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Medicaid Nursing Home Cost: What Residents Pay (2026-2027)

By Modinul Islam Khan Updated November 9, 2026

Reviewed November 9, 2026. Your Medicaid nursing home cost is set by your income, not by the facility’s price. Once Medicaid covers your stay, you pay a monthly “patient liability” (also called share of cost), which is most of your income minus a personal needs allowance and a few other allowed deductions, and Medicaid pays the rest of the Medicaid rate. The federal minimum personal needs allowance is $30 a month, and states can set more.

Quick answer: Take your monthly income, subtract your state’s personal needs allowance, any income allowance for a spouse or family at home, and health insurance premiums or medical costs Medicaid doesn’t pay. What’s left goes to the nursing home each month. Under the 2026 federal standards (CMS had not published 2027 standards as of November 9, 2026), a spouse at home can receive part of your income so their own monthly income reaches at least $2,705 in most states, up to a cap of $4,066.50.

This page covers what residents pay. For who qualifies and how to apply, see our main guide to Medicaid for nursing home care.

How Medicaid nursing home cost is calculated each month

After you qualify, your state runs a calculation called the post-eligibility treatment of income. Federal rules (42 CFR 435.725 and 435.832) tell states to start with your total income, including income that was disregarded when they checked eligibility, and subtract these amounts in order:

Personal needs allowance (PNA). Money you keep for clothing and other personal needs. The federal minimum is $30 a month for an aged, blind or disabled individual and $60 a month for an institutionalized couple whose income is considered available to each other. Many states set a higher amount.
An income allowance for a spouse at home. If your husband or wife still lives in the community, the spousal impoverishment rules let part of your income go to them (see the 2026 figures below).
An allowance for other family at home, such as a dependent child, adjusted for family size.
Medical expenses no one else pays, including Medicare and other health insurance premiums, deductibles and coinsurance, plus necessary care your state recognizes but its Medicaid plan doesn’t cover, within limits the state sets.

Whatever remains is your patient liability. You pay it to the nursing home each month, and Medicaid pays the facility the rest of its Medicaid rate. States may also allow a home maintenance allowance for up to 6 months if a doctor certifies you’re likely to return home. Your state sends a notice with your amount.

Example: patient liability for a single resident

These numbers are hypothetical; your state’s allowance and deductions will differ.

Step (hypothetical example)	Monthly amount
Social Security and pension income	$2,100
Minus personal needs allowance (example state amount)	– $50
Minus a private health insurance premium Medicaid doesn’t pay	– $150
Patient liability paid to the nursing home	$1,900
Medicaid pays	The facility’s Medicaid rate minus $1,900

Example: patient liability with a spouse at home

Hypothetical: the resident has $3,000 a month, the spouse at home has $1,200 of their own income, the personal needs allowance is $50, and the state uses the 2026 federal minimum maintenance needs allowance of $2,705.

Step (hypothetical example)	Monthly amount
Resident’s income	$3,000
Minus personal needs allowance	– $50
Minus spouse’s income allowance ($2,705 minimum needs minus spouse’s own $1,200 income)	– $1,505
Patient liability paid to the nursing home	$1,445

If the spouse has high housing costs, the allowance can be larger, but generally not above the federal maximum. Ask your state for its worksheet.

Spousal allowances that lower what you pay (2026 figures)

Spousal impoverishment rules protect the spouse at home (the “community spouse”). For your cost, the income allowance matters most: every dollar shifted to the spouse is a dollar you don’t pay the nursing home. CMS set these figures in its Updated 2026 SSI and Spousal Impoverishment Standards bulletin (April 27, 2026). As of November 9, 2026, CMS has not published 2027 standards, so these remain the current federal figures.

2026 federal standard (CMS)	Amount	Effective
Minimum monthly maintenance needs allowance, all states except Alaska and Hawaii	$2,705.00	July 1, 2026
Minimum monthly maintenance needs allowance, Alaska / Hawaii	$3,381.25 / $3,111.25	July 1, 2026
Maximum monthly maintenance needs allowance	$4,066.50	January 1, 2026
Community spouse resource allowance (assets the spouse keeps), range	$32,532 to $162,660	January 1, 2026

The resource allowance is the share of the couple’s countable assets the spouse at home keeps; it affects whether you qualify rather than your monthly payment. A separate family allowance applies if other family members live in the household. Each state picks its own figures within the federal limits. Home equity limits and other asset rules are covered in our nursing home Medicaid guide.

What Medicare pays for a nursing home stay (2026)

Medicare Part A covers short-term skilled nursing facility (SNF) care, not long-term custodial care. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first; the day you leave doesn’t count, and time under observation or in the emergency room doesn’t count either. Here’s what you pay per benefit period in 2026 under Original Medicare, according to Medicare.gov and CMS:

Days in a benefit period	What you pay in 2026 (Original Medicare)
Days 1-20	$0 each day, after the $1,736 Part A deductible (not owed again if you already paid it for the hospital stay in the same benefit period)
Days 21-100	$217 each day
Day 101 and beyond	All costs

As of November 9, 2026, CMS has not published 2027 Part A amounts, so these 2026 figures apply until it does. Medicare Advantage plans may charge different SNF copayments, even in the first 20 days; check your plan’s Evidence of Coverage. Many residents move to Medicaid after Medicare-covered rehab ends; see Medicaid vs. Medicare.

