Report · Published April 2026

Long-Term Care Cost by State: 2026 Report

A state-by-state analysis of what long-term care actually costs in 2026 — with rankings, scenarios, and data for every U.S. state plus the District of Columbia. Based on the CareScout 2025 Cost of Care Survey.

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Executive summary

In-home caregiver
$80,080/yr
$6,673/mo · YoY +3%
Adult day
$24,700/yr
$2,058/mo · YoY -5%
Assisted living
$74,400/yr
$6,200/mo · YoY +5%
Nursing home (semi)
$114,975/yr
$9,581/mo · YoY +3%
Nursing home (private)
$129,575/yr
$10,798/mo · YoY +1%

National median figures. CareScout 2025 Cost of Care Survey; data collected July–November 2025.

Table of contents

  1. Five key findings
  2. Most and least expensive states
  3. Three planning scenarios
  4. Who pays — Medicare, Medicaid, LTC insurance, out-of-pocket
  5. Full state-by-state data
  6. Methodology and data sources
  7. How to cite this report

Five key findings

1. The national median nursing home is now six figures — for a shared room

A semi-private nursing home room has a national median cost of $114,975 per year ($9,581/mo) in 2025; a private room runs $129,575 per year ($10,798/mo) — the highest levels CareScout has ever recorded. The median household income for adults 65 and older is around $60,000, meaning a single year of nursing home care costs roughly twice what the typical older American earns. CareScout Cost of Care

2. Cost growth cooled in 2025 — but is still running ahead of wages

Long-term care costs grew an average of just 1.8% in 2025, far below the 9.2% jump in 2024 but still outpacing flat Social Security COLAs. Nursing home private rooms were nearly flat (+1%), assisted living rose 5%, non-medical in-home care rose 3%, and adult day care actually fell 5%. From 2019 to 2024, home care costs surged approximately 50% — the largest five-year run-up of any care type. AARP Public Policy Institute

3. Where you live matters more than whether you pick home or facility care

For a private nursing home room, the most expensive state (Oregon, $221,373/yr) costs 2.4× morethan the cheapest (Texas and Missouri, $91,250/yr). For assisted living, Hawaii's $145,065/yr median is 2.9× higherthan Alabama's $50,400/yr. Geography is often a bigger cost lever than care type.

4. Home care is no longer the cheap option — in many states it rivals assisted living

The national median for full-time-equivalent in-home non-medical caregiving is $80,080/yrat 44 hours per week — higher than the $74,400/yr median for assisted living. In expensive states like Wyoming, Vermont, and Washington, in-home care crosses $100,000/yr. Families who assume "home is cheaper" are often shocked when they price out 24/7 shifts.

5. Medicaid covers 63% of nursing home residents — but requires asset spend-down first

As of 2025, 63% of nursing facility residents have Medicaid as their primary payer (Medicare covers only 14%, out-of-pocket 23%). Medicaid pays 44% of all institutional LTC spending and 69% of Medicaid home-care spending. But qualifying means spending down assets to roughly $2,000 in most states — a reality that catches most families by surprise. KFF

Most and least expensive states

Rankings below show the five most and five least expensive states for three flagship care types, based on 2025 median annual costs.

Assisted living community

National median: $74,400/yr · YoY +5%

5 most expensive

  1. 1. Hawaii$145,065/yr
  2. 2. Alaska$118,578/yr
  3. 3. Massachusetts$113,700/yr
  4. 4. Connecticut$104,106/yr
  5. 5. Vermont$103,137/yr

5 least expensive

  1. 1. Alabama$50,400/yr
  2. 2. Mississippi$51,420/yr
  3. 3. Arkansas$54,744/yr
  4. 4. North Dakota$56,745/yr
  5. 5. South Dakota$58,800/yr

Nursing home — private room

National median: $129,575/yr · YoY +1%

5 most expensive

  1. 1. Oregon$221,373/yr
  2. 2. Connecticut$200,750/yr
  3. 3. New York$200,750/yr
  4. 4. Hawaii$196,735/yr
  5. 5. Washington$191,625/yr

5 least expensive

  1. 1. Missouri$91,250/yr
  2. 2. Texas$91,250/yr
  3. 3. Oklahoma$93,075/yr
  4. 4. Arkansas$96,725/yr
  5. 5. Louisiana$96,908/yr

