Does Medicaid pay for home care?

Research highlights: Yes. Medicaid is the largest payer of home care in the United States, covering about two-thirds of all home care spending. Among reporting states, it pays providers a median of roughly $19 an hour for personal care, though rates and weekly hour limits vary widely by state.

Unlike Medicare, Medicaid covers nursing home care indefinitely as long as you stay eligible. In 2023, Medicaid spent $145.9 billion on home and community-based services, about 63.8% of its long-term care budget.

Related research: How long will Medicare pay for home health care? | How much does in-home care cost? | Who pays for home care? | Home care vs nursing home cost

How much does Medicaid pay for home care per hour?

Medicaid pays providers a median of about $19 an hour for personal care services, the non-medical help that makes up most home care. Among the 34 states reporting time-based rates, more than half pay under $20 an hour.

Skilled services pay more. Among states able to report comparable rates, the median Medicaid rate is about $41 an hour for a home health aide and $70 an hour for a registered nurse.

Rates differ sharply by state and by the Medicaid program or waiver involved, and not every state could report them.

One important distinction: this is what Medicaid pays the agency, not what the caregiver takes home. The worker’s wage is lower, closer to $17 an hour, as we cover in our breakdown of home health aide pay.

Median Medicaid payment rate among reporting states (2025)	Per hour
Personal care (non-medical home care)	~$19
Home health aide	~$41
Registered nurse	~$70

How many hours of home care does Medicaid cover per week?

There is no single national answer, and that is the honest reality of Medicaid. The number of weekly hours is set by a functional assessment of each person’s needs, conducted by the state or its managed care plan.

Two people in different states with identical needs can be approved for very different hours.

The range is wide. Some people receive only a few hours per week, while higher-need beneficiaries may receive 40 or more hours, depending on state rules, service caps and care-plan approval.

Some states and waivers cap weekly hours outright; others tie the total purely to assessed need.

Because home care is mostly an optional Medicaid benefit delivered through waivers, states also control how many people they serve. That is why many states maintain waiting lists for home and community-based services, even for people who qualify.

What sets your weekly Medicaid hours	Detail
Primary driver	State functional needs assessment
Typical low end	A few hours per week, depending on state and program rules
Higher-need cases	40+ hours per week
Hard weekly cap?	Varies; some states cap, others do not

How long will Medicaid pay for nursing home care?

Indefinitely, as long as you stay eligible. This is one of the biggest differences between Medicaid and Medicare. Medicaid covers nursing home care for as long as you need it and continue to meet the financial and functional rules, with no day limit.

Medicare, by contrast, stops after 100 days and only covers short-term skilled care. That is why Medicaid, not Medicare, is the workhorse of long-term nursing home coverage, serving as the primary payer for about 63% of certified nursing facility residents.

Nursing facility care is a mandatory Medicaid benefit in every state.

The trade-off is strict eligibility. You generally must meet low income and asset limits, often around $2,000 in countable assets, and require a nursing-home level of care.

See how the home option compares in our guide to home care vs nursing home cost.

Nursing home coverage	Medicare	Medicaid
Time limit	Up to 100 days per benefit period	No limit (while eligible)
Type of care	Short-term skilled only	Long-term custodial care
Prior hospital stay required	Yes (3 days)	No
Share of nursing facility residents (as primary payer)	~14%	About 63%

What percentage of home care is paid by Medicaid?

Medicaid is the primary payer, covering nearly two-thirds of all home care spending in the United States in 2023. No other source comes close.

This surprises most people. Four in ten adults wrongly believe Medicare is the main payer for low-income people who need home or nursing care. It is not.

Medicare’s home benefit is short-term and skilled, while Medicaid funds the ongoing, non-medical personal care that long-term clients actually need.

The remaining third of home care spending is split among out-of-pocket payments, private long-term care insurance, Medicare and other sources.

For the full payer picture, see our guide to who pays for home care.

US home care spending (2023)	Share
Paid by Medicaid	Nearly two-thirds
All other sources (out-of-pocket, private insurance, Medicare, other)	About one-third

How much does Medicaid spend on home care, and what share of long-term care is that?

Medicaid spent $145.9 billion on home and community-based services (HCBS) in 2023. That is up from $129.4 billion in 2022, an increase of about 13%, as states continued shifting more long-term care spending toward home and community-based care.

That figure represents 63.8% of all Medicaid long-term care (LTSS) spending, with the remaining 36.2% going to institutional care like nursing homes.

Home care passed institutional care in Medicaid’s budget back in 2013 and has led ever since.

State commitment varies enormously, though. The HCBS share of Medicaid long-term care spending ranged from 35.8% in Arkansas to 94.8% in Wisconsin, with states like Kentucky (48.4%) also falling below 50%.

About 8.4 million people used Medicaid HCBS in 2023.

Medicaid long-term care (LTSS) spending, 2023	Amount	Share
Home and community-based services (HCBS)	$145.9 billion	63.8%
Institutional care (nursing homes, etc.)	$82.7 billion	36.2%
Total Medicaid LTSS	$228.6 billion	100%

Sources & additional resources

• KFF. “Medicaid Home Care (HCBS) in 2025.” KFF.
• KFF. “States’ Management of Medicaid Home Care Spending.” KFF.
• KFF. “Payment Rates for Medicaid Home Care Ahead of the 2025 Reconciliation Law.” KFF.
• Centers for Medicare & Medicaid Services. “Trends in Users and Expenditures for HCBS as a Share of Total Medicaid LTSS.” Medicaid.gov.
• KFF. “10 Things About Long-Term Services and Supports (LTSS).” KFF.
• Paying for Senior Care. “Medicaid & Home Care: State by State Benefits & Eligibility.” Paying for Senior Care.
• KFF. “A Look at Nursing Facility Characteristics.” KFF.

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