Can Medicaid Help With Housing? Waivers, Vouchers, and Limits

Medicaid can help with housing, but not by paying your rent. Federal law keeps room and board off the list of things Medicaid dollars can cover, so the monthly rent or mortgage check has to come from your own income or from a separate housing program. What Medicaid does pay for is the support that makes independent living possible in the first place: personal care in your home, case management, accessibility modifications, one-time costs when you leave a nursing facility, and in some states pre-tenancy and tenancy-sustaining services. Paired with a HUD voucher or a supportive housing unit, those services are often what lets a person stay housed at all.

Why Rent Is Off the Table

The limit is written into the statute. When Congress authorized Medicaid to cover home and community-based services under Section 1915(c) waivers, it excluded room and board from the covered costs.¹ Federal regulations restate the point: no federal Medicaid matching funds can go toward room and board under HCBS waivers, with only narrow exceptions for respite care in an approved facility and a small food-and-rent allowance for an unrelated live-in caregiver.²

The exclusion applies in every state. Even when a state builds a housing-focused Medicaid program, the federal share stops at the rent line. Medicaid can pay for the caseworker who helps you find an apartment and the behavioral health services that keep you stable in it. The monthly rent itself has to come from somewhere else, whether that’s SSI, a Housing Choice Voucher, or your own income.

Services That Help You Stay in Your Home

The most direct way Medicaid helps with housing is by funding the hands-on services that let someone live at home instead of in a nursing facility. States design their Home and Community-Based Services waivers under federal rules, and the specific service menu varies, but the common building blocks include:³

Personal care assistance with bathing, dressing, eating, and other daily activities.
Case management to connect you with medical care, social services, and housing resources.
Home modifications such as wheelchair ramps, grab bars, widened doorways, and bathroom renovations. Average spending runs about $6,300 per person, though state caps vary.
Adult day health services offering daytime health monitoring and social engagement.
Respite care to relieve family caregivers.
Transportation to medical appointments and other covered services.

None of these are rent. But for someone who can’t safely bathe or cook alone, they’re what makes staying in the apartment possible. States can also propose services beyond the standard menu, including supports designed to help people transition out of or avoid institutions.³

One-Time Costs When You Leave an Institution

Medicaid gets closest to actually paying housing expenses when someone moves out of a nursing facility, psychiatric hospital, or similar institution. Those transitions come with startup costs that most people have no way to cover, and Medicaid can pick up many of them. Covered one-time expenses can include security deposits, utility activation fees, up to six months of utility arrears to restore service, moving costs, basic furniture and household goods, and pantry stocking of up to 30 days of food.⁴ Application and housing inspection fees are also covered.

Transition benefits carry firm limits. A beneficiary can typically use them only once per qualifying transition, and they don’t extend to ongoing rent. Some states fund these costs through HCBS waivers and others through state-only dollars. One estimate puts total one-time transition expenses at roughly $1,800 per person.⁵

Money Follows the Person

The federal Money Follows the Person demonstration is the main organized route for moving out of an institution with Medicaid support. Its goals include increasing use of community-based services, removing state-level barriers to community transitions, and strengthening quality assurance for HCBS. Congress extended MFP funding through September 30, 2027, and grantees can continue transitioning participants through December 31, 2030.⁶ If you or a family member is in a nursing facility and wants to move to the community, ask the facility’s social worker or your state Medicaid agency whether MFP is available and whether you qualify.

Housing Supports Through Section 1115 Waivers

A smaller group of states has gone further, using Section 1115 demonstration waivers to cover housing-related services that reach beyond standard transition assistance. As of early 2026, 18 states had approved Section 1115 waivers with housing support components.⁷ These waivers let states test approaches the regular Medicaid program doesn’t allow.⁸ Common covered services include:

Pre-tenancy support such as gathering documents, filling out housing applications, budgeting, and navigating landlord requirements.
Tenancy-sustaining services including tenant rights education and help resolving conflicts with landlords to prevent eviction.
One-time transition and moving costs such as deposits, utility setup, movers, and basic household goods.

States including Arizona, Arkansas, and California have built housing supports into their approved 1115 demonstrations, often targeting people experiencing chronic homelessness or at risk of institutionalization.⁷

This area is changing. CMS guidance from 2023 and 2024 that encouraged states to address health-related social needs, including housing, was rescinded on March 4, 2025. States with already-approved 1115 demonstrations can continue running their programs through the waiver’s expiration date, but states with pending proposals may face obstacles in getting new housing components approved. If your state already covers housing supports through 1115, those services remain available for now. If not, the path to new coverage through this route is less certain.

Pairing Medicaid With a HUD Rental Program

Because Medicaid can’t pay rent, the housing help that actually works for most beneficiaries is a pairing: a HUD program covers the housing, Medicaid covers the services. Two federal programs are built for that coordination.