In-home non-medical caregiver

National median: $80,080/yr · YoY +3%

5 most expensive

  1. 1. Wyoming$105,248/yr
  2. 2. Vermont$102,960/yr
  3. 3. Washington$102,960/yr
  4. 4. Maine$101,816/yr
  5. 5. South Dakota$101,244/yr

5 least expensive

  1. 1. Mississippi$54,912/yr
  2. 2. Arkansas$57,200/yr
  3. 3. Louisiana$59,488/yr
  4. 4. Alabama$61,776/yr
  5. 5. New Mexico$68,640/yr

Three planning scenarios

Each scenario uses median 2025 costs projected with 3% annual growth. Your actual experience will vary by metro area, provider, and care intensity — use the interactive calculator to model your own case.

Scenario 1 — Mom stays home with part-time help (Florida, 5 years)

A 78-year-old in Jacksonville needs roughly 20 hours/week of non-medical help for five years. At Florida's 2025 median of $73,216/yr for 44 hours/week (≈$32/hr × 20 hrs × 52 wks ≈ $33,280/yr), the 5-year total with 3% growth comes to roughly $176,688. Most of it is paid out-of-pocket unless she qualifies for Medicaid home and community-based services. CareScout Florida

Scenario 2 — Dad moves to assisted living (Massachusetts, 3 years)

A 75-year-old in the Boston metro goes into a one-bedroom assisted living apartment at Massachusetts's 2025 median of $113,700/yr. Over three years with 5% growth, total projected cost is roughly $358,439 — almost all out-of-pocket since Medicare does not cover assisted living. A long-term care insurance policy with a 90-day elimination period and $200/day benefit would cover about $65,700/yr, leaving substantial room to cover. CareScout Massachusetts

Scenario 3 — Nursing home with Medicaid spend-down (Ohio, 4 years)

An 82-year-old widow in Cleveland needs skilled nursing care in a semi-private room at Ohio's 2025 median of $110,230/yr. Over four years at 3% growth, total exposure is $461,161. If she starts with $250,000 in savings, she exhausts them in about 2.3 years and transitions to Medicaid for the remainder — a path that 63% of nursing home residents follow. CareScout Ohio

Who pays — Medicare, Medicaid, LTC insurance, out-of-pocket

  • Medicare does not cover long-term care. It pays for up to 100 days of skilled nursing after a qualifying hospitalization — that is it. In a 2025 survey, 58% of Americans incorrectly believed Medicare covered long-term care. Nationwide Retirement Institute
  • Medicaid is the dominant public payer — 63% of nursing home residents (KFF 2025), covering 44% of all institutional LTC spending and 69% of Medicaid home care spending. Eligibility typically requires countable assets below ~$2,000 per applicant in most states.
  • Long-term care insurance covers about 7% of Americans 60+. Annual LTC insurance claim payouts reached $17 billion in 2024, up more than 80% since 2015 — the remaining pool of policyholders is aging into claims. Milliman
  • Out-of-pocket is the bridge. Roughly 80% of family caregivers pay care-related expenses out of pocket — averaging $7,200 per year on top of unpaid time.

Full state-by-state data (2025)

Annual median cost. Click any state name to view the source press release.

