Fact #4 - Both the federal government and states pay for Medicaid. Each state administers Its Medicaid program independently, so while the fundamental eligibility criteria are consistent across the United States; there can be significant differences in the rules from state to state. Medicaid eligibility is primarily based on an individual's level of disability and assets and Income. In cases where the applicant is married, the assets and income of both spouses are considered. Local Medicaid offices in each state make these determinations. Elder law attorneys have extensive experience with the multiple layers of Medicaid law and can provide personalized advice to help you prepare for long-term care expenses while preserving assets. Early planning can provide significant benefits, including ensuring that a spouse at home retains enough income and assets for living expenses.