Guide
Does Medicaid pay for nursing homes? Rules and how to apply
Updated October 15, 2026 · Reviewed against official sources
Medicaid is a federal and state health program for people with limited resources. It's not the same as Medicare. Many older adults have both (they're called "dual eligible"). For long-term care, Medicaid is the most important source of help, because Medicare doesn't pay for daily custodial care, meaning help with bathing, dressing or eating.
What Medicaid covers in long-term care
- Nursing homes (also called nursing facilities): a mandatory benefit in every state for people who meet the medical and financial requirements.
- Home and community-based services (HCBS): personal care at home, adult day care, respite care for the caregiver, meals, small home modifications and, in some states, services in assisted living. These services are offered mainly through waivers and often have limited spots and waiting lists.
Medicaid doesn't pay for rent or meals in assisted living. In states that allow it, it pays only for the care part.
Medical requirement: the "level of care"
The state assesses whether your loved one needs a nursing facility level of care. It usually looks at how much help they need with bathing, dressing, eating, moving around or using the bathroom, and whether they have memory problems that require supervision. You can get an early idea with our Katz and Lawton scales, which are only a guide and don't replace the official assessment.
Financial requirements: 2026 figures
Rules vary by state. These are the federal reference figures for 2026, published by CMS:
| Item | 2026 |
|---|---|
| Typical asset (resource) limit for one person | $2,000 (varies by state) |
| Income limit in many states ("special income rule," 300% of SSI) | $2,982 a month |
| Assets the spouse living at home can keep (minimum and maximum) | $32,532 to $162,660 |
| Minimum protected monthly income for the spouse at home (starting July 1, 2026, all states except Alaska and Hawaii) | $2,705 |
| Maximum protected monthly income for the spouse at home | $4,066.50 |
| Home equity limit, depending on the state | $752,000 to $1,130,000 |
What usually doesn't count: the main home (within the equity limit), one vehicle, personal belongings and certain funeral funds.
Important exceptions: California uses its own limits. Since January 1, 2026, the Medi-Cal asset limit for older adults has been $130,000 per person and $65,000 for each additional person in the household. Read Medi-Cal and IHSS in California. New York also has its own limits: see New York Medicaid.
If income is over the limit
There are still options. Depending on the state, there are two paths:
- "Medically needy" programs: the person qualifies after using their excess income on medical expenses. This is called a "spend-down."
- Miller trust (also called a Qualified Income Trust): in states with an income cap, the money over the limit is deposited each month into a special account. When the person dies, the state receives whatever is left in that account, up to what Medicaid paid.
A person living in a nursing home on Medicaid usually pays almost all of their monthly income to the facility as their "share of cost" (also called patient liability) and keeps a small allowance for personal needs. Medicaid pays the rest.
The 5-year look-back
When someone applies for Medicaid long-term care, the state reviews asset transfers from the past 60 months. If your loved one gave away money, put the house in a child's name or sold something for less than it was worth, they may get a penalty period: a stretch of time when Medicaid won't pay for the nursing home. That period is calculated by dividing the amount transferred by the average monthly cost of a nursing home in the state.
Before putting assets in the children's or anyone else's name, it's wise to talk with an elder law attorney. A transfer made without planning can leave your loved one without coverage for several months, right when they need it most.
Protection for the spouse who stays at home
Spousal impoverishment rules keep the husband or wife who still lives at home from being left without resources. They can keep part of the couple's assets and receive part of the income of the spouse who lives in the nursing home, within the limits in the table above.
Estate recovery
After the person dies, federal law requires the state to try to recover what Medicaid paid for nursing home care and other long-term care services received from age 55 on. There are protections: the state can't collect while the spouse is alive, or if there's a child under 21 or a child who is blind or has a disability. There are also hardship exceptions. Each state applies the rule in its own way; check with the Medicaid agency or an attorney.
Waivers: Medicaid to stay at home or in assisted living
If your loved one prefers to stay at home, ask about your state's waiver programs. Some examples:
- Texas: STAR+PLUS, including assisted living care through STAR+PLUS HCBS.
- California: IHSS, which can pay a family member to provide care, and the Assisted Living Waiver.
- Florida: the SMMC Long-Term Care program.
- New York: managed long-term care (MLTC) and CDPAP.
- Where available: the PACE program, which combines Medicare and Medicaid in a single care team.