StateIn-home caregiverAdult dayAssisted livingNH semi-privateNH private
Alabama$61,776$14,950$50,400$100,010$105,441
Alaska⚠$86,944$45,500$118,578$333,975—
Arizona$86,944$24,700$74,220$100,375$137,240
Arkansas$57,200$19,760$54,744$89,425$96,725
California$91,520$24,440$82,800$146,000$182,135
Colorado$94,952$27,300$78,303$121,910$146,183
Connecticut$82,368$28,340$104,106$182,500$200,750
Delaware$80,080—$90,600$173,923$181,588
District of Columbia$86,944$28,600$77,934$146,730$173,740
Florida$73,216$19,500$66,000$124,100$146,000
Georgia$73,216$23,400$60,600$105,850$113,150
Hawaii$93,808$30,615$145,065$185,679$196,735
Idaho⚠$88,088—$59,468$125,925$146,142
Illinois$82,368$23,725$72,645$99,645$110,595
Indiana$80,080$33,020$66,564$107,310$123,918
Iowa$94,037$19,370$61,200$111,325$120,450
Kansas$77,220$52,000$71,370$104,025$108,770
Kentucky$74,360$22,880$63,480$116,618$135,050
Louisiana$59,488$22,958$61,950$91,250$96,908
Maine$101,816$29,900$81,720$167,718$178,850
Maryland$80,080$30,313$85,980$155,125$173,375
Massachusetts$91,520$29,120$113,700$173,375$189,800
Michigan$79,508$39,000$69,000$135,050$143,628
Minnesota$100,672$31,200$77,790$127,750$166,440
Mississippi$54,912$16,380$51,420$114,975$118,625
Missouri$75,504$24,700$63,960$80,893$91,250
Montana$86,944$69,395$72,900$107,675$114,975
Nebraska$82,368$42,250$73,110$100,521$110,595
Nevada$84,656$20,800$73,845$141,438$173,558
New Hampshire$91,520$24,180$96,300$146,913$161,330
New Jersey$86,944$26,000$101,550$153,300$173,375
New Mexico$68,640$52,000$71,400$109,500$127,597
New York$80,080$37,440$82,140$186,333$200,750
North Carolina$68,640$21,970$74,400$116,800$129,575
North Dakota$77,792$66,300$56,745$138,335$147,643
Ohio$77,792$21,580$71,700$110,230$124,666
Oklahoma$75,504$23,920$72,540$84,315$93,075
Oregon$91,520$52,000$82,494$201,115$221,373
Pennsylvania$77,792$30,420$76,218$143,445$164,250
Rhode Island$91,520$16,900$93,366$145,270$160,600
South Carolina$71,786$18,720$64,200$108,405$115,340
South Dakota$101,244—$58,800$113,333$122,275
Tennessee$70,928$20,800$67,140$113,150$120,450
Texas$68,640$23,400$67,200$67,525$91,250
Utah$89,804$36,400$62,790$104,025$127,750
Vermont$102,960—$103,137$169,360$186,333
Virginia$80,080$20,995$83,328$123,005$140,160
Washington$102,960$64,740$90,550$157,859$191,625
West Virginia$68,640—$76,080$154,030$159,140
Wisconsin$82,940$18,200$74,940$127,750$147,825
Wyoming$105,248$39,437$63,900$118,990$131,081

Methodology and data sources

All state-level cost figures come from the CareScout 2025 Cost of Care Survey, the direct successor to the Genworth Cost of Care Survey that has been the industry reference for more than two decades. CareScout collected 25,000+ rates from providers across all 50 states and DC between July and November 2025; individual state results were published on BusinessWire on March 2, 2026.

In 2025 CareScout merged "homemaker services" and "home health aide" into a single "non-medical caregiver" metric because their price gap had closed. We annualize by multiplying a $35/hr national median by 44 hours per week for 52 weeks ($80,080). Adult day health is $95/day × 5 days × 52 weeks ($24,700). Assisted living and nursing home figures are monthly rate × 12.

Supporting data on payer mix comes from the Kaiser Family Foundation and the KFF 2025 Nursing Facility Characteristics brief. Home health aide wage data is from the BLS Occupational Outlook Handbook (May 2024). Long-term care inflation trend data comes from the AARP 2026 Long-Term Care Affordability Report. LTC insurance coverage and claims data are from Milliman's 2024 industry report.

Medians hide substantial intra-state variation: urban metros typically run 20–40% above a state median, while rural markets may sit below it. Individual provider rates can diverge much further. This dataset is a planning reference, not a quote.

Data flag:Idaho's figures are approximate and drawn from a mirrored press release; they should be verified against CareScout's direct Idaho release before citing.

How to cite this report

APA: Sandwich / Terahertz Inc. (2026, April). Long-term care cost by state: 2026 report. Sandwich. https://www.joinsandwich.com/reports/cost-of-care-2026

MLA:Sandwich / Terahertz Inc. "Long-Term Care Cost by State: 2026 Report." Sandwich, April 2026, https://www.joinsandwich.com/reports/cost-of-care-2026.

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