Medicaid Pending: What It Means and What to Do

“Medicaid pending” is the period after a Long-Term Care Medicaid application has been filed but before the state makes a decision. For a nursing home resident, it can be a tense time. The resident is receiving care, the bill is growing, and no one yet knows whether, or from what date, Medicaid will pay. This guide explains how the pending period works, what nursing homes can and cannot do, what families should pay in the meantime, and how to keep the application moving.

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

What “Medicaid pending” means

When a nursing home says a resident is “Medicaid pending,” it means an application has been filed and the facility is waiting for a decision. Many nursing homes admit people as Medicaid pending, or allow a private-pay or Medicare resident to switch to Medicaid pending, if they believe the person is likely to qualify. If the application is approved, Medicaid pays the facility for covered care back to the eligibility date, and the facility refunds or credits anything the resident paid above the amount they owed. If it is denied, the resident may owe the facility the private rate for the pending months.

How long it lasts

Federal rules require states to decide most applications within 45 days, or within 90 days when eligibility depends on a disability decision. In practice, long-term care applications often take longer, because of verification requests, missing documents and questions about transfers. A pending period of two to four months is common, and complicated cases can last longer. See How long approval takes.

Protections during the pending period

Residents of Medicaid-certified nursing homes have federal protections that matter during this period:

A facility may not require a third-party guarantee of payment as a condition of admission or continued stay. A family member who signs as a “responsible party” generally agrees to use the resident’s money to pay, not their own.
A facility may not require a resident to waive the right to Medicaid or to promise to stay private pay for a set time.
A resident may not be discharged for nonpayment while a Medicaid application is pending in most situations. Federal rules treat a resident as not having failed to pay if they have submitted the paperwork needed for Medicaid and the claim is pending. If the application is denied, nonpayment can become a basis for discharge, with written notice and appeal rights.
Discharges require 30 days’ written notice in most cases, with the right to appeal. See Nursing home discharges and evictions.

If a facility threatens to discharge a resident while an application is pending, the long-term care ombudsman program in the state can help at no cost.

What to pay while waiting

Families often ask whether they should pay the nursing home while the application is pending. Common approaches:

Pay the expected patient liability each month. Once approved, the resident will owe their monthly income minus allowed deductions (such as the personal needs allowance and health insurance premiums). Paying that amount during the pending months keeps the debt from piling up. See Patient liability.
Do not spend down below the limit on private-pay bills if that money could be spent in other allowed ways. Paying the full private rate during the pending period can use up money that might have been protected for a spouse or spent on allowed items. See Allowed spend-down.
Keep the personal needs allowance. The resident is entitled to keep a small monthly amount for personal needs.
Keep records of every payment.

If the resident pays more than the patient liability for months that Medicaid ends up covering, the facility should refund or credit the excess after approval.

Keeping the application moving

Respond to every request on time. Most denials during the pending period are for missing information.
Ask for an extension in writing if you need more time to get a document.
Keep a contact log with dates, names and what was discussed.
Ask the nursing home’s business office for a status update. Many facilities track pending applications and may have their own contact at the agency.
Check whether a decision is overdue. If the state has not decided within the required time and you have provided everything asked for, you may be able to request a fair hearing on the delay. See Fair hearings.

What can go wrong

A denial for missing verification. Often fixable by sending the document and reapplying, or by requesting a hearing.
A penalty for a transfer. If the state finds a gift in the look-back period, it may approve eligibility but impose a penalty period during which Medicaid will not pay for nursing home care. The resident may owe the facility for those months. This is one of the hardest situations for families; see Curing a transfer.
Assets slightly over the limit. Eligibility can be denied for a month when assets were even a little over the limit.
Income over the cap without a Miller trust. In income-cap states this causes a denial until a Miller trust is set up and funded.

Medicare and the pending period

Many residents enter a nursing home under Medicare Part A after a qualifying hospital stay. Medicare can pay for up to 100 days of skilled care per benefit period, with a daily coinsurance after day 20, but coverage often ends earlier when skilled care is no longer needed. Filing the Medicaid application during the Medicare period means the pending period runs while Medicare is still paying, which reduces the private-pay gap. Medicaid can also help with the Medicare coinsurance for eligible residents. See Medicaid vs. Medicare.

Questions to ask the nursing home’s business office

Has the facility received a copy of the application and any notices from the state?
What monthly amount does the facility expect us to pay while the application is pending?
Who at the facility follows up with the Medicaid office, and how will they share updates with us?
If the resident paid more than the final patient liability, how and when will the excess be refunded?
Will the resident keep the same room after Medicaid approval?
What happens if the application is denied or a penalty period is imposed?

Ask for important answers in writing, and keep copies of every bill and statement from the facility.

A month-by-month example

James enters a nursing home on March 10 after a hospital stay, and Medicare pays for skilled care through April 15. His daughter files a Medicaid application on April 2. The state sends a verification request on April 20, and she responds on April 28. A second request about a 2022 withdrawal arrives on May 25; she sends an explanation with receipts on June 3. The state approves James on June 30, with coverage starting April 16, the day after Medicare stopped paying. His patient liability is set at $1,850 a month.

Because his daughter paid the facility $1,850 for each pending month instead of the private rate, the family owes little when the decision arrives, and James’s remaining savings, already at the limit, were not used up on private-pay bills. Had she waited until June to apply, retroactive coverage might still have reached back, but the risk of a gap would have been greater, and the stress of an unpaid balance would have lasted longer.

If the resident dies while the application is pending

An application does not necessarily end when the applicant dies. In many states, the person’s representative or the executor can continue the application so that Medicaid pays for covered months before death, which may resolve the nursing home’s bill. Tell the caseworker promptly and ask what is needed to continue the case. Be aware that once benefits are paid, the state may later seek repayment from the estate under estate recovery.

Getting experienced help

The pending period is when many costly mistakes happen: a spouse pays the full private rate out of savings that could have been protected, or a deadline is missed while the family is busy with care decisions. A Certified Medicaid Planner can handle verification requests, explain what to pay the facility, and help resolve transfer questions. As a rough guide, published fees for help with an application range from about $500 to $6,000, full planning from about $2,500 to $15,000 or more, and hourly help from about $150 to $600.

Frequently asked questions

Can a nursing home refuse a Medicaid pending resident? A facility may decide how many Medicaid beds it has and may decline new admissions it does not expect to be paid for. Once someone is a resident, the protections above apply. See Can nursing homes refuse Medicaid residents?.

Can the facility require us to pay privately first? A certified facility may not require a resident to remain private pay for a set period as a condition of admission. See Can a nursing home require private pay before Medicaid?.

Will we get money back after approval? If the resident paid more than the patient liability for months Medicaid covers, the excess should be refunded or credited.

What if the application is denied? Read the notice, note the appeal deadline and act quickly. See Denied? What to do next.

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