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Lawyer I Trust Guide · General U.S. information · Reviewed September 14, 2026
Medicaid is a joint federal and state program that provides medical assistance to individuals who meet specific eligibility criteria. While many people associate Medicaid primarily with low-income health coverage, it is also the primary public payer for long-term care services and supports (LTSS) in the United States. Understanding how Medicaid interacts with long-term care planning is a critical component of preparing for future health needs.
## Understanding Long-Term Care Services
Long-term care encompasses a wide range of services needed by individuals who have a chronic illness or disability that limits their ability to perform daily activities. These services can be provided in various settings, including nursing facilities, assisted living communities, or within an individual’s own home.
Under federal law, Medicaid provides coverage for these services for eligible individuals. However, eligibility is not automatic. Applicants must generally meet both clinical and financial criteria. Clinical eligibility often involves a functional assessment to determine the level of care required, while financial eligibility involves an evaluation of an applicant’s income and countable resources.
## Financial Eligibility and Asset Planning
Because Medicaid is a “means-tested” program, the government evaluates an applicant’s financial situation to determine if they qualify for assistance. This process involves looking at both income and assets. Some assets may be considered “countable,” while others may be “exempt” or “disregarded” depending on the specific rules of the state.
In some instances, individuals may engage in long-term care planning to better understand how their assets will be treated. For example, some states participate in Long-Term Care Partnership Programs. These programs are a collaboration between state governments and private insurance companies. If an individual purchases a qualified long-term care insurance policy, they may be eligible for an “asset disregard.” This feature allows the policyholder to protect a portion of their assets equal to the amount of insurance benefits paid out by the policy, which are then excluded from the Medicaid eligibility calculation.
## The Role of Spousal Protections
When one spouse requires long-term care and the other does not, Medicaid rules often include provisions to prevent the “community spouse” (the spouse not receiving care) from becoming impoverished. These rules may allow for the protection of a certain amount of income and resources for the community spouse. States may perform an assessment of a couple’s combined countable resources at the beginning of a period of institutionalization to help the couple understand what assets may be protected and what remains available to pay for the cost of care.
## Navigating the System
The Medicaid system is complex, and the rules governing eligibility and the types of services covered can change. Because Medicaid is administered at the state level, the specific pathways to eligibility—such as those for individuals with disabilities or those who are working—can vary.
Beneficiaries and their families are encouraged to utilize official resources to stay informed. Many states have established Medicaid Advisory Committees and Beneficiary Advisory Councils to provide input on policy development and administration. Additionally, federal resources, such as the toll-free number 1-800-MEDICARE, can provide general information regarding the intersection of Medicare and Medicaid benefits. Because errors can occur and program rules are subject to change, it is important to verify all information through official state agency websites or authorized government representatives.
## Sources and further reading
* [42 U.S. Code § 1396 – Medicaid and CHIP Payment and Access Commission](https://www.law.cornell.edu/uscode/text/42/1396)
* [Ga. Comp. R. & Regs. R. 120-2-16-.34 – Georgia Long-Term Care Insurance Partnership Program](https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-120-2-16-.34)
* [210 R.I. Code R. 210-RICR-50-00-6.5 – LTSS Determination of Countable Resources](https://www.law.cornell.edu/regulations/rhode-island/210-RICR-50-00-6.5)
* [42 CFR § 431.12 – Medicaid Advisory Committee and Beneficiary Advisory Council](https://www.law.cornell.edu/cfr/text/42/431.12)
Educational information only. This guide is not legal advice. Laws and procedures vary by jurisdiction.