Nevada Medicaid for Seniors & Long-Term Care

The Home and Community Based Services Waiver for the Frail Elderly (FE Waiver) is Nevada's primary Section 1915(c) HCBS waiver for seniors, providing community-based, in-home services so frail and elderly Nevadans can avoid nursing facility placement. To qualify, an applicant must be age 65 or older, be at risk of nursing home placement (meeting nursing facility level of care), and be financially eligible. ADSD also operates a similar state-funded program, the Community Options Program for the Elderly (COPE), for people who need a lower level of support.

HCBS waiver programs in Nevada have limited slots and there may be waiting periods. Contact ADSD at (702) 486-3545 (southern Nevada) or (775) 687-4210 (northern Nevada) to apply for HCBS services or ask about wait times.

Nevada 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 is $163/month in Nevada, well above the $30/month federal minimum. Medicaid covers the gap. If income exceeds the institutional Medicaid limit, Nevada may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Federal Medicaid law protects community spouses (the spouse who remains at home) from impoverishment under the Spousal Impoverishment rules in 42 USC 1396r-5. The community spouse may keep up to $162,660 in countable assets (2026 Community Spouse Resource Allowance, or CSRA — federal maximum) and is entitled to a Minimum Monthly Maintenance Needs Allowance (MMNA), with the federal floor at approximately $2,643.75/month in 2026. The primary home is an exempt asset while the community spouse lives in it. Nevada's specific CSRA and MMNA figures align with federal standards and are updated annually.

Nevada operates a Medicaid Estate Recovery Program (MERP) as required by federal law (42 USC 1396p). After the death of a Medicaid recipient who was 55 or older and received long-term care, DHCFP may file a claim against the estate for the cost of services. The primary home is generally protected while a surviving spouse is alive or while a minor or disabled child lives there. MERP claims are waived in cases of undue hardship — contact DHCFP for details.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact Nevada Medicaid or ADSD to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.