).  

What does Medicaid cover for seniors? The list of inclusions and exceptions varies by state, but there are certain mandatory medical services that the federal government requires states to include in their Medicare programs. Your state's Medicaid office can help you determine coverage availability.

These are some of the services Medicaid covers for seniors and other eligible individuals:

• Transportation to medical care
• Inpatient hospital services
• Outpatient hospital services
• Rural health clinic services
• Federally qualified health center services
• Lab and X-ray services
• Nursing facility services
• Screening, diagnostic, and treatment services
• Family planning services
• Physician services
• Home health services
• Medication-assisted treatment
• Routine patient costs of items and services for those enrolled in qualifying clinical trials

Optional coverage availability varies greatly by location. However, these are some of the services Medicaid may cover, depending on your location:

• Other licensed health practitioner services
• Private duty nursing
• Clinic services
• Dental care and dentures
• Physical, occupational, and speech-language therapy
• Prescription drugs
• Prosthetics
• Eyeglasses
• Services for people age 65 and older in an institution for mental disease
• Hospice care
• Case management
• TB-related services
• Home and community-based services
• Community First Choice services

Your state may dictate which services Medicaid does not cover. However, these are common exclusions to the program for seniors:

• Unreasonable or medically unnecessary services
• Cosmetic surgery
• Non-prescription drugs and health supplements
• Experimental treatments (note: experimental therapies are not FDA-approved)
• Personal comfort items
• Home modifications for disability
• Alternative treatments such as acupuncture or massage, unless prescribed by a doctor and under certain conditions (in some states)

Medicaid is a joint federal state program that provides health care coverage to eligible residents meeting specific criteria. Low-income families and seniors, pregnant women, and adults who are blind or disabled are included in the mandatory eligibility groups. 

Determining financial eligibility for Medicaid can be challenging, since it varies from state to state. In some states, the income limit for regular Medicaid is $967/month for a single person and $1,450 for a couple. 

This limit matches 100% of the Social Security Income federal benefit rate. In other states, the income level is $1,304.17/month for a single person and $1,762.50 for a couple. Seniors trying to verify their eligibility can work with elder law attorneys or certified Medicaid planners.

In addition to annual income limits, Medicaid also limits assets. However, there are exceptions — an applicant's home, vehicle, and personal belongings are generally not considered assets if they live in the home. 

Other assets, including cash, CDs, retirement accounts, most life insurance policies, and vacation properties, are considered "countable assets" and play a role in determining eligibility.

When considering how to use Medicaid, it's natural to consider whether it covers care in a skilled nursing facility or nursing home. Medicaid covers the costs of nursing home care, including skilled nursing and custodial care, when deemed medically necessary, unlike Medicare, which covers up to 100 days of medically necessary skilled nursing care per benefit period after a qualifying hospital stay

However, Medicaid only pays for skilled nursing if individuals need this level of care. Most states require seniors to complete a functional needs assessment as part of the application process.

Although most states don’t cover the cost of housing for assisted living, some run their own licensed assisted living facilities which are paid for in full or part by Medicaid. Click on your state below for information about its Medicaid office and program. 

Home and community-based service (HCBS) waivers are state-specific provisions that adjust the rules of the Medicaid program and offer more flexible options. They allow states to provide coverage that might not otherwise exist or waive some Medicaid eligibility requirements.

Medicaid provides vital health care services and support to older adults in America. In fact, Medicaid covers 61% of long-term care in the United States. This coverage includes medically necessary care in nursing homes,  memory care units, as well as services in some assisted living facilities and private homes through state-specific  waiver programs. Assisted living coverage varies by state and usually does not cover  room and board.

Medicaid is a joint federal-state program that provides health care for individuals and families who are considered low-income. It may be an option for you or your loved one to help pay for memory care, nursing home care, or other long-term care options. 

States set specific rules for their Medicaid programs, making it difficult to determine if you or your loved one qualifies and the services they may receive. Not all facilities accept Medicaid patients, and it can be useful to work with an eldercare lawyer or certified Medicaid planner to help you understand your benefits.

• Assurance of transportation. (n.d.). Centers for Medicare & Medicaid Services
• Community First Choice (CFC) 1915(k). (n.d.). Centers for Medicare & Medicaid Services
• Cost sharing. (n.d.). Medicaid.gov
• Cost sharing out of pocket costs. (n.d.). Centers for Medicare & Medicaid Services
• December 2024 Medicaid and CHIP enrollment data highlights. (2024). Centers for Medicare & Medicaid Services
• Differences between Medicare and Medicaid. (2025). Medicare Interactive
• Fight over Medicaid cuts in threatening GOP plans for Trump's 'Big, Beautiful Bill.' (2025). NPR
• HHS announces transformation to make America healthy again. (2025). U.S. Dept. of Health and Human Services
• Home & Community Based Services 1915(i). (n.d.). Centers for Medicare & Medicaid Services
• How Medicaid can help seniors cover the cost of assisted living. (2025). American Council on Aging 
• How to receive financial compensation via medicaid to provide care for a loved one. (2025). American Council on Aging
• Institutional long term care. (n.d.). Centers for Medicare & Medicaid Services
• Lamkin, Andrew. What are the countable and non-countable assets for Medicaid? (2021). LamkinElderLaw.com
• List of Medicaid eligibility groups. (n.d.). Centers for Medicare & Medicaid Services
• Managed care. (n.d.). Centers for Medicare & Medicaid Services
• Mandatory & optional Medicaid benefits. (n.d.). Centers for Medicare & Medicaid Services
• Mascaro, Lisa. House Republicans have unveiled proposed Medicaid cuts. Democrats say millions will lose coverage. (2025). PBS.org
• Medicare coverage for people with disabilities. (n.d.). Center for Medicare Advocacy
• Medicaid coverage of nursing home care: When, where, and how much they pay. (2024). American Council on Aging
• Medicaid eligibility: 2025 income, asset & care requirements for nursing homes & long-term care. (2025). American Council on Aging
• Medicaid eligibility income chart by state. (2025). American Council on Aging
• Medicaid enrollees by age. (2021). KKF.org
• Medicaid enrollment by state. (n.d.). Wisevoter.com
• Medicaid planners: Pros & cons of public and private assistance. (2024). American Council on Aging
• Prescription drugs. (n.d.) Centers for Medicare & Medicaid Services
• Rhinehart, Charlene. What does Medicaid cover? 50 services you need to know about. (2023). GoodRx.com
• Self-directed services. (n.d.). Medicaid.gov
• Seniors & Medicare and Medicaid enrollees. (n.d.). Centers for Medicare & Medicaid Services
• Substance use disorders. (n.d.). Centers for Medicare & Medicaid Services
• Surprising things your state Medicaid may not cover. (2025). Cornell University
• Trump administration and DOGE eliminate staff who help older adults and people with disabilities. (2025). Medicare Rights Center