How many Americans are on Medicaid?
- In February 2026, 74,877,742 people, about 74.9 million, were enrolled in Medicaid and the related Children’s Health Insurance Program
- That is down from a pandemic peak of about 94 million in March 2023, after pandemic-era continuous coverage ended
- Enrollment still sits above the pre-pandemic level of roughly 71 million in early 2020
- Medicaid and CHIP cover about one in five Americans, making Medicaid the nation’s largest public health insurance program for low-income Americans
| Period |
Medicaid and CHIP enrollment |
| Early 2020 (pre-pandemic) |
About 71 million |
| March 2023 (peak) |
About 94 million |
| February 2026 (current) |
74,877,742 (about 74.9 million) |
Medicaid accounts for nearly one-fifth of all health care spending nationally. Its role in long-term care, the focus below, is even larger than its role in general coverage.
About 74.9 million Americans were enrolled in Medicaid and CHIP in February 2026, down from the pandemic peak but still above pre-pandemic levels.
What is the income limit to qualify for Medicaid?
- For many long-term care Medicaid pathways, the 2026 special income level is about $2,982 a month, with countable assets usually limited to $2,000 for an individual
- That income figure equals 300% of the federal SSI benefit rate, the threshold many states use for nursing home and waiver eligibility
- A 60-month, or five-year, look-back applies to asset transfers, and transfers for less than fair market value can trigger a penalty period
- Limits vary by state and pathway; in expansion states, many adults qualify through a different MAGI-based pathway up to 138% of the poverty level, not the long-term care pathway
- Long-term care Medicaid also applies functional or medical eligibility rules, such as needing help with daily activities, and the details vary by state
| Long-term care Medicaid (2026) |
Typical limit |
| Monthly income (many states) |
About $2,982 |
| Countable assets (individual) |
$2,000 |
| Look-back period |
5 years (60 months) |
Certain assets, such as a primary home within Medicaid home-equity limits, one vehicle and personal belongings, may be exempt depending on state rules. Spousal protections also let a community spouse keep more, so the rules are more flexible than the headline limits suggest, as our nursing home payment research explains.
Many long-term care Medicaid pathways use an income limit near $2,982 per month, a $2,000 asset limit and a five-year look-back on asset transfers.
How many people have both Medicare and Medicaid?
- About 11.9 million people had both Medicare and Medicaid coverage in 2025, including many low-income seniors and people under 65 with disabilities
- Dual-eligible enrollees account for a far larger share of Medicaid spending than of enrollment, on account of their higher per-person costs
- Seniors and people with disabilities together make up about 1 in 5 Medicaid enrollees but over half of all Medicaid spending
- These enrollees are the most likely to use long-term care, which Medicaid covers and Medicare largely does not
For many dual-eligible people, especially seniors, Medicaid often fills the gaps that Medicare leaves, such as long-term custodial care and help with premiums. That coordination makes Medicaid essential to senior care financing.
How much does Medicaid spend on long-term care?
- Medicaid spent about $228.6 billion on long-term services and supports in 2023, the official national total
- Home and community-based services accounted for about $145.9 billion, the larger share
- Institutional long-term care accounted for about $82.7 billion
- Home and community-based services made up 63.8% of Medicaid LTSS spending, continuing the long shift toward aging in place
| Medicaid long-term care spending (2023) |
Amount |
| Home and community-based services |
$145.9 billion |
| Institutional long-term care |
$82.7 billion |
| Total Medicaid long-term services and supports |
$228.6 billion |
| HCBS share of Medicaid LTSS spending |
63.8% |
These are official Medicaid long-term services and supports expenditures. A separate analysis of CMS financial data reported a narrower $173.2 billion total, with $112.8 billion for home and community-based services and $60.4 billion for institutional care, about 19.6% of Medicaid spending. The two measures use different methods and are not interchangeable.
Decades ago nearly all of this money went to institutions. The rebalancing toward home care reflects both resident preference and lower per-person costs for community services.
Medicaid spent $228.6 billion on long-term care in 2023, with nearly two-thirds going to home and community-based services.
