How Medicaid pays for nursing home care

Medicaid and nursing home care

Medicaid.gov lists nursing facility services among the benefits that every state must provide. Medicaid.gov says the payment covers room and board along with the daily care, as one bundled amount.

The government's long-term care site, run by the Administration for Community Living, makes a point that surprises many families. Unlike Medicare, Medicaid does pay for custodial care in nursing homes. Custodial care means everyday help with things such as bathing and getting dressed.

To be paid by Medicaid, a nursing home must be licensed by the state and certified under federal standards. Before you make plans, ask each home you visit whether it accepts Medicaid.

Where Medicare coverage stops

Medicare.gov says Medicare generally does not cover long nursing home stays unless you are getting skilled nursing care. Skilled care needs a trained nurse or therapist, such as help changing sterile dressings or rehab after a hip replacement.

Medicare Part A can pay for up to 100 days in a Medicare-certified home. You first need a hospital stay of at least 3 days in a row. Medicare.gov lists the 2026 costs for this. Once you have paid the $1,736 Part A deductible, you pay $0 a day for days 1 through 20. Days 21 through 100 cost $217 a day, and after day 100 you pay all costs.

Medicaid.gov says Medicaid also covers nursing facility care beyond that 100-day limit. That is the main reason people turn to Medicaid when a stay becomes long. Our Medicaid vs Medicare guide explains how the two programs fit together.

Income and asset rules

Medicaid looks at two things for nursing home care, which are how much you earn and how much you own. What you own is called your assets or resources. The Administration for Community Living says your income and assets cannot go over the levels your state uses.

The limits are not the same in every state, so this page does not give one number. Your state Medicaid office can tell you its limits. The state also decides whether you need the level of care a nursing home gives, because some Medicaid services depend on that need.

Once you qualify, most of your monthly income usually goes toward the cost of care. Medicaid.gov says a person in a nursing home keeps a personal needs allowance of at least $30 a month. A few other amounts are also protected, such as money for the medical costs of the person and for family members. Medicaid then pays whatever is left of the bill.

States count each kind of asset in their own way. A legal aid office or your state Medicaid office can explain how your case would be handled.

The 5-year look-back

When you apply for nursing home coverage, the state checks your recent money moves. Federal law sets a look-back period of 60 months, which is 5 years, for most gifts and transfers made on or after February 8, 2006. The state looks back from the date you are in a nursing home and have applied for Medicaid.

Suppose you gave away money or property in that time, or sold it for less than it was worth. Medicaid can then delay paying for your nursing home care, and that delay is called a penalty period. The length comes from a simple division in federal law. The value of what was given away is divided by the average monthly cost of nursing home care for a private-pay patient in your state.

The law treats some transfers differently, such as property moved to a spouse. The rules are detailed and the stakes are high. Before you give away or sell anything, talk with a legal aid office or an elder law attorney about your own case. This guide is general information and not legal advice.

Protections for a spouse who stays home

Nursing home care can cost so much that it wipes out a couple's savings. Congress passed the spousal impoverishment rules in 1988 so the spouse at home would not be left with nothing. Medicaid.gov says these rules protect part of the couple's combined resources for the spouse in the community. Some of the income of the spouse in the facility can be set aside as well.

CMS published the 2026 figures in an April 27, 2026 bulletin.

• The community spouse can keep a resource amount between a minimum of $32,532 and a maximum of $162,660 in 2026.
• The monthly income amount for the community spouse is at least $2,705 in most states starting July 1, 2026. It is no more than $4,066.50. Alaska and Hawaii have higher minimums than that.
• The home equity limit has a minimum of $752,000 and a maximum of $1,130,000 for 2026.

Each state can pick any amount between the minimum and the maximum. Ask your state Medicaid office which amounts it uses.

Medicaid.gov adds that states must try to recover some costs from the estate of a person who got nursing home care after age 55. States may not do this while a spouse, a child under 21 or a blind or disabled child is living. They must also have a way to waive recovery in cases of undue hardship.

Where to get free help

You do not have to work through this alone, and several kinds of help cost nothing.

• The State Health Insurance Assistance Program, called SHIP, gives free one-on-one help with Medicare and with questions about how Medicare and Medicaid work together. You can find your local office at shiphelp.org.
• Legal aid offices give free help with civil legal problems to people with low incomes. The Legal Services Corporation lists a legal aid group in every state on its website. The Administration for Community Living notes that federally funded legal programs may also help older adults for free.
• Your state Medicaid office can tell you how to apply and can explain your state's limits. You can find it through the directory on Medicaid.gov.

Your local Area Agency on Aging can point you to other services, and you can find it by calling the Eldercare Locator at 1-800-677-1116. If the person needing care would rather stay at home, read about Medicaid for family caregivers and about assisted living and Medicaid.

A community health center or a cash-pay doctor can help with everyday care while you wait for a decision. If you think you are having an emergency, call 911 or go to the nearest emergency room.