83% of Boomers Prefer Home Care, But a 34-Month Medicaid Wait May Not Mean What Families Think

She added her name to a Medicaid home care waiting list years ago and told her family the future was handled. But the list she joined may not even know whether she qualifies yet, and the countdown she believes has started may be pointing to the wrong place.

Picture a retired schoolteacher in her seventies. Long before she needs help bathing, cooking, or managing medications, she signs up for her state’s Medicaid home care list. At Sunday dinner, she tells her children she is “on the list.” To her, that seems like enough. No one has reviewed her finances, and no one has checked whether she meets the level of need required for care. She saw that the wait was 34 months, so she assumes the clock is already ticking.

She is far from alone in wanting that outcome. A recent insurer survey on financial planning found that 83% of Boomers would prefer care at home if a health event required long-term support. The complication is that the list she joined may not be the same kind of list behind that 34-month figure.

Medicaid Home Care Lists Are Not All the Same

Medicaid is the joint federal-state program that helps pay for long-term care for people with limited income and assets. Medicare is different. Most people receive Medicare at 65, but it does not cover ongoing custodial help at home. Families often confuse the two, and that confusion can shape plans like hers.

States commonly provide Medicaid home care through waivers, which can limit the number of people served. When demand exceeds available slots, a waiting list or interest list can develop.

KFF, the health policy research organization, surveys state Medicaid officials each year about these programs and finds that some lists include only people the state has already determined eligible. Others include people whose eligibility has not yet been reviewed. Some states call those interest lists or referral lists, even though they mean something very different.

Why the 34-Month Average Can Be Misleading

KFF says people on waiting or interest lists who eventually received services waited 34 months on average. But that national figure combines both kinds of lists.

The difference matters. In one recent year, 32 states screened people for eligibility on at least one waiver list. Eight states — Alaska, Florida, Iowa, New Mexico, Oklahoma, Oregon, South Carolina and Texas — screened no one on any list, yet those states accounted for 56% of everyone waiting nationwide. In other words, more than half the people on the lists lived in states where being added to a list did not mean anyone had already determined they qualified.

There is another limitation. Most people on these lists are waiting for programs serving people with intellectual or developmental disabilities. That makes the 34-month national average a weak guide for how long an older adult might wait.

Reaching the Top of the List Is Only the Beginning

If a person is on an unscreened list, having a name called is only the start. The state may then require a full financial application. There may also be a level-of-care assessment to show the person needs the type of help the program covers, along with a possible spend-down of savings to meet state limits.

If income or assets are too high, reaching the top of the list still does not guarantee services. Years spent waiting may bring someone closer to an opening without answering whether she can actually accept it. Family members may also discover that a home, an IRA, or a recent gift to a grandchild affects eligibility in ways nobody had previously checked.

A screened list works differently. In that case, the state has already completed some form of eligibility review before adding the person, so the place on the list carries more weight. Families also have a better chance of learning about problems before the name reaches the top.

Two Questions Families Should Ask

Families can reduce confusion by asking the state Medicaid agency or the office that runs the waiver two questions:

1. Is this a screened waiting list or an unscreened interest list?
2. Has anyone already reviewed her finances or care needs?

If the answers are “unscreened” and “no,” then being on the list is not the same as being approved for services. The work of gathering financial records and learning the state’s rules still lies ahead. Getting the answer in an email or letter can help, because a friendly phone call may not matter much years later when the name finally comes up.

Timing matters, too. A parent who is healthy now has time to sort through paperwork, records and family decisions calmly. After a fall or hospital stay, the same tasks often have to be done in a rush.

States Will Have to Provide More Clarity Starting in 2027

More transparency is coming. KFF says that beginning in 2027, states will have to report whether people on their waiting lists have been screened for eligibility. That should make national comparisons easier to understand.

Until then, being “on the list” can feel like a plan. For families, the key question is whether the list knows anything about the person yet.