Health care at any level is expensive, but at the top of the list is nursing home care. The national annual median cost of care for a resident in a private room in a nursing home is now $127,750, according to Genworth and CareScout. A semi-private room clocks in at a similarly staggering $111,325 per year.
Footing the bill for nursing home costs is a financial challenge for most people.
“Nursing homes are one of most expensive levels of care, and most people don’t have that money,” says Amie Clark, a senior care expert and creator of AgingToday.com, a company specializing in geriatric care management and senior housing advisory.
There is, however, one option for older adults who don’t have the funds to pay for a nursing home: Medicaid.
[READ: Make the Most of a Nursing Home Visit]
Does Medicaid Cover Nursing Home Costs?
The short answer is yes. Medicaid, not to be confused with Medicare, is a federal health insurance program for low-income individuals, and it’s administered at the state level. Medicaid kicks in when there are no other options available to a senior who needs nursing home care.
“Medicaid was built to be the payer of last resort for people in poverty,” says Chris Orestis, a Maine-based senior care advocate and expert in retirement, long-term care and specialty senior living funding solutions.
Data from KFF, an independent source of health policy research, shows that Medicaid is the primary payer for nursing home care, covering 63% of nursing home residents.
[READ: Tips for Choosing a Good Nursing Home]
How to Get Medicaid to Pay for Nursing Home Care
Securing Medicaid coverage for nursing home care takes some effort, and requirements for eligibility can be complex. However, you may qualify for Medicaid nursing home care even if you previously have not been eligible for other Medicaid services.
Income requirements
Eligibility is usually based on modified adjusted gross income, or MAGI, which is your taxable income plus certain deductions, including nontaxable Social Security benefits, individual retirement contributions and tax-exempt interest. It’s usually the same or quite close to your adjusted taxable income that’s listed on your tax return.
Most states also have multiple Medicaid programs, each with different eligibility criteria. However, generally speaking, if you make less than 100% to 200% of the federal poverty level and are elderly, disabled or a parent/caretaker, for instance, you probably qualify for a Medicaid program.
If you make less than 133% of the federal poverty level, you’ll most likely qualify for a Medicaid program in your state. In 2025, the federal poverty level is $15,650 annually for a single person and $21,150 for a couple in all 48 contiguous states and the District of Columbia. In Alaska, the rates are $19,550 for a single person and $26,430 for a couple. In Hawaii, the rate is $17,990 for a single person and $24,320 for a couple.
Asset requirements
For a single person, your assets can’t be greater than one house, one car and $2,000 or less in all accounts combined. For a married couple, assets can’t exceed one house, one car and approximately $3,000 in all accounts.
If you have more than that, you likely won’t qualify for Medicaid benefits, unless you go through an involved spend-down process to reduce your assets, says Kelsey Simasko, an attorney with Simasko Law in Mount Clemens, Michigan.
It can be a challenging process, though, especially because the state will review your assets and income over the prior five years to evaluate your eligibility. This is called the “look back” period. If Medicaid determines that you moved some assets in violation of its rules, you may lose some or all of your nursing home coverage. So, it’s a good idea to work with an elder law attorney to make sure you’re doing it right.
Care requirements
Each state sets its own criteria for how much care you may need, a measure called Nursing Home Level of Care, or NHLOC. Assessment tools vary but typically focus on determining the individual’s physical functioning, cognitive ability and medical and behavioral health needs. People who don’t meet these criteria won’t qualify for nursing home coverage under Medicaid.
Medicaid-certified facilities
Medicaid-certified facilities accept payment from Medicaid. This is an important designation to look for when considering which facility is the right one for your needs, especially if you anticipate needing to rely on Medicaid for payment in the future.
Medicaid variability by state
Medicaid is a state-level program, meaning that each state has its own rules, requirements and coverage limitations. Below is an overview of what’s generally available in each state, according to the American Council on Aging.
[TABLE]
[Nursing Homes: A Guide for 2025]
How many nursing home residents use Medicaid
[TABLE]
Which Nursing Home Expenses Does Medicaid Cover?
Once you qualify, Medicaid will typically cover these costs:
— General health coverage
— Nursing services
— Room and board
— Rehabilitative services
— Pharmaceutical services
— Medical social services
— Meals
— Other care in an approved nursing home
Are There Limits to What Medicaid Covers?
Although Medicaid can be a lifeline for seniors in nursing homes, there are some limits to what it covers. For example, it doesn’t cover amenities or nonmedical services.
Medicaid also doesn’t pay for medical services rendered outside the nursing home, such as going to a doctor or a specialist’s office. Look to Medicare Part B to cover most of those costs.
Who Is Medicaid Nursing Home Coverage For?
Nursing home care is designed for individuals with medical conditions or physical disabilities that are too severe for them to live at home but not acute enough to require hospitalization.
In many cases, nursing home care involves rehabilitation services, such as physical therapy, occupational therapy and other services designed to help restore some level of mobility and independence.
Keep in mind, Medicaid should have no bearing on the quality of care you or your loved one receive.
“The people providing the care probably have no idea what the payer source is,” Clark says. “So once you’re in there, I don’t think it has any effect on the kind of care they give.”
Finding Nursing Home Facilities Accepting Medicaid
If you expect you might need to rely on Medicaid in the future, it’s best to find out whether that’s an option at any nursing home you might be considering. Not all nursing homes accept Medicaid payment, and those that do may limit the number of beds available, meaning you may get put on a waiting list until space opens up.
You can start your search for nursing homes that accept Medicaid via the compare tool on the Centers for Medicare and Medicaid’s website. Put in your location and filter by “Medicaid-certified” to see only facilities that accept Medicaid.
You can also look for the best nursing homes near you, whether you’ll be relying on Medicaid or not, with U.S. News’ Best Nursing Homes 2025 rating. U.S. News looked at almost 15,000 facilities throughout the country and rated them in two different areas: short-term rehabilitation and long-term care.
More from U.S. News
What Is Medicare’s Chronic Care Management Program?
The Value of Pet Ownership for Older Adults
How to Stay Active in Assisted Living
Does Medicaid Cover Nursing Homes? originally appeared on usnews.com
Update 05/05/25: This story was previously published at an earlier date and has been updated with new information.
