Medicaid long-term care eligibility comes down to income, assets, and proven medical need. Here is how each test works in 2026.
What are the income and asset limits for 2026?
For 2026, a single senior seeking Medicaid long-term care generally needs monthly income at or below roughly $2,982 (300% of the SSI federal benefit rate) and countable assets at or below $2,000. Married couples are treated differently: the community spouse can keep between $32,532 and $162,660 in assets plus a monthly income allowance. Exempt assets such as your home (within an equity cap), one car, and burial funds do not count. Because every state sets its own thresholds and some require a Qualified Income Trust for higher earners, confirm your numbers by calling 1-800-MEDIGAP (1-800-633-4427).
What is the medical or functional test?
Beyond money, you must demonstrate a need for care. For nursing home Medicaid, a state assessor or physician confirms you require a nursing-home level of care, typically meaning you need substantial help with activities of daily living like bathing, dressing, eating, or transferring, or you have a cognitive impairment such as dementia. Home and community-based waiver programs use a similar functional test so you can receive care at home instead. This assessment is mandatory and separate from the financial review. A specialist at 1-800-MEDIGAP can explain how your state conducts it.
Why does the 5-year look-back matter?
When you apply for long-term care Medicaid, the agency reviews 60 months of financial history. Gifts or below-market transfers in that window trigger a penalty period of ineligibility, calculated using your state's penalty divisor. Because penalties can last months or years, eligibility planning works best when started early, ideally five or more years before you expect to need care. Call 1-800-MEDIGAP to understand how the look-back affects your situation.