What is Medicaid Pending?
Medicaid Pending – Quick Facts
You’ve applied for Medicaid but haven’t received approval or denial yet.
Some nursing homes and care providers will start services during this period.
Residents usually pay most of their income, keeping only a small allowance.
States generally have 45–90 days to process applications.
If denied, the nursing home may try to collect unpaid costs from you or your family.
A Medicaid Planner can improve your approval chances and avoid costly delays.
What Does “Medicaid Pending” Mean and Why Is It Important?
“Medicaid Pending” is the status given to applicants who have submitted their Medicaid application but are still waiting for a decision. Many seniors in this phase already need long-term care but can’t afford the full cost out of pocket. This waiting period can be stressful and financially challenging.
Some nursing homes, assisted living facilities, and in-home care providers agree to start care for Medicaid Pending applicants, expecting that Medicaid will later approve the application and pay retroactively from the filing date. In these cases, residents are not billed for services covered under Medicaid—though assisted living room and board is never paid by Medicaid.
Note: Medicaid Pending is different from Retroactive Medicaid, which can cover up to three months of care before the application date if eligibility is later confirmed.
Who Pays the Nursing Home During Medicaid Pending?
While waiting for Medicaid approval, the state doesn’t pay the nursing home. Instead, residents contribute most of their income toward their care, keeping only a small Personal Needs Allowance (PNA). This amount varies by state—for example:
- California: $35/month
- Texas: $75/month
- Florida: $160/month
Health insurance premiums, like Medicare, may also be deducted from income before payment to the facility.
If the applicant is married and their spouse isn’t applying for Medicaid, some income can be transferred to them through the Monthly Maintenance Needs Allowance—up to $3,948/month in most states (2025).
Families should avoid paying the full nursing home bill during this period; if Medicaid approves the application, the facility will be paid by Medicaid, not reimbursing family members.
How to Find Nursing Homes That Accept Medicaid Pending Residents
Not every nursing home will accept residents in Medicaid Pending status. Some states even require you to already be living in a Medicaid-certified nursing home before applying (e.g., Georgia requires 30 days’ residence).
To find a facility that accepts Medicaid Pending:
- Make a list of local Medicaid-approved nursing homes.
- Call each one to ask if they take Medicaid Pending residents.
- Submit your Medicaid application and supporting documents directly to the facility to speed the process.
Be aware that many nursing homes have limited Medicaid-funded beds, and availability can change quickly.
How Long Does Medicaid Approval Take?
Federal guidelines require Medicaid agencies to decide on applications within:
- 45 days for most applications
- 90 days if a disability determination is needed
The total time can be longer due to document gathering, functional assessments, or errors in the application. Missing paperwork or mistakes can cause delays or denials—though some denials can be reversed with corrections, and others can be appealed.
Why Professional Help Can Make a Difference
Applying for Medicaid is complex—especially for married applicants or those close to the income or asset limits. Medicaid Planners and Elder Law Attorneys can help ensure your application is accurate and complete, greatly increasing your chances of approval and reducing wait times.
