Minnesota Medicaid for seniors and long-term care
Last verified: June 2026
Long-term care Medicaid rules are complex
Minnesota has more long-term care waiver options than most states — including a unique pre-eligibility program called Alternative Care
Medical Assistance for seniors: income and asset rules
Seniors age 65 and older who need long-term care face different eligibility rules than working-age adults. Income and asset limits apply. The income limit for long-term care MA in Minnesota is 300% of the Social Security Federal Benefit Rate — the same threshold used in most states. As of 2026, this equals $2,829 per month for an individual ($942 × 3).
The asset limit for a single individual is $3,000. A couple where one spouse enters a nursing facility may retain the community spouse resource allowance (CSRA): the community spouse may keep between $29,724 and $148,620 of the couple's combined non-exempt assets (2025 federal CSRA figures). Minnesota also allows a community spouse minimum monthly maintenance needs allowance (MMMNA) to ensure the spouse at home retains adequate income.
Assets that are generally excluded include the primary home (with caveats for vacant homes), one vehicle, personal belongings, prepaid funeral arrangements, and certain other assets. An elder law attorney can help structure assets before applying for long-term care MA.
The Elderly Waiver (EW): home care instead of a nursing facility
The Elderly Waiver (EW) is Minnesota's largest HCBS waiver for adults age 65 and older. It allows people who meet nursing facility level of care to receive services at home or in an assisted living facility instead — at a cost to Medicaid generally lower than nursing facility placement.
EW services include home health aide, personal care attendant, adult day services, adult foster care, assisted living, case management, homemaker services, and respite care. The program operates through county social services and Lead Agencies who coordinate care. Enrollment is not capped, but you must meet the nursing facility level of care standard and the MA financial criteria.
- Personal care assistance (PCA)
- Home health aide and skilled nursing visits
- Adult day services
- Adult foster care and family adult foster care
- Assisted living and residential care home services
- Homemaker and chore services
- Respite care for family caregivers
- Case management and care coordination
- Environmental modifications and assistive technology
Alternative Care (AC): the pre-eligibility bridge program
The Alternative Care (AC) program is a Minnesota-specific option funded entirely by the state — no federal Medicaid match. It covers people age 65 and older who meet the nursing facility level of care but whose income or assets currently exceed the MA long-term care limits. AC provides many of the same home and community-based services as the Elderly Waiver while the person "spends down" assets to MA eligibility levels.
Participants pay a monthly premium for AC based on their income and assets. Once their resources fall to the MA asset limit, they transition from AC to the Elderly Waiver. Ask your county social services office about whether AC applies to your situation before assuming you don't qualify for any assistance.
Consumer Directed Community Supports (CDCS)
Minnesota's Consumer Directed Community Supports (CDCS) program lets MA members with disabilities and some elderly members design their own care plan and hire their own workers — including family members in some cases — rather than receiving services through a provider agency. CDCS gives members a monthly budget based on assessed needs.
CDCS is available to members enrolled in several HCBS waiver programs, including the Elderly Waiver, CADI (Community Access for Disability Inclusion), and the Brain Injury waiver. Per MN DHS, CDCS is one of the more flexible self-direction options in the country and allows members to hire, train, and supervise their own support staff. A financial management services (FMS) organization assists with payroll, taxes, and purchasing.
Nursing facility coverage and estate recovery
Medical Assistance covers nursing facility care for eligible members. Minnesota has many nursing facilities that accept MA, though some facilities may have limited MA-funded beds. Your county social services office can help identify MA-certified facilities in your area.
Minnesota operates an estate recovery program through DHS. The state may seek reimbursement from the estate of an MA member who received long-term care services — nursing facility or HCBS — after age 55. Recovery is also possible for members of any age who received institutional long-term care. Estate recovery does not apply to MA medical coverage received before age 55 outside of long-term care settings.
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. Minnesota's share of that population is administered through Medical Assistance (Minnesota 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
Medical Assistance (Minnesota 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, Minnesota 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 Minnesota uses this approach with Medical Assistance (Minnesota 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 Medical Assistance (Minnesota 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 Medical Assistance (Minnesota 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 Medical Assistance (Minnesota 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. Minnesota's current CSRA is set by Medical Assistance (Minnesota 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).
Estate recovery applies to long-term care recipients age 55 and older
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