What share of long-term care spending does Medicaid cover?
- Medicaid covers about 61% of the $459 billion spent on long-term care in the United States in 2023, the largest single payer
- It is the primary payer for 63% of nursing facility residents, more than six in ten
- Medicaid also pays for more than a third of the nation’s home health care spending
- By contrast, out-of-pocket spending accounted for about 17% of U.S. long-term care costs in a 2022 analysis
| Long-term care category |
Medicaid share |
| All long-term care spending |
About 61% |
| Nursing facility residents (primary payer) |
63% |
| Home health care spending |
More than one-third |
These figures describe Medicaid’s role across several national long-term care measures, including overall spending, nursing facility primary payer status and home health care spending. They are broader than Medicaid’s own LTSS expenditure total above.
No other payer comes close. Medicare generally does not pay for ongoing non-medical custodial care, though it may cover limited skilled nursing facility care under specific conditions. Private long-term care insurance plays a limited role, leaving Medicaid as the default safety net once savings run out.
Medicaid is the largest payer of long-term care, covering about 61% of U.S. spending and serving as the primary payer for 63% of nursing facility residents.
How long are Medicaid home and community-based services waitlists?
- In 2025, about 607,000 people were on Medicaid HCBS waiting or interest lists, with an average reported wait of 32 months among responding states
- Waitlists exist because most home care is an optional Medicaid benefit that states deliver through capped waivers
- People with intellectual or developmental disabilities are about 74% of those waiting, while older adults and adults with physical disabilities are about 23%
- These lists are incomplete and not directly comparable across states, since screening rules, eligibility checks and reporting methods differ
Being on a waiver waiting list does not always mean no Medicaid home care, since over 80% of those waiting are eligible for personal care or other state plan services while they wait.
About 5.1 million people used Medicaid home care in 2023, compared with 1.4 million in institutional care, but demand still outpaces specialized waiver slots.
This research is for informational purposes only and is not financial, legal or medical advice. Medicaid eligibility limits, spending figures and waitlist data change over time and vary widely by state. Confirm current rules with your state Medicaid agency before making decisions.
Sources and additional resources
Source note: The 74,877,742 Medicaid and CHIP enrollees in February 2026 come from CMS enrollment data highlights. The 94 million March 2023 peak and 71 million pre-pandemic level come from KFF’s enrollment tracker, and Medicaid being the largest public health insurance program for low-income Americans, about one in five, comes from Pew and KFF.
The long-term care special income level near $2,982 a month (300% of SSI) and the $2,000 asset limit come from KFF 2026 non-MAGI eligibility data, with the underlying SSI benefit rate from SSA. The 138% poverty expansion threshold comes from HealthCare.gov, and the 60-month look-back from a CMS transfer-of-assets backgrounder.
Medicaid spending $228.6 billion on long-term services and supports in 2023, with $145.9 billion for HCBS, $82.7 billion for institutions and a 63.8% HCBS share, comes from the official Medicaid.gov LTSS report. The narrower $173.2 billion figure and Medicaid paying more than a third of home health care spending come from Pew Research Center.
Medicaid covering 61% of the $459 billion spent on U.S. long-term care in 2023 comes from KFF Medicaid 101. The 17% out-of-pocket figure comes from KFF’s 2022 LTSS analysis, and the nearly one-fifth share of national health spending from KFF and CMS National Health Expenditure data. Medicare’s limited long-term care role comes from Medicare.gov.
The 11.9 million people with both Medicare and Medicaid in 2025 come from KFF’s dual-eligible state profiles. Seniors and people with disabilities being about one in five enrollees but over half of spending comes from KFF Medicaid 101, and Medicaid as primary payer for 63% of nursing facility residents comes from KFF’s 2025 nursing facility analysis.
The about 607,000 people on HCBS waiting or interest lists in 2025, the average 32-month wait, the 74% with intellectual or developmental disabilities and the over 80% eligible for state plan services come from KFF’s waiting list analysis. The 5.1 million using home care versus 1.4 million in institutional care come from KFF’s 2025 home care analysis.
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