Your mother's savings are running low after two years in assisted living, or your father just moved into a nursing home after a stroke and the bills are arriving. Someone says, "You need to apply for Medicaid," and you open the state's website to find dozens of forms, terms you don't recognize and rules that seem to change by county.
Take a breath. Thousands of families go through this every month, and it can be done one step at a time. Medicaid is the main public payer for long-term care in the United States, covering nursing home care and, in many states, care at home or in assisted living for people who qualify17. This guide explains how to apply for Medicaid for an elderly parent. Because each state sets its own limits, confirm the details with your state Medicaid agency.
Which kind of Medicaid does your parent need?
Older adults can qualify for several kinds of Medicaid. Knowing which one fits your parent's situation helps you fill out the right application.
- Long-term care in a nursing home. Often called institutional or nursing home Medicaid. Covers the nursing home stay for people who meet financial and medical rules.
- Home and community-based services. Waiver programs that pay for care at home, in adult day programs or in assisted living7. See Medicaid waivers for home care and Medicaid waivers for assisted living.
- Regular Medicaid for older adults. Helps with medical costs for people with low income and assets1.
- Medicare Savings Programs. Help paying Medicare premiums and cost-sharing, with their own limits8.
- PACE. In some areas, the PACE program combines Medicare and Medicaid to cover all care.
If your parent has Medicare, Medicaid works alongside it. Medicare pays first for covered services, and Medicaid can cover long-term care Medicare doesn't1. See when Medicare stops paying for a nursing home. If your parent only needs help with Medicare premiums and copays, see Medicare Savings Programs. If the application is denied, see our guide to appealing a Medicaid denial.
How to qualify for Medicaid as an older adult
For long-term care Medicaid, states look at three things. For one state's rules in detail, see Texas Medicaid nursing home eligibility.
Income
States count your parent's income, such as Social Security and pensions. Many states let people in nursing homes or on waivers qualify under a special income level that is higher than for regular Medicaid9. Some states that use a firm income cap allow a qualified income trust, sometimes called a Miller trust, for people over the limit. Others let people "spend down" excess income on medical bills. See the Medicaid spend-down.
Assets
Countable assets include bank accounts, investments and most property other than certain exempt items. The home, one car, personal belongings and some burial funds are often exempt, within limits. Asset limits for a single person are low in most states.
Care needs
For nursing home or waiver coverage, your parent must need a nursing home level of care, as decided by a state assessment of daily activities, medical needs and memory.
The five-year look-back
When your parent applies for long-term care Medicaid, the state reviews asset transfers made during the previous five years. Gifts or sales for less than fair value can trigger a penalty period, a stretch of time when Medicaid won't pay for long-term care3. Gifts to grandchildren, adding a child's name to a deed, or paying family for care without a written agreement can all raise questions. See the Medicaid look-back period before moving any money.
Documents to gather
Most states ask for proof of nearly everything. Start gathering early, because some records take weeks to get.
- Proof of identity, age and citizenship or immigration status, such as a birth certificate or passport.
- Social Security and Medicare cards, and any other insurance cards.
- Proof of income: Social Security award letters, pension statements and annuity statements.
- Bank and investment statements, often for several months, and sometimes for the full look-back period.
- Property records: deeds, property tax bills and vehicle titles.
- Life insurance policies, prepaid funeral contracts and burial plot records.
- Long-term care insurance policies.
- Power of attorney or guardianship papers if you are applying for your parent.
- Medical records or a doctor's statement about care needs, if requested.
Make copies of everything, and keep a log of what you sent, who you spoke with and when. A single folder or binder for all Medicaid papers saves a lot of searching later.
How to apply, step by step
- Get legal authority. If you will apply for your parent, you need a durable power of attorney, an authorized representative form or guardianship. See power of attorney and guardianship.
- Find the right office. Apply through your parent's state Medicaid agency, online, by mail, by phone or in person2. The Area Agency on Aging can point you to the right place5.
- Time the application. Apply as soon as your parent may be eligible. Medicaid can pay for covered care up to three months before the application month if your parent qualified then4.
- Fill out every question. Leaving items blank is a common reason for delays. Write "none" when something doesn't apply.
- Submit and keep proof. Get a receipt, confirmation number or certified mail record.
- Respond quickly to requests. Caseworkers often ask for more documents with short deadlines. Missing one can mean a denial.
- Complete the care assessment. For nursing home or waiver coverage, a nurse or caseworker assesses care needs. Be honest about the hard days.
Applying when your parent is already in a nursing home
If your parent is already in a nursing home, ask the business office whether the home participates in Medicaid and whether it has staff who help residents apply. Many do, and they know the local caseworkers and forms. Still, keep your own copies and stay involved, because you are the one who knows your parent's finances.
Tell the home in writing that a Medicaid application is pending. Federal rules limit when a nursing home can discharge a resident for nonpayment while paperwork is being processed. See nursing home eviction. If your parent is coming from a hospital, ask the discharge planner to start the paperwork early. See hospital discharge planning.
Talking with your parent about Medicaid
Many older adults feel ashamed about needing Medicaid, or worry about losing their home or leaving nothing to their children. Explain that Medicaid is the way most people pay for long nursing home stays, and that they paid into the system through taxes over a lifetime. Involve your parent in decisions as much as possible, share the documents you are sending, and be clear about what will happen to their income and home. If your parent has dementia and can no longer take part, act according to what you know of their wishes and keep other family members informed to prevent misunderstandings later.
State-by-state differences
Program names, income and asset limits, which assets are exempt and how waivers work all vary by state. Some states use a firm income cap and others don't; some count income differently for a married couple. Check your state Medicaid agency's website for current figures, and ask the Area Agency on Aging about local programs5. Our state guides explain the programs in Texas, Florida, California and other states.
After you apply
Processing often takes weeks to months. You will receive a written notice approving or denying the application. If your parent is approved for nursing home Medicaid, most of their income will usually go toward the cost of care, with a small personal needs allowance kept for personal items, and some protected for a spouse at home10.
Medicaid must be renewed, usually once a year. Watch the mail for renewal forms and report changes in income, assets or address. After your parent dies, the state may seek repayment of long-term care costs from their estate, with some protections for family. See Medicaid estate recovery.
If the application is denied
Read the denial notice carefully. It should explain the reason and how to ask for a fair hearing, along with the deadline. Many denials are for missing paperwork and can be fixed by reapplying or sending the missing items. If you disagree with the decision, request a hearing in time; the decision must be based on the evidence presented11. Legal aid offices and elder law attorneys can help.
Common mistakes to avoid
- Waiting too long. Families sometimes wait until savings hit zero. Plan earlier so the timing works.
- Giving money away. Gifts during the look-back can delay coverage3.
- Missing deadlines. Put every due date on a calendar.
- Mixing your money with your parent's. Keep separate accounts and records. See managing a parent's finances.
- Paying for help you can get free. Area Agencies on Aging, SHIP counselors and legal aid offer free guidance6.
For a complex situation, such as a married couple, a home, a business or significant assets, an elder law attorney can be worth consulting before you apply. Our guide to paying for senior care covers other options while you wait.
