Medicaid (Baseline)

Last updated: August 21, 2026 Reviewed by: George A. Mellendorf

What it is

Medicaid is a joint federal-state program and the nation's largest single payer of long-term care, covering approximately 61% of nursing home residents nationally and the majority of home- and community-based services (HCBS) spending for people with functional dependency. It was designed as a safety net for low-income Americans, not as a middle-class long-term care benefit — which is exactly why the planning techniques in Pillars 6 and 7 exist. See Medicaid.gov's overview of seniors and dual Medicare-Medicaid enrollees for the federal framework.

Medicaid funds long-term care through three main pathways: nursing home (institutional) Medicaid, Home and Community-Based Services (HCBS) waivers for home care and assisted living services, and PACE (Program of All-Inclusive Care for the Elderly), a combined Medicare/Medicaid managed-care benefit available in about half of U.S. counties.

The 2026 financial eligibility numbers

Two tests must be passed simultaneously: a resource (asset) test and an income test. Figures below are 2026 federal figures — states have discretion within these ranges, so always confirm the exact number in your state.

Category	2026 Countable Limit	Notes
Single applicant assets	$2,000	Higher in a few states
Community Spouse Resource Allowance (CSRA)	Up to $157,920	Federal maximum; some states allow up to this figure, others less
Applicant income (income-cap states)	$2,901/month	300% of SSI; ~24 states use an income cap, others use spend-down
Community spouse minimum income (MMMNA)	$2,555–$3,948/month	Federal floor to ceiling; state-set within that range
Home equity cap (non-spouse cases)	$752,000–$1,130,000	State elects; Florida uses $752,000; no cap in California
Personal needs allowance (in nursing home)	$30–$200/month	State-set; retained by applicant for personal use

Source: distilled from the Medicaid Planning white paper (2026 figures, CMS & state Medicaid agency data). Every figure changes annually and varies by state — confirm current numbers with a licensed elder-law attorney and the official Medicaid.gov eligibility page for your state.

Who it fits

Applicants whose countable assets are already at or near the state limit
Families who have completed a spend-down (see Pillar 6 and 7 for how that's done correctly)
Anyone already relying on Medicaid as a primary long-term care funding source

Not a last resort — a legitimate pillar

Despite its reputation, Medicaid is not something to be ashamed of or to avoid discussing. It is a legitimate, heavily used funding pillar that millions of American families rely on. The planning conversation isn't whether to consider Medicaid — it's how and when to position assets so that qualifying for it doesn't require losing everything first. For a consumer-facing summary of how Medicaid fits alongside other funding sources, see LTC News' guide to Medicaid for long-term care.

Not mutually exclusive. Most families combine two or three pillars — this one rarely stands alone. The Journey Assessment ranks all ten pillars against your specific situation and recommends the top three.

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Supporting Articles

Blog How to Start the Long-Term Care Conversation With Aging Parents
Blog Medicaid Estate Recovery: What Happens to a Home After Death
Blog Spousal Impoverishment Protections: Keeping the At-Home Spouse Solvent
Blog Assisted Living vs. Nursing Home: How the Funding Actually Differs
Blog Irrevocable Trusts for Medicaid Planning: What They Do and When to Use Them
Blog How Families Actually Combine the 10 Funding Pillars
State Guide Florida: Florida Medicaid Long-Term Care
State Guide California: California Medi-Cal Long-Term Care
State Guide Texas: Texas Medicaid Long-Term Care
State Guide New York: New York Medicaid Long-Term Care
State Guide Pennsylvania: Pennsylvania Medicaid Long-Term Care
State Guide Illinois: Illinois Medicaid Long-Term Care
State Guide Ohio: Ohio Medicaid Long-Term Care
State Guide Michigan: Michigan Medicaid Long-Term Care
State Guide North Carolina: North Carolina Medicaid Long-Term Care

Sources

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