Unlike Medicare, Medicaid covers long-term nursing home care. Here's what it pays for and who qualifies.
What does Medicaid cover in a nursing home?
For eligible seniors, Medicaid covers the full cost of nursing home care — room and board, nursing services, personal care, meals, and most medications — in a Medicaid-certified facility. It is the nation's primary payer of long-term custodial care, financing care for the majority of nursing home residents. In exchange, residents generally must contribute nearly all of their monthly income (Social Security, pensions) toward the cost, keeping only a small personal-needs allowance set by their state. Medicaid then pays the remaining balance directly to the facility. Because Medicaid is administered by states, exact rules and covered services vary. Call 1-800-MEDIGAP (1-800-633-4427) to understand your state's coverage.
Who qualifies for Medicaid nursing home coverage?
Medicaid nursing home eligibility has two parts: financial and medical. Financially, you must meet your state's income limit and asset limit — typically around $2,000 in countable assets for an individual, though a home, one vehicle, and certain other assets are usually exempt. Spouses of nursing home residents are protected by 'spousal impoverishment' rules that let the community spouse keep a portion of assets and income. Medically, you must require a nursing-home level of care. Many families legally 'spend down' excess assets to qualify. A five-year look-back period reviews asset transfers, so early planning matters. Call 1-800-MEDIGAP for free help navigating qualification.