Two Types of Eligibility Requirements

To qualify for Medicaid home care, a person must meet two distinct sets of criteria. First, they must meet financial eligibility requirements — income and asset limits set by the state. Second, they must meet functional eligibility requirements — meaning they must demonstrate a need for assistance with daily activities.

Both criteria must be met. A person with significant care needs who earns too much income may not qualify for standard Medicaid, though some programs have higher income limits or spend-down provisions.

Financial Eligibility: Income and Asset Limits

Medicaid income and asset limits vary by state and by program type. For long-term care programs (which include most home care programs), income limits are typically set at 300% of the federal Supplemental Security Income (SSI) benefit rate — approximately $2,829 per month in 2026 for an individual.

Asset limits are also applied. Most states allow individuals to keep a primary home, one vehicle, personal belongings, and a small amount of liquid assets (typically $2,000 for an individual). Some states have higher asset limits or no asset test for certain programs.

• Income limit: typically up to ~$2,829/month for individuals (varies by state)
• Asset limit: typically $2,000 for individuals (home and car usually exempt)
• Married couples have separate rules — the community spouse can keep more assets
• Some states have "spend-down" programs for those slightly over the income limit

Functional Eligibility: Level of Care Assessment

Functional eligibility is determined through a formal assessment, usually conducted by a registered nurse or care coordinator from the state Medicaid agency or a managed care organization. The assessment evaluates the person's ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

Most states require that a person need assistance with at least two or three ADLs to qualify for home care services. Some programs also consider cognitive impairment, behavioral needs, and medical complexity.

• ADLs assessed: bathing, dressing, grooming, eating, toileting, transferring, mobility
• IADLs assessed: meal prep, medication management, housekeeping, transportation
• Cognitive assessment: memory, judgment, safety awareness
• Medical needs: wound care, medication administration, chronic condition management

The Application Process

The process for applying for Medicaid home care typically involves several steps:

• Step 1: Apply for Medicaid through your state's Medicaid agency or healthcare.gov
• Step 2: Once approved for Medicaid, request a referral for home care services
• Step 3: A care coordinator schedules a functional needs assessment in your home
• Step 4: Based on the assessment, a care plan is developed specifying authorized services and hours
• Step 5: A home care agency or consumer-directed caregiver is selected
• Step 6: Services begin according to the approved care plan

What If You Don't Qualify Right Away?

If you are denied Medicaid or home care services, you have the right to appeal the decision. Common reasons for denial include income or assets slightly above the limit, or a functional assessment that doesn't meet the threshold for the specific program.

A Medicaid planning specialist or elder law attorney can help you explore options such as spend-down programs, asset restructuring strategies, or alternative programs with different eligibility criteria.