The Atlas
All 50 states,
one playbook per state.
Medicaid rules are state-by-state. Penalty divisors range from $5,700/month in Texas to $15,600 in Alaska. Home-equity limits split into two federal tiers. Estate recovery posture varies from minimum-TEFRA to aggressive. Pick your state.
How does Medicaid long-term-care planning work state by state?
Medicaid is a federal-state joint program. Federal sets the floor (asset and income caps, 5-year lookback, community-spouse minimums); each state layers the specifics: penalty divisor, CSRA posture, estate-recovery aggressiveness, home-equity limit, and managed-care vs. fee-for-service delivery. Each state page has its current 2026 figures.
AlabamaAL
Divisor $8,200/mo · Fee-for-service
AlaskaAK
Divisor $27,450/mo · Fee-for-service
ArizonaAZ
Divisor $8,667/mo · Managed LTC
ArkansasAR
Divisor $9,110/mo · Fee-for-service
CaliforniaCA
Divisor $14,440/mo · Managed LTC
ColoradoCO
Divisor $10,814/mo · Fee-for-service
ConnecticutCT
Divisor $15,526/mo · Fee-for-service
DelawareDE
Divisor $13,378/mo · Managed LTC
FloridaFL
Divisor $10,645/mo · Managed LTC
GeorgiaGA
Divisor $11,122/mo · Fee-for-service
HawaiiHI
Divisor $8,850/mo · Managed LTC
IdahoID
Divisor $10,901/mo · Managed LTC
IllinoisIL
Divisor $8,980/mo · Managed LTC
IndianaIN
Divisor $7,651/mo · Managed LTC
IowaIA
Divisor $9,703/mo · Managed LTC
KansasKS
Divisor $8,734/mo · Managed LTC
KentuckyKY
Divisor $9,896/mo · Fee-for-service
LouisianaLA
Divisor $7,200/mo · Fee-for-service
MaineME
Divisor $12,294/mo · Fee-for-service
MarylandMD
Divisor $12,501/mo · Fee-for-service
MassachusettsMA
Divisor $13,500/mo · Managed LTC
MichiganMI
Divisor $12,216/mo · Managed LTC
MinnesotaMN
Divisor $11,653/mo · Managed LTC
MississippiMS
Divisor $9,430/mo · Fee-for-service
MissouriMO
Divisor $8,235/mo · Fee-for-service
MontanaMT
Divisor $9,816/mo · Fee-for-service
NebraskaNE
Divisor $8,228/mo · Fee-for-service
NevadaNV
Divisor $13,098/mo · Managed LTC
New HampshireNH
Divisor $12,893/mo · Fee-for-service
New JerseyNJ
Divisor $12,250/mo · Managed LTC
New MexicoNM
Divisor $9,209/mo · Managed LTC
New YorkNY
Divisor $15,282/mo · Managed LTC
North CarolinaNC
Divisor $11,904/mo · Fee-for-service
North DakotaND
Divisor $13,451/mo · Fee-for-service
OhioOH
Divisor $7,787/mo · Managed LTC
OklahomaOK
Divisor $7,432/mo · Fee-for-service
OregonOR
Divisor $14,585/mo · Fee-for-service
PennsylvaniaPA
Divisor $12,812/mo · Managed LTC
Rhode IslandRI
Divisor $10,190/mo · Managed LTC
South CarolinaSC
Divisor $9,759/mo · Fee-for-service
South DakotaSD
Divisor $9,750/mo · Fee-for-service
TennesseeTN
Divisor $8,846/mo · Managed LTC
TexasTX
Divisor $7,339/mo · Managed LTC
UtahUT
Divisor $7,344/mo · Fee-for-service
VermontVT
Divisor $12,535/mo · Fee-for-service
VirginiaVA
Divisor $7,324/mo · Managed LTC
WashingtonWA
Divisor $14,059/mo · Fee-for-service
West VirginiaWV
Divisor $11,903/mo · Fee-for-service
WisconsinWI
Divisor $10,708/mo · Managed LTC
WyomingWY
Divisor $10,114/mo · Fee-for-service
States using the federal-max CSRA ceiling plus minimum-TEFRA estate recovery: California, Massachusetts, New York, Hawaii, and a few others. Check your state's page for current posture — some states that appear generous on the CSRA tighten the rules elsewhere (home-equity limits, managed-care waiting lists).
The divisor tracks the state's private-pay nursing-home cost. Alaska runs ~$15,600/month; Texas ~$5,700/month — a 2.7× spread that directly changes how quickly existing gifts unwind into ineligibility months. A $100,000 gift = ~6 months ineligible in Alaska, ~17 months in Texas.
Income-cap states set a hard income ceiling; over-cap applicants use a Qualified Income Trust (Miller Trust) to shield the excess. Medically-needy states allow applicants to "spend-down" excess income on medical bills until they fall below the threshold. The planning lever is state-specific.
Primary residency at the time of application governs. Snowbirding complicates the Snapshot Date (which state's asset rules apply?), estate recovery exposure (where will the home sit at death?), and documentation. Work with an elder-law attorney familiar with both states before relying on either.
Federal floors update every January (CSRA, home equity, MMMNA). State penalty divisors typically refresh January or July, sometimes quarterly. Each state page on ElderCareAtlas shows the "last verified" date so you know how fresh the number is.