MEDICAID GUIDE • Last updated: November 12, 2026
State Medicaid Guides for Senior Care
Independent, state-by-state coverage guides. What 51 state Medicaid programs actually pay for — nursing home care, HCBS waivers, assisted living support, spend-down rules, and how to apply.
States Covered
51
+ DC
Medically-Needy Pathway
27
of 51 states
Waivers Researched
82
senior HCBS programs
Top States for Senior Medicaid Coverage
Full rankings →
#1
B
Illinois
check Medically-needy pathway
check 2 senior waivers
check No income cap
View Guide arrow_forward
#2
B
Michigan
check Medically-needy pathway
check No income cap
View Guide arrow_forward
#3
B
New York
check Medically-needy pathway
check 3 senior waivers
check No income cap
View Guide arrow_forward
#4
B
District of Columbia
check Medically-needy pathway
check No income cap
View Guide arrow_forward
#5
A
Washington
check Medically-needy pathway
check 2 senior waivers
check No income cap
View Guide arrow_forward
All 50 States + DC
Updated November 12, 2026| State | Grade | Program | Income Limit (indiv) | Medically Needy | Waivers | Rank | |
|---|---|---|---|---|---|---|---|
| Alabama | F | Alabama Medicaid | $2,982 | — | 1 | #46 | View → |
| Alaska | D | Alaska Department of Health, Division of Public Assistance | $2,982 | — | 2 | #39 | View → |
| Arizona | B | Arizona Health Care Cost Containment System (AHCCCS) | $2,982 | — | 1 | #9 | View → |
| Arkansas | D | Arkansas Department of Human Services | $2,982 | — | 2 | #37 | View → |
| California | B | California Department of Health Care Services | No cap (spend-down) | check | 2 | #18 | View → |
| Colorado | C | Colorado Department of Health Care Policy and Financing | $2,982 | — | 1 | #25 | View → |
| Connecticut | C | Connecticut Department of Social Services | No cap (spend-down) | check | 1 | #27 | View → |
| Delaware | A | Delaware Division of Medicaid and Medical Assistance | $2,485 | — | 2 | #4 | View → |
| District of Columbia | B | Department of Health Care Finance (DHCF) | $2,982 | check | 1 | #10 | View → |
| Florida | C | Florida for Health Care Administration | $2,982 | — | 2 | #29 | View → |
| Georgia | F | Georgia DCH | $2,982 | — | 2 | #44 | View → |
| Hawaii | A | Hawaii Med-QUEST Division | No cap (spend-down) | check | 1 | #3 | View → |
| Idaho | A | Idaho Department of Health and Welfare | $3,002 | — | 1 | #5 | View → |
| Illinois | B | Illinois Department of Healthcare and Family Services | $1,330 | check | 2 | #11 | View → |
| Indiana | B | Indiana Family and Social Services Administration | $2,982 | — | 1 | #17 | View → |
| Iowa | B | Iowa Department of Health and Human Services | $2,982 | — | 1 | #23 | View → |
| Kansas | B | Kansas Department of Health and Environment (KDHE) | $2,982 | check | 1 | #19 | View → |
| Kentucky | D | Kentucky Cabinet for Health and Family Services' Department for Medicaid Services | $2,982 | — | 1 | #38 | View → |
| Louisiana | F | Louisiana Department of Health | $2,982 | check | 3 | #51 | View → |
| Maine | F | State of Maine Department of Health and Human Services | $2,982 | check | 1 | #41 | View → |
| Maryland | A | Maryland Department of Health | No cap (spend-down) | check | 2 | #6 | View → |
| Massachusetts | F | MassHealth (Executive Office of Health and Human Services) | No cap (spend-down) | check | 3 | #45 | View → |
| Michigan | B | Michigan Department of Health and Human Services | $2,982 | check | 1 | #14 | View → |
| Minnesota | A | Minnesota Department of Human Services | No cap (spend-down) | check | 1 | #8 | View → |
| Mississippi | F | Mississippi Division of Medicaid | $2,982 | — | 2 | #47 | View → |
| Missouri | D | MO HealthNet Division, Department of Social Services | No cap (spend-down) | check | 1 | #36 | View → |