What the Medicaid rate covers, and extras you can be charged

Under 42 CFR 483.10, a facility can’t charge your personal funds for services included in the Medicaid payment: nursing, food and nutrition, activities, room and bed maintenance, routine hygiene items (such as toiletries, incontinence supplies and basic laundry) and medically related social services.

A facility may charge for extras only if you specifically ask for them, they aren’t needed for your care plan, Medicaid doesn’t pay, and the facility tells you about the charge and its amount, orally and in writing. Examples include:

A private room, unless it’s therapeutically required (for example, isolation for infection control)
Phone, TV, radio or personal electronics for personal use
Cosmetic and grooming services beyond what Medicaid pays for
Personal clothing, gifts, outside social events and privately hired nurses or aides
Special food you request in place of facility meals (food and supplements a doctor orders can’t be charged)

These extras usually come out of your personal needs allowance. A facility can’t require you to buy them as a condition of admission or continued stay, and it must tell you in writing at least 60 days before changing what it charges for them.

Private-pay rate vs. Medicaid rate

Nursing homes charge private-pay residents their own daily rate. Once you qualify for Medicaid, the facility is paid the rate your state Medicaid program pays, and your share is limited to your patient liability.

Federal rules (42 CFR 483.15) also limit what families can be asked to pay. A nursing home can’t require a third party, such as an adult child, to guarantee payment as a condition of admission or continued stay. For a Medicaid-eligible resident, it also can’t require a gift, money or donation as a precondition of admission or continued stay beyond what the state plan requires.

Many residents pay privately first, then apply when savings run low. Ask before move-in whether the facility is Medicaid-certified and whether you can keep your room after switching. While an application is processing, see our guide to Medicaid pending status for families and nursing homes. If the main need is dementia care, compare costs in our guide to memory care facilities that accept Medicaid.

Asset transfers and penalty periods: the cost of giving money away

Medicaid.gov explains that people who need long-term services are denied that coverage if they gave away assets for less than fair market value during the five years before applying. CMS guidance sets this look-back at 60 months for transfers made on or after February 8, 2006.

According to CMS, the penalty length in months equals the value of assets transferred during the look-back period divided by your state’s average monthly private-pay cost of nursing facility care. States can’t round down, so partial months count. The penalty starts on the later of the month of the transfer or the date you’re otherwise eligible and receiving nursing home level care, and once it starts it keeps running. During the penalty, you or your family pay the private rate. Legitimate ways to spend down are covered in our Medicaid spend down guide. Talk with an elder law attorney before transferring assets.

Estate recovery: costs after death

According to Medicaid.gov, states must seek recovery from the estates of enrollees age 55 or older for nursing facility services, home and community-based services, and related hospital and prescription drug services. Key protections:

States may not recover from the estate of an enrollee who is survived by a spouse, a child under 21, or a blind or disabled child of any age.
States must have procedures to waive recovery when it would cause an undue hardship.
During the lifetime of a resident who is permanently institutionalized, a state may place a lien on the home, but not if a spouse, a child under 21, a blind or disabled child, or a sibling with an equity interest lives there. The lien must be removed if the resident is discharged and returns home.

Rules differ by state, so ask your state Medicaid agency for its rules in writing.

Keeping your cost correct over time

Read every patient liability notice. Check your income, premiums and spousal allowance, and report income or premium changes. If something’s wrong, use the appeal rights on the notice.
Renew on time. Missing Medicaid renewal paperwork can end coverage and leave you owing the private rate.
Get free counseling. Your State Health Insurance Assistance Program (SHIP) gives unbiased one-on-one help with Medicare and Medicaid costs. Find yours at shiphelp.org.

Frequently asked questions

How much does a nursing home cost with Medicaid?

You pay your patient liability: monthly income minus the personal needs allowance, any spouse or family allowance, and uncovered medical costs such as insurance premiums. Medicaid pays the rest. The amount depends on your income and state rules, not the facility’s private price.

What is the personal needs allowance for nursing home residents?

It’s the income you keep for personal items. Federal rules require at least $30 a month for an individual ($60 for an institutionalized couple), and states can set more. Check your state Medicaid agency for its figure.

Can my spouse at home keep some of my income?

Yes, if their own income is below your state’s maintenance needs allowance. Under the 2026 federal standards, the minimum is $2,705 a month in most states (from July 1, 2026) and the maximum is $4,066.50. The amount shifted to your spouse is subtracted before your patient liability is set. CMS had not released 2027 figures as of November 9, 2026.

Can a nursing home make my children pay?

A certified nursing home can’t require a third-party guarantee of payment as a condition of admission or continued stay. A family member with legal access to your money may sign to pay from your funds without becoming personally liable. Read any admission agreement before signing.

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