Section 811 Project Rental Assistance

Section 811 PRA provides rental subsidies for extremely low-income people with disabilities and requires state housing agencies to partner formally with state Medicaid agencies. The Medicaid agency identifies and refers eligible tenants, while the housing agency administers the rental assistance. Tenants must be eligible for community-based long-term services through Medicaid or a state-funded program.⁹ The program is designed to combine Medicaid services and affordable housing in the same package.¹⁰

Mainstream Vouchers

HUD Mainstream Vouchers provide rental assistance for non-elderly people with disabilities aged 18 to 61 who are transitioning out of institutions, at serious risk of institutionalization, homeless, or at risk of homelessness. Public Housing Agencies that run Mainstream Vouchers can coordinate directly with state Medicaid agencies for referrals, housing search help, and connections to supportive services.¹¹ If you already receive Medicaid HCBS and need rent help, a Mainstream Voucher is one of the closest fits.

Permanent Supportive Housing

Permanent supportive housing combines an affordable apartment with onsite services, often targeting people who have experienced chronic homelessness or who live with serious mental illness or substance use disorders. Medicaid funds the service side, not the unit. Covered services commonly include behavioral health treatment, targeted case management, peer support, and daily living skills training such as medication management and budgeting.¹² If you’re working with a supportive housing provider or health center, ask which of the onsite services Medicaid covers for you.

Who Qualifies

Housing-related Medicaid services generally require meeting two tests: financial eligibility for Medicaid, and a functional assessment showing you need an institutional level of care. HCBS waiver income and asset limits are typically tied to the same thresholds used for nursing home Medicaid, which are strict and vary by state. On the functional side, the state has to determine that without waiver services you would otherwise require placement in a nursing facility or similar institution, and periodic reassessments confirm you still meet that threshold.² HCBS housing supports aren’t a general Medicaid benefit; they’re targeted at people whose care needs are serious enough that the alternative is institutional care.

The Waitlist

Qualifying doesn’t mean getting services right away. HCBS waivers have limited slots and long waitlists. In 2025, 41 states maintained waiting lists for HCBS, with more than 600,000 people waiting nationally. The average wait across all populations was 32 months. People with intellectual and developmental disabilities waited an average of 37 months, and autism-specific waivers averaged 63 months. Waivers for older adults and people with physical disabilities had shorter average waits of around 15 months. States that screen for eligibility before adding someone to the list tend to have shorter waits than those that don’t.¹³ Apply as early as possible; the clock doesn’t start until you’re on the list.

If You Own a Home: Estate Recovery

Homeowners considering Medicaid HCBS should know about a financial consequence that surprises many families. Federal law requires every state to seek recovery from the estates of Medicaid beneficiaries who were 55 or older when they received benefits, and the recoverable costs explicitly include HCBS, not just nursing facility care.¹⁴

Your home is generally exempt from Medicaid liens while you’re alive and living in it. Federal law also blocks recovery against a home when a surviving spouse, a child under 21, or a blind or disabled child of any age lives there.¹⁴ Once none of those protected individuals live there, the state can seek reimbursement from your estate for services you received. States vary in how aggressively they pursue recovery and whether they extend it to non-probate assets, so your exposure depends on where you live. If you own property and are considering HCBS, talking to an elder law attorney before enrolling is worth the cost.

Where to Start

Your state Medicaid agency is the first stop. Every state runs its own HCBS waivers with different names, different eligibility processes, and different service menus. The agency can tell you which waivers are open, whether there’s a waitlist, and how to apply. If your state has an approved Section 1115 demonstration with housing supports, the Medicaid agency is also the entry point for those services.

If you’re currently in a nursing facility or other institution and want to move to the community, ask the facility’s social worker about Money Follows the Person and any state-specific transition programs. They provide the most hands-on help with the move itself, including upfront costs and connections to community services.

For the rent side, contact your local Public Housing Agency about Housing Choice Vouchers, Mainstream Vouchers, and Section 811 availability. These HUD programs operate independently from Medicaid but are designed to work alongside it, and voucher demand exceeds supply almost everywhere, so expect waitlists there too. A case manager or social worker familiar with both Medicaid and housing programs can help you apply to multiple programs at once, which is usually the fastest way to actually get housed.

1
Office of the Law Revision Counsel. 42 U.S. Code 1396n – Compliance With State Plan and Payment Provisions
2
eCFR. 42 CFR Part 441 Subpart G – Home and Community-Based Services: Waiver Requirements
3
Medicaid.gov. Home and Community-Based Services 1915(c)
4
Centers for Medicare & Medicaid Services. CMCS Informational Bulletin – Coverage of Services and Supports to Address Health-Related Social Needs
5
Office of the Assistant Secretary for Planning and Evaluation (ASPE). Understanding Medicaid Home and Community Services: A Primer
6
HHS TAGGS. Money Follows the Person Rebalancing Demonstration
7
KFF. Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
8
KFF. Medicaid Section 1115 Waivers: The Basics
9
HUD Exchange. Section 811 PRA Program Eligibility Requirements
10
HUD Exchange. Section 811 PRA Service Partner: State Medicaid and Human Services Agencies
11
ACL Administration for Community Living. From HUD: New Flexibilities in Mainstream Voucher Program
12
National Health Care for the Homeless Council. Medicaid and Permanent Supportive Housing: A Quick Guide for Health Centers
13
KFF. A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025
14
Office of the Law Revision Counsel. 42 U.S. Code 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets