Does Medicaid pay for nursing home care?

How eligibility works

Medicaid is a joint federal-state program, so the details differ in every state, but the structure is consistent:

• Medical need. The state must determine you require a nursing home level of care.
• Income. Most states cap monthly income; where income exceeds the cap, many states allow a qualified income trust (a "Miller trust") to bridge the gap. In practice, most of a resident's income then goes toward the cost of care, with a small personal needs allowance retained.
• Assets. Countable assets must fall below a low limit — commonly around a couple thousand dollars for an individual. Certain assets are typically not counted: a home under an equity limit while a spouse or dependent lives there, one vehicle, personal belongings, and prepaid burial arrangements.

Of the 14,693 certified nursing facilities in our records, the overwhelming majority are certified for both Medicare and Medicaid — but a minority accept only one. Facility pages show the certification on record.

The five-year lookback — what it really penalizes

When you apply, the state reviews the previous 60 months of financial transactions. Assets given away or sold below fair market value during that window trigger a penalty period: a span of ineligibility calculated by dividing the transferred amount by the state's average monthly nursing home cost.

Two points families get wrong:

• The penalty does not start when you made the gift. It starts when you would otherwise be eligible — meaning you are in the facility, out of money, and not covered.
• Ordinary generosity counts. Helping a grandchild with tuition four years ago is a transfer. Keep records of anything that could be mistaken for asset-shielding.

This is the area where an elder law attorney reliably pays for themselves. Planning done more than five years out has options; planning done in a hospital hallway has very few.

If one spouse stays at home

Federal spousal impoverishment rules exist so that the at-home spouse is not left destitute. They allow the community spouse to keep a share of the couple's countable assets up to a federal maximum, plus a minimum monthly income allowance — both adjusted annually. The home is generally protected while the community spouse lives there.

These protections are not automatic in practice: they must be claimed correctly on the application, and the numbers vary by state.

Estate recovery — the part nobody mentions

States are required to seek recovery from the estates of deceased Medicaid recipients who received long-term care, which in practice usually means a claim against the home after death. Some states limit recovery, and hardship waivers exist. Ask your state's Medicaid agency what its recovery policy is before assuming a house will pass to heirs intact.

Where to get help

Free, unbiased help exists and most families never use it: your State Health Insurance Assistance Program (SHIP) for Medicare questions, your Area Agency on Aging for local options, and the long-term care ombudsman for problems inside a facility. For asset planning, use a certified elder law attorney, not a free "Medicaid planning" seminar selling annuities.

Comparing facilities that accept Medicaid? Start with state records; for assisted living, see how Medicaid works in assisted living.

Common questions

Does Medicaid cover nursing home care?

Yes. Medicaid is the largest payer of long-term nursing home care in the US, covering care for residents who meet their state's medical and financial eligibility rules.

What is the Medicaid five-year lookback?

When you apply, the state reviews 60 months of financial records. Assets transferred for less than fair market value in that window create a penalty period of ineligibility, calculated from the amount transferred and the state's average nursing home cost.

Can Medicaid take the house?

Not while a spouse or dependent lives there, and generally not during the resident's lifetime. After death, states pursue estate recovery, which often means a claim against the home. Rules and hardship exceptions vary by state.

How much money can you keep and still qualify?

Countable assets must generally fall below a low limit, often around a couple thousand dollars for an individual, though several assets are excluded and a community spouse may keep a protected share. Limits change annually and differ by state.

Check a specific facility

Records for 14,693 nursing homes and 5,584 assisted living facilities: search by name or city · browse by state · by ownership group.