Maine Medicaid for seniors and long-term care

Last verified: June 2026

What MaineCare covers for seniors and people needing long-term care

MaineCare covers nursing facility care and a range of home and community-based services for eligible Maine seniors and adults with disabilities. The goal of Maine's long-term care Medicaid policy has shifted in recent years toward keeping people in their homes and communities rather than in institutional settings — Maine's Home and Community Benefits (HCB) waiver program supports that shift.

• Skilled nursing facility (nursing home) care
• Home health aide and personal care services
• Consumer Directed Personal Assistance (CDPA) — member hires and directs their own worker
• Home and Community Benefits (HCB) waiver services — home-based alternatives to nursing facility
• Adult Day Services
• Respite care for family caregivers
• Assisted living and residential care facility services (for qualifying members)
• Hospice care
• Medical equipment and supplies at home
• Transportation to medical appointments

Source: Maine DHHS Office of Aging and Disability Services; MaineCare Benefits Manual, Long Term Care chapters.

Financial eligibility for MaineCare long-term care

Long-term care MaineCare has its own income and asset rules — separate from the MAGI-based rules that apply to most adults. The income limit for nursing facility care is generally 300% of the SSI Federal Benefit Rate. Asset limits are $10,000 for a single applicant.

Source: Maine DHHS OADS; federal spousal impoverishment rules (42 U.S.C. § 1396r-5). Asset and income figures are approximate — verify with OADS before applying. Maine's $10,000 individual asset limit is more generous than many states, which use $2,000.

Consumer Directed Personal Assistance: choosing your own caregiver

Maine's Consumer Directed Personal Assistance (CDPA) program lets qualifying MaineCare members hire, train, and direct their own personal care workers — including, in some cases, family members. This is a significant option for members who have a trusted caregiver already in their life and want to formalize and fund that relationship through MaineCare.

CDPA is available under the Home and Community Benefits waiver. A fiscal intermediary handles payroll. Not all MaineCare members qualify for CDPA — functional eligibility (need for personal care) must be established through an assessment by OADS.

Maine Medicaid estate recovery

Maine operates an estate recovery program. Per Maine DHHS, the state may seek reimbursement from the estates of MaineCare members who were age 55 or older when they received nursing facility care, home and community-based services, or related hospital and prescription drug services. The primary home is generally exempt during the lifetime of a surviving spouse or dependent child. Maine follows the federal minimum estate recovery rules — recovery is limited to the probate estate. Consult a Maine elder law attorney before making asset transfers if a family member may need MaineCare long-term care.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Maine's share of that population is administered through MaineCare (Maine Medicaid). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

MaineCare (Maine Medicaid) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, Maine may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Maine uses this approach with MaineCare (Maine Medicaid).

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through MaineCare (Maine Medicaid) differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact MaineCare (Maine Medicaid) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult MaineCare (Maine Medicaid) or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Maine's current CSRA is set by MaineCare (Maine Medicaid) and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments