What Is Medicaid? How It Works for Seniors and Families (2026)

Medicaid can pay for nursing home care that Medicare normally doesn't cover, and whether your parent qualifies depends on the state they live in.1 If you're asking what Medicaid is: a joint federal and state program that helps cover medical costs for some people with limited income and resources, and each state runs its own version.1

In This Guide

• What Is Medicaid, and Who Runs It?
• Who Is Medicaid For? Two Sets of Rules
• What Medicaid Pays For
• Can You Have Medicare and Medicaid?
• Applying, Decisions and Denials
• Find Your State's Medicaid Program
• Frequently Asked Questions
• Learn More

What Is Medicaid, and Who Runs It?

Medicaid has two layers. The federal government sets general rules every state program must follow, and each state runs its own program inside them, so eligibility and benefits vary by state.1 Each state describes its program in a Medicaid state plan, which the Centers for Medicare & Medicaid Services (CMS) reviews to approve federal funding.7

Who Is Medicaid For? Two Sets of Rules

Medicaid helps certain low-income people, families and children, pregnant women, the elderly and people with disabilities.1 Which of two rulebooks applies decides whether savings count.

• Income-only groups: Medicaid judges children, pregnant women, parents and expansion adults on Modified Adjusted Gross Income (MAGI), with no asset test.2
• Age, disability and long-term care: people 65 and older (when age is a condition of eligibility), people being determined blind or disabled, and long-term care applicants are taken out of Medicaid's MAGI rules for those determinations and judged by different financial methods.2

Those methods follow Supplemental Security Income (SSI) rules. In 2026, the SSI resource limit is $2,000 for one person and $3,000 for a couple. So a single applicant for nursing home Medicaid commonly faces a 2026 countable-asset limit of about $2,000, though each state sets its exact limit and some are less restrictive. Under SSI rules, the home you live in and one car used for transportation don't count.3

Age alone doesn't switch rulebooks: someone 65 or older evaluated for a MAGI group still has no Medicaid asset test.2

Medicaid expansion covers adults age 19 to under 65 who aren't on Medicare, with income up to 133 percent of the federal poverty line.8 As of 2026, 41 states including DC have adopted Medicaid expansion and 10 have not.9 Either way, Medicaid expansion isn't the route for a parent who's 65 or older.

Medicaid also uses the federal poverty guideline: for 2026, $15,960 a year for one person and $21,640 for two in the 48 contiguous states and DC (Alaska and Hawaii have their own). Don't hold a paycheck up against those numbers: Medicaid counts income under its own rules.10 See your state's income limits.

For long-term care, federal law has Medicaid look back 60 months from the application at assets transferred for less than they were worth. California's Medi-Cal uses 30 months for nursing-facility care, and other states may also differ.11

What Medicaid Pays For

Every state's Medicaid plan has to cover nursing home care for adults 21 and older, plus home health services, for the groups federal rules call "categorically needy" (not every eligibility group).4

Medicaid home and community-based services (HCBS), such as personal care attendants and adult day care, are optional for states. A state can offer HCBS to everyone eligible for its full benefit package through its state plan, or through waiver programs. A waiver can be limited to specific groups and capped, and a capped waiver is what produces a waiting list.4 That's why help at home differs so much by state.

See what Medicaid covers, nursing home Medicaid by state and HCBS waivers by state.

Can You Have Medicare and Medicaid?

Yes. Medicare is federal health insurance for people 65 or older and some younger people with certain disabilities or conditions, and its coverage is the same in every state (compare the two).1

People with both Medicare and full-benefit Medicaid are dually eligible. Medicare pays first, and Medicaid pays last. Through the Medicare Savings Programs, Medicaid pays Medicare premiums, deductibles and/or coinsurance for people eligible for both. Special plans for dual eligibles include the Program of All-Inclusive Care for the Elderly (PACE).12 See Medicare Savings Programs by state and our PACE guide.

Applying, Decisions and Denials

You apply to your state's Medicaid agency, which federal rules give 90 days to decide if you apply on the basis of disability and 45 days for everyone else, except in unusual circumstances.5

If a Medicaid claim is denied, or isn't acted on with reasonable promptness, federal law gives you the right to a Medicaid fair hearing.6

Coverage can also reach backward: by federal default, Medicaid covers care from as early as the third month before the application month if the person was eligible then, though a state's window can be shorter. For Medicaid applications made on or after January 1, 2027, Medicaid's retroactive window drops to two months for most enrollees and one month for the expansion adult group.2 If a parent is already paying privately for a nursing home, don't put the application off.

The new Medicaid work requirement, which states must start by January 1, 2027, applies only to the expansion adult group13, which is limited to people under 65.8 More in 2027 Medicaid changes.

Find Your State's Medicaid Program

Medicaid by state links every state's guide, with its agency, limits and how to apply.

Learn More

Find personalized help figuring out which Medicaid pathway fits your parent in your state at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.