Medicaid for Nursing Home Care: Eligibility, Costs and How to Apply

Reviewed October 5, 2026. Medicaid is the main way Americans pay for long-term nursing home care. If you qualify, Medicaid pays the nursing home’s daily rate at a Medicaid-certified facility, and you contribute most of your monthly income toward the cost, keeping a small personal needs allowance. To qualify, you generally need to meet your state’s medical need standard, have limited countable assets (often about $2,000 for a single person) and have income under your state’s limit or use an approved way to spend down extra income.

Quick answer: Medicare doesn’t pay for long-term custodial nursing home care; it covers only short skilled nursing facility stays after a qualifying hospital stay. Medicaid fills that gap. Married couples have special protections so the spouse at home isn’t impoverished. For 2026, CMS sets the community spouse resource allowance between $32,532 and $162,660, and home equity limits between $752,000 and $1,130,000, depending on the state.

Medicaid vs. Medicare for nursing home care

Medicare figures: CMS 2026 premiums and deductibles. Many people use both: Medicare for a rehab stay after a hospitalization, then Medicaid if they need to stay long term.

How to qualify for Medicaid nursing home care

1. Medical need

Your state must find that you need a nursing home level of care, usually through an assessment of your health and ability to manage daily activities such as bathing, dressing, eating and moving around.

2. Asset limits

Most states follow or build on the SSI resource standard of $2,000 for an individual and $3,000 for a couple in 2026 (CMS), though some states set different limits. Countable assets typically include cash, bank accounts and investments. Your home (up to the state’s equity limit, or if a spouse or dependent lives there), one car, personal belongings and certain burial funds are usually exempt.

3. Income limits

States handle income in one of two main ways. Many use a special income limit of up to 300% of the SSI federal benefit rate, which is $2,982 a month in 2026 (three times the $994 SSI rate). In those states, people with higher income may be able to qualify by putting the excess into a qualified income trust, often called a Miller trust. Other states use a medically needy approach, where your nursing home costs are subtracted from your income. See how the Medicaid spend down works.

What you pay: patient liability and personal needs allowance

Once you’re on Medicaid in a nursing home, most of your monthly income, such as Social Security and pensions, goes to the facility as your share of cost, sometimes called patient liability. Medicaid pays the rest of the Medicaid rate. Before that, you keep:

• A personal needs allowance for clothing, haircuts and other personal items. Federal law sets a minimum of $30 a month, and most states set a higher amount.
• Health insurance premiums, such as your Medicare Part B premium, in many states. Medicaid often pays the Part B premium for nursing home residents who qualify.
• An allowance for a spouse at home, if needed, as described below.

Protections for a spouse at home (2026)

Spousal impoverishment rules let the spouse who stays at home, called the community spouse, keep a share of the couple’s assets and receive part of the nursing home spouse’s income. CMS published these 2026 standards (CMS Informational Bulletin, April 27, 2026):

Alaska and Hawaii have higher minimum maintenance allowances ($3,381.25 and $3,111.25). Each state picks its own figures within the federal limits. Starting in 2028, the 2025 federal budget law caps the home equity limit at $1 million for most applicants. Read what the 2025 Medicaid changes mean.

The five-year look-back rule

Medicaid reviews asset transfers made in the five years before you apply. According to Medicaid.gov, people who need long-term services “will be denied LTSS coverage if they have transferred assets for less than fair market value during the five-year period preceding their Medicaid application.” Gifts to family, selling a house below market value or moving money into some trusts can create a penalty period. For a state example, see the New Jersey Medicaid look-back period, and talk with an elder law attorney before transferring assets.

How to apply for Medicaid nursing home care

1. Contact your state Medicaid agency or the nursing home’s business office. Many facilities help residents apply. See how to find your state’s Medicaid portal.
2. Gather documents: ID, proof of income, five years of bank and financial statements, property records, insurance policies and burial contracts.
3. Complete the level-of-care assessment arranged by your state.
4. Respond quickly to requests for more information.
5. Ask about retroactive coverage for recent months. Starting in 2027, retroactive coverage is shorter for new applicants.

While an application is processing, a resident may be “Medicaid pending.” Our guide to pending Medicaid explains what that means for families and facilities.

Choosing a Medicaid nursing home

• Confirm the facility is certified for Medicaid and has Medicaid beds available.
• Compare inspection results, staffing and quality ratings on Medicare Care Compare.
• Ask whether residents who start as private pay can stay after switching to Medicaid.
• If you’re in New York, see NY Medicaid long-term care plans; in Louisiana, see Louisiana Medicaid long-term care support.

Keeping Medicaid in a nursing home

Residents still need to renew Medicaid, usually once a year. Missing renewal paperwork can lead to a loss of coverage and a bill from the facility. See Medicaid renewal and redetermination. If you also have Medicare, read about dual eligibility.

Frequently asked questions

Does Medicaid pay for nursing home care?

Yes. Medicaid covers long-term nursing home care at Medicaid-certified facilities for people who meet medical need, income and asset rules.

How much does a nursing home cost with Medicaid?

You generally pay most of your monthly income toward your care, minus a personal needs allowance and certain deductions. Medicaid pays the remainder.

Can I keep my house if I go on Medicaid?

Often, yes, especially if a spouse or dependent lives there or your equity is under your state’s limit ($752,000 to $1,130,000 in 2026). States may seek repayment from your estate after death through estate recovery.

What is the income limit for Medicaid nursing home care?

Many states use up to $2,982 a month in 2026 (300% of the SSI benefit rate), with a qualified income trust option for higher incomes. Other states use a spend down. Check your state’s rules.

Does Medicare pay for nursing homes?

Only for short-term skilled care after a qualifying hospital stay, up to 100 days per benefit period. It doesn’t cover long-term custodial care.

This article is general information, not legal or financial advice. Rules vary by state. Medicare365 is not affiliated with or endorsed by CMS, any state Medicaid agency or any U.S. government agency.

Official sources

• CMS: Updated 2026 SSI and spousal impoverishment standards
• Medicaid.gov: Eligibility policy
• CMS: 2026 Medicare Parts A and B premiums and deductibles
• Medicare.gov: Care Compare