Applying for Nursing Home Medicaid

Most families apply for nursing home Medicaid under pressure. A parent has had a fall or a stroke, the hospital wants to discharge, Medicare’s short-term coverage is running out, and the nursing home’s business office is asking how the bill will be paid. This guide explains how a nursing home Medicaid application works from start to finish, what is different about it compared with other kinds of Medicaid, and how to avoid the mistakes that cause delays, penalties and unpaid bills. It is general education. Your state guide explains the forms and offices used where you live.

Figures change periodically. Double-check current amounts before relying on them.

How nursing home Medicaid differs from other Medicaid

Nursing home Medicaid (sometimes called “institutional Medicaid”) is a required benefit in every state. That has three practical consequences:

There is no waiting list. If the person meets the medical and financial rules and lives in a Medicaid-certified nursing facility, the state must pay. This is different from most home and community-based waivers, which often have enrollment caps.
The financial rules are stricter than for ordinary health coverage. Assets are counted, the five-year look-back applies, and most of the resident’s income goes to the nursing home each month as the patient liability.
There are special protections for a spouse at home. The spousal impoverishment rules let the spouse at home keep a share of the couple’s assets and a monthly income allowance.

When to apply

The best time to apply is usually as soon as the person is in the nursing home (or about to be) and is close to meeting the asset limit. A few points shape the timing:

Medicare may pay first. After a qualifying hospital stay of at least three days as an inpatient, Medicare Part A can pay for up to 100 days of skilled nursing care per benefit period, with full coverage for days 1 to 20 and a daily coinsurance for days 21 to 100. Medicare stops paying when the person no longer needs daily skilled care, which can happen well before day 100. Families should plan the Medicaid application during the Medicare period, not after it ends.
Retroactive coverage can reach back. In most states Medicaid can pay for care in the three months before the application month if the person was eligible in those months. For applications filed on or after January 1, 2027, federal law shortens this window to two months for most older and disabled applicants. See Retroactive coverage.
Assets must be at or below the limit on the right date. Eligibility is generally tested as of the first moment of the month (or another point set by state rules). Applying in a month when the account balance is $500 over the limit can mean a denial for that month.
For married couples, the “snapshot” date matters. The state looks at the couple’s combined assets as of the first day of the first continuous period of institutionalization (expected to last at least 30 days). That snapshot sets the spouse at home’s share. See The snapshot date.

Step 1: Confirm the facility accepts Medicaid

A nursing home must be certified to take Medicaid, and some facilities have only a limited number of Medicaid beds. Ask the admissions or business office:

Is the facility Medicaid-certified, and is the person’s bed in a certified section?
Will the person be able to stay in the same bed or room after switching from private pay or Medicare to Medicaid?
What does the facility need from the family during the Medicaid pending period?

Federal rules protect residents in certified facilities. A facility may not require a third-party guarantee of payment as a condition of admission, and it may not require a resident to give up the right to apply for Medicaid. A family member who signs as a “responsible party” generally is agreeing to use the resident’s money to pay the bill, not to pay from their own pocket. Read the admission agreement carefully. See Getting into a Medicaid nursing home.

Step 2: Check the medical rule

The person must need a nursing-home level of care. In most states this is decided through a level-of-care assessment that looks at help needed with activities of daily living (bathing, dressing, eating, toileting, transferring and continence), skilled nursing needs, and supervision needed because of dementia or other cognitive impairment. A federal pre-admission screening (PASRR) is also required for anyone entering a Medicaid-certified nursing home, to identify serious mental illness or intellectual disability. See Nursing home level of care.

Step 3: Check the money rules

Nursing home Medicaid uses three money tests.

Income. About half the states use an income cap, often 300 percent of the federal SSI benefit, which is $2,982 a month in 2026. People over the cap in those states usually need a Qualified Income (Miller) Trust. Other states use a “medically needy” approach in which the person qualifies if the nursing home bill is higher than their income. Either way, once approved, most income goes toward the cost of care. See Income limits by state.

Assets. A single applicant can usually keep about $2,000 in countable assets, though some states set higher limits. The home is often exempt while the person intends to return or a spouse or certain relatives live there. One vehicle, personal belongings, an irrevocable prepaid funeral plan and certain other items are usually exempt. See Exempt assets and Asset limits by state.

Transfers. Gifts or sales for less than fair value in the 60 months before the application (in most states) can cause a penalty period, a stretch of time when Medicaid will not pay for nursing home care even though the person is otherwise eligible.

Step 4: Spend down the right way

If countable assets are above the limit, the extra must be spent or converted before Medicaid will pay. There is a right way and a wrong way to do this. Paying the nursing home privately is allowed but often wasteful. Other allowed uses can include paying off debts, buying an irrevocable prepaid funeral plan, making repairs or improvements to an exempt home, buying a needed vehicle or medical equipment, and, for married couples, steps that protect more for the spouse at home. Gifts to family members during this period are the most common and expensive mistake. See Allowed spend-down.