| Montana | F | Montana Department of Public Health and Human Services, Senior and Long Term Care Division | No cap (spend-down) | check | 2 | #43 | View → |
| Nebraska | B | Nebraska Department of Health & Human Services (DHHS) | $1,330 | check | 1 | #12 | View → |
| Nevada | B | Nevada Department of Health and Human Services, Division of Health Care Financing and Policy | $2,982 | — | 3 | #13 | View → |
| New Hampshire | C | New Hampshire Department of Health and Human Services | $2,982 | check | 1 | #32 | View → |
| New Jersey | C | New Jersey Department of Human Services - Division of Medical Assistance and Health Services | $2,982 | — | 1 | #33 | View → |
| New Mexico | C | New Mexico Health Care Authority | $2,982 | — | 1 | #30 | View → |
| New York | B | New York State Department of Health | $1,836 | check | 3 | #21 | View → |
| North Carolina | C | NC Medicaid, Division of Health Benefits (North Carolina Department of Health and Human Services) | No cap (spend-down) | check | 2 | #34 | View → |
| North Dakota | B | North Dakota Department of Health and Human Services | No cap (spend-down) | check | 1 | #15 | View → |
| Ohio | B | Ohio Department of Medicaid | $2,982 | — | 3 | #20 | View → |
| Oklahoma | F | Oklahoma Health Care Authority | $2,982 | — | 1 | #49 | View → |
| Oregon | C | Oregon Department of Human Services | $2,982 | — | 4 | #31 | View → |
| Pennsylvania | B | Pennsylvania Department of Human Services | No cap (spend-down) | check | 1 | #16 | View → |
| Rhode Island | F | Rhode Island Executive Office of Health and Human Services | $2,982 | check | 3 | #50 | View → |
| South Carolina | D | South Carolina Department of Health and Human Services | $2,982 | — | 1 | #35 | View → |
| South Dakota | C | South Dakota Department of Social Services | $2,982 | — | 1 | #28 | View → |
| Tennessee | D | Tennessee Bureau of TennCare | $2,982 | — | 1 | #40 | View → |
| Texas | B | Texas Health and Human Services Commission | $2,982 | — | 2 | #24 | View → |
| Utah | A | Utah Department of Health & Human Services | No cap (spend-down) | check | 2 | #1 | View → |
| Vermont | F | Department of Vermont Health Access | $2,982 | check | 1 | #48 | View → |
| Virginia | B | Virginia Department of Medical Assistance Services | $2,982 | check | 1 | #22 | View → |
| Washington | A | Washington State Health Care Authority | No cap (spend-down) | check | 2 | #2 | View → |
| West Virginia | F | West Virginia Department of Human Services Bureau for Medical Services | $2,982 | check | 1 | #42 | View → |
| Wisconsin | A | Wisconsin Department of Health Services | $2,982 | check | 3 | #7 | View → |
| Wyoming | C | Wyoming Department of Health | $2,982 | — | 1 | #26 | View → |
Income limit shown is for long-term care (nursing-home) Medicaid, usually 300% of SSI ($2,982 in 2026). 24 states apply a hard income cap that requires a Miller Trust above it; in the others there is no hard cap, and income above a small personal needs allowance goes toward the cost of care (spend-down). Figures checked against each state agency's 2026 standards in November 2026. Which states require a Miller trust, and how it works → How the 5-year look-back works, and every state's penalty divisor → Waivers counts senior HCBS waiver programs we found in each state; states often have additional non-senior waivers (I/DD, HIV, TBI) that don't apply to elder care and aren't counted here.
Who this is for
Families in the middle of the "how do we pay for Mom's care" conversation — people who want to understand their options before hiring a Medicaid planner.
We publish state Medicaid coverage data, waiver details, and eligibility rules so you can figure out your own path.
Methodology
Each state's data is sourced from the CMS Transparency API, the state's Medicaid agency, NCOA, and KFF. Grounded review monthly.
Read methodology arrow_forward