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LGBT – Paying for Long-term Care – Public & Private

Applying for Medicaid

Medicaid regulations related to long-term care include a series of “spousal impoverishment protections” that prevent a healthy spouse from losing a primary residence or savings in order to qualify a spouse for Medicaid. In most states these protections don’t apply to same-sex couples. However:

  • States have received guidance from the Centers for Medicare and Medicaid Services on how they can extend the spousal impoverishment protections to same-sex couples.
  • The intent of this guidance is to encourage additional states to recognize that same-sex couples have the same need for spousal protections.
  • SAGE (Services and Advocacy for LGBT Elders) has produced a guide to help the LGBT community understand Medicaid and spousal impoverishment, including estate recovery, and the implications for same-sex couples.

Good To Know

The National Resource Center on LGBT Aging has an excellent section on “Medicaid and the LGBT Community: Paying for Long-Term Care” that we recommend you read. It provides in depth coverage on what LGBT individuals and couples should look for in applying for Medicaid.

Older Americans Act Programs

Older Americans Act (OAA) programs are available to adults aged 60 and older. There are no specific financial eligibility criteria for OAA services, though Congress has directed that they generally be targeted for low-income, frail seniors, minority older adults, seniors living in rural areas and other older adults of greatest social need. Additionally:

  • Not all providers of aging services funded through the OAA are inclusive and culturally competent.
  • Check with LGBT friends and acquaintances to see if they have any suggestions.
  • Your local LGBT community center may be helpful in steering you toward inclusive providers.
  • The National Resource on LGBT Aging has a special section for LGBT Older Adults with many resources including a tool that helps you find resources in your state.

Veterans Affairs LTC Benefits

While “Don’t Ask, Don’t Tell” is gone now, the impact of its demise on LGBT veterans is yet to be determined. In general, VA benefits are some of the best. Should you want to do some research before contacting the VA directly, here are a few resources you may find helpful:

  • The United States Department of Veterans Affairs has a list of organizations that may be of assistance.
  • The Servicemembers Legal Defense Network has a lot of information for LGBT service members on their website and offer free legal advice.

Long-term Care Insurance

Many issues need to be considered before buying Long-term Care Insurance. In addition to the information provided in the Costs & How to Pay Section of this site, you should note that:

  • Different states have different policies and these may include different definitions of “family” that could affect eligibility requirements for same-sex partners.
  • These definitions may also affect a public employee’s ability to buy into benefits, depending on the state. Thorough research should be done before purchasing any policy.
  • As you read this section, it may be a good time to reference Lambda Legal’s map of relevant state laws.

Reverse Mortgages

For LGBT people living with others, where the home is not jointly owned, you may want to consult an LGBT- friendly lawyer, Lambda Legal, or the National Center for Lesbian Rights for assistance.


The use of Annuities to pay for long-term care may not involve special considerations for LGBT people, but seeking advice from a trusted professional is always advised:

  • There may be issues under “Immediate Annuities” for transgender individuals because payment is gender-based under the assumption that women live longer than men and therefore receive smaller monthly payments
  • Work with a trusted legal professional or consult the National Center for Transgender Equality to determine how being transgender affects the calculation for this insurance in your state


Charitable Remainder Trusts may be a good option for LGBT individuals with assets, though same-sex couples should be sure that state laws don’t have a negative impact on them should one partner die. For more information, refer to Lambda Legal’s “Take the Power: Tools for Life and Financial Planning.”

Spousal Impoverishment Laws in your state may impact how same-sex couples are treated under Medicaid Disability Trusts, so be sure to do your homework before entering into this arrangement. To learn more, see the National Resource Center on LGBT Aging’s “Medicaid and the LGBT Community: Paying for Long-Term Care.”