Step 5: Gather documents

Caseworkers verify everything. Expect requests for identity papers, proof of income, statements for every account, information about life insurance and funeral plans, deeds, vehicle titles, and records of large withdrawals or transfers in the look-back period. Many states ask for 60 months of bank statements; some ask for fewer at first and more if something looks unusual. See the Application documents checklist and How Medicaid verifies income and assets.

Step 6: File the application

Depending on the state, you may apply online, on paper, by phone or in person at a county or regional office. Nursing home staff sometimes help file. Some states use a separate long-term care form or a supplement to the general application. Key points:

File as soon as you can sign a complete enough form. You can send missing documents afterward. The filing date protects the earliest possible coverage date.
Answer every question. Leaving a question blank causes delays. “Unknown” with an explanation is better than a blank.
Report every account and transfer. Applications are signed under penalty of perjury. Leaving something off can cause a denial, a fraud referral or later recovery of benefits.
Keep copies and proof of filing. Write down the date, the case number and the name of anyone you speak with.

Step 7: Respond to verification requests

After filing, the state usually sends a written request for more information, often with a deadline of about 10 days (some states allow more). Missing a deadline is one of the most common reasons for denial. If you cannot get a document in time, ask in writing for an extension before the deadline and explain what you are doing to get it. Some states schedule an interview by phone or in person.

Step 8: The decision and the patient liability

If approved, the notice should show the coverage start date and the monthly amount the resident must pay the nursing home (the patient liability, also called share of cost or resident liability). That amount is the resident’s income minus allowed deductions such as the personal needs allowance, health insurance premiums and, for married residents, the spousal income allowance. Check the math. Errors are common, and a wrong figure can cost hundreds of dollars a month.

If denied, read the notice for the reason and the appeal deadline. See Denied? What to do next and Fair hearings and appeals.

Married couples: extra steps

When one spouse enters a nursing home and the other stays at home, the application involves more work:

Both spouses’ assets are counted at the start, no matter whose name is on the account.
The spouse at home keeps a share called the community spouse resource allowance (CSRA). After approval, assets above the applicant’s own limit must be moved into the spouse at home’s name within the time the state allows.
The spouse at home may receive part of the applicant’s income if their own income is below the minimum allowance.
There are ways to raise the allowances through a fair hearing or court order in some situations. See Raising the allowances.

Married-couple applications are where planning before filing often protects the most.

Common problems and how to avoid them

The nursing home bill piles up while the application is pending. Keep paying the expected patient liability amount each month if you can, so the debt does not grow. Ask the business office to note in writing that an application is pending.
A gift is discovered during review. A gift made years ago to help a grandchild, or a parent’s habit of writing monthly checks to a child, may count as a transfer. Gather the facts and an explanation early. Some transfers are exempt or can be undone; see Curing a transfer and Exempt transfers.
Income is just over the cap. In an income-cap state, even a dollar over can mean a denial without a properly set up and funded Miller trust.
The power of attorney does not allow needed steps. Older documents may not permit gifts, trust funding or Medicaid planning. See Powers of attorney.
No one is authorized to act. If the person cannot sign and there is no power of attorney, use the state’s authorized representative form or ask about guardianship.

Getting experienced help

Nursing home applications are among the most complex Medicaid applications, and the money at stake is large: in many states a single month of nursing home care costs more than $9,000. Experienced help is especially valuable when there is a spouse at home, gifts or transfers in the past five years, a home or business, a trust or annuity, income over the cap, or a prior denial. A Certified Medicaid Planner can review the situation before filing, explain which assets are protected, plan an allowed spend-down and handle verification requests. As a rough guide, published fees for help preparing and filing an application range from about $500 to $6,000, full planning plus the application from about $2,500 to $15,000 or more, and hourly rates from about $150 to $600. Free help with paperwork is available from the state Medicaid agency, the nursing home’s business office and the free Medicare counseling program in your state (SHIP), though these generally do not give planning advice. See Questions to ask before paying anyone for help.

Frequently asked questions

Can the nursing home apply for us? Many nursing homes help residents apply, and in many states a staff member can act as an authorized representative. Remember that the facility’s interest is getting paid. It may not advise on protecting assets for a spouse or handling past gifts.

Does the person have to be in the nursing home before applying? In general, nursing home Medicaid is for people who live in a nursing facility or are about to be admitted. Home care is applied for through a waiver or other community program.

What happens to the house? The home is often exempt while the person intends to return home or a spouse or dependent relative lives there, subject to a home equity limit. The state may later seek repayment from the estate. See Your home and Medicaid and Estate recovery.

Can we apply if we are still over the asset limit? You can, but the application will be denied for months when assets are over the limit. It is usually better to complete an allowed spend-down first, or to file in the month when assets will be at the limit.

What if Medicare is still paying? Applying while Medicare is paying is common. Medicaid can cover the daily coinsurance for days 21 to 100 for eligible residents and take over fully when Medicare stops.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.