Many waivers have waiting lists. That's why it's a good idea to sign up as soon as possible, even if your loved one doesn't need the service yet. In the meantime, see what support is available in help for family caregivers and home care for seniors.
How to apply for Medicaid
- Find your state's Medicaid agency. If you don't know where to go, call the Eldercare Locator at 1-800-677-1116 (Monday through Friday; you can ask for help in Spanish) or search at eldercare.acl.gov.
- Gather documents: ID, proof of citizenship or immigration status, Medicare card, proof of income, bank statements (sometimes going back several months or years), deeds and insurance policies.
- Ask for the medical assessment of level of care.
- Submit the application online, by phone or in person. In Texas, for example, you apply at YourTexasBenefits.com or by calling 2-1-1.
- Answer every letter on time. If the application is denied, you have the right to a fair hearing.
If your loved one is in the hospital, the hospital social worker can often help start this process. At the nursing home, the admissions staff or the business office also usually guides families.
What is "Medicaid pending"?
Sometimes a person needs to move into a nursing home right away, but Medicaid takes weeks or months to approve. Many nursing homes accept the resident as "Medicaid pending": they admit the person while the application is being decided, and Medicaid pays later if it's approved. Medicaid can also cover months before the application (retroactive coverage), although some states, like Florida, already limit it for older adults: ask how it works in your state.
Points to confirm:
- Whether the facility accepts "Medicaid pending" residents and whether it's Medicaid-certified. You can check this on each listing in our directory.
- What happens with the payments for those months if the application is denied. Get it in writing and keep it.
- For applications filed on or after January 1, 2027, retroactive coverage for older adults drops from 3 months to 2 months, because of a 2025 federal law (P.L. 119-21). That's why it's best to apply as soon as possible.
Immigration status
Medicaid rules for some people who aren't citizens changed on October 1, 2026. Before applying, read our guide on immigration status and benefits and talk with an immigration attorney at a nonprofit organization.
Frequently asked questions
Will Medicaid take my mom's house?
Not while she's alive and the house counts as her main home within the equity limit. After she dies, the state may try to recover what it paid through estate recovery, with the protections described above (for example, while her spouse is alive).
Can I have Medicare and Medicaid at the same time?
Yes. Medicare pays first for medical services and short-term rehab; Medicaid covers long-term care and helps with costs Medicare doesn't pay. Read what Medicare covers.
How long does approval take?
It depends on the state and on how complete the application is. Having your documents ready and answering each letter quickly helps a lot.
Do all nursing homes accept Medicaid?
Not all of them. Most are certified, but some have few beds for residents on Medicaid. Always ask before admission.
Next steps
- If your loved one is in the hospital, see what to do on our hospital discharge page.
- Find nursing homes that accept Medicaid with our guided search or search near you.
- Check how much a nursing home costs while you wait for approval.
Medicaid rules vary by state and change every year. This guide is for information only and is not legal or financial advice.
Sources
- CMS/CMCS, Informational Bulletin, December 9, 2025 (2026 SSI and spousal impoverishment standards): https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf (accessed October 15, 2026)
- CMS/CMCS, Informational Bulletin, April 27, 2026 (updated 2026 standards): https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf (accessed October 15, 2026)
- CMS/CMCS, Informational Bulletin, November 18, 2025 (Medicaid provisions of P.L. 119-21): https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf (accessed October 15, 2026)
- Medicaid.gov, Spousal Impoverishment: https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html (accessed October 15, 2026)
- Medicaid.gov, Estate Recovery: https://www.medicaid.gov/medicaid/eligibility-policy/estate-recovery (accessed October 15, 2026)
- California DHCS, reinstatement of the Medi-Cal asset limit: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf (accessed October 15, 2026)
- Texas HHSC, STAR+PLUS: https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus (accessed October 15, 2026)
- ACL, Eldercare Locator: https://eldercare.acl.gov/ (accessed October 15, 2026)
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
What does Medicare cover?
Medicare pays for up to 100 days of rehab after a 3-day inpatient stay, not long-term nursing home care. 2026 costs, home health and hospice.
How much care costs
Nursing home, assisted living, adult day care, and home care prices by state (CareScout 2025). What the rate includes, what's extra, and how to pay.
Immigration status and benefits
Who can get Medicaid and Medicare based on immigration status in 2026: emergency Medicaid, state programs and public charge. An informational guide.
Medicaid and the family home
Will Medicaid take the house? When the home doesn't count, which transfers the law allows, how the spouse is protected and what estate recovery is.
