Does Medicaid cover nursing home?
Yes — nursing facility care is a mandatory Medicaid benefit, room and board included, once you meet your state's long-term-care financial limits and a nursing-facility level-of-care standard.
What flips the answer
- Covered when
You meet your state's long-term-care financial limits and the nursing-facility level-of-care standard, in a Medicaid-certified facility — covered, room and board included.
- Not covered when
Your income/assets exceed the long-term-care limits (until spend-down or qualified planning), or an asset transfer falls within the look-back period.
- Not covered when
You don't meet the nursing-facility level-of-care standard, or the home isn't Medicaid-certified.
Medicaid is the primary payer of long-term nursing home care in the U.S. Nursing facility services are a mandatory benefit, and — unlike Medicare — Medicaid pays for ongoing custodial care, including the room-and-board cost, once you qualify.
Eligibility has two parts. Financially, you must fall within your state's long-term-care Medicaid income and asset limits, which are stricter than regular Medicaid and come with spousal-impoverishment protections for a married applicant's spouse and a look-back period on gifted or transferred assets. Functionally, a screening must confirm you need a nursing-facility level of care.
After approval, most of your monthly income is directed to the facility as a 'patient pay amount' (you keep a small personal-needs allowance) and Medicaid covers the remaining cost. The facility must be Medicaid-certified.
Long-term-care income/asset limits, spousal-impoverishment rules, and level-of-care screening vary by state within federal guidelines.
How to actually get it covered
- 1
Verify you meet your state's long-term-care Medicaid income and asset limits.
- 2
Complete a level-of-care assessment confirming you need nursing-facility care.
- 3
Select a Medicaid-certified nursing home.
- 4
Apply for long-term-care Medicaid; expect an asset look-back review of past transfers.
- 5
Once approved, most income becomes a monthly patient-pay amount and Medicaid pays the balance.
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