How Long Medicaid Approval Takes

“How long will this take?” is one of the first questions families ask after filing a Long-Term Care Medicaid application, and one of the hardest to answer. Federal rules set deadlines for states to decide applications, but long-term care applications often take longer because of verification, look-back reviews and medical assessments. This guide explains the deadlines, the real-world factors that speed up or slow down a decision, and what you can do if a decision is overdue.

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

The federal deadlines

Federal Medicaid rules require states to decide applications promptly and within set time limits:

45 days for most applications, including those based on age (65 or older);
90 days when eligibility depends on a disability determination.

The clock generally runs from the date the application is filed. States may go past these limits only in unusual circumstances, such as when the applicant delays providing information or an administrative emergency beyond the agency’s control occurs. Many states do not meet these deadlines for complex long-term care cases, but the deadlines matter because they give applicants a basis to ask for action.

What a typical timeline looks like

Stage	Typical time
Gathering documents before filing	1 to 6 weeks
Filing to first verification request	1 to 4 weeks
Responding to each request	10 days or so per request (deadline set by the state)
Additional requests and look-back review	2 to 8 weeks
Functional assessment (for waivers)	Can run in parallel; varies widely
Decision	Often 45 to 90 days from filing; complex cases longer

These are general ranges, not promises. A simple application from a single person with one bank account and no transfers may be decided in a few weeks. A married couple’s application with several accounts, a home, a trust and past gifts may take several months.

What makes applications faster

A complete application. Every question answered, every account listed, signed by the right person.
Documents sent up front. Including recent statements for every account and proof of income.
Quick, complete responses to every verification request.
Clear explanations of large withdrawals and transfers, with receipts.
One point of contact in the family who tracks deadlines and keeps copies.
A simple financial picture. Few accounts, no business, no trusts, no transfers.

What slows applications down

Missing documents. The single biggest cause of delay.
Transfers in the look-back period that need explanation or valuation.
Real estate other than the home, which may need an appraisal or proof of listing for sale.
Trusts and annuities, which the state must review to decide whether they count.
Married couples, because both spouses’ finances and the spousal allowances must be worked out.
Income over the cap in states that require a Miller trust.
Disputes about level of care or a delayed assessment.
Agency backlogs, which vary from county to county and season to season.
A change of caseworker in the middle of the review.

Nursing homes and waivers

For nursing home Medicaid, the decision is mainly financial once the level of care is confirmed. There is no waiting list, and once approved, coverage can reach back to the eligibility date, including retroactive months. See Retroactive coverage.

For waiver services, there may be three separate steps: the financial decision, the functional assessment and a waiver slot. Even after Medicaid financial approval, services may not start until a slot opens and a care plan is written. Waiting lists can add months or years in some states. See Applying for a waiver and Waiver waiting lists.

Can an application be expedited?

There is generally no formal “rush” process for Long-Term Care Medicaid, but some situations get priority:

a hospital discharge with nowhere safe to go;
a nursing home resident at risk of discharge;
adult protective services involvement;
serious risk to health or safety at home.

Ask the caseworker whether priority processing is available, and explain the situation in writing. See Can an application be expedited?.

If the decision is overdue

Check that you have sent everything requested. If something is outstanding, the delay may be counted against the applicant.
Contact the caseworker in writing. Ask for the status, any missing items and an expected decision date.
Ask for a supervisor if you do not receive a response.
Request a fair hearing on the delay. In most states, failure to act on an application with reasonable promptness is itself a ground for a hearing. A hearing request often prompts a decision. See Fair hearings and appeals.
Ask for help. The long-term care ombudsman program (for nursing home residents) and free legal aid programs may be able to help with an overdue case. See How free legal aid works.

What to do while you wait

Keep paying the expected patient liability to the nursing home, if possible. See Medicaid pending.
Avoid gifts or large transfers. They can cause a penalty even during the pending period.
Keep assets at or below the limit. If income builds up in a bank account during a long pending period, the balance can push the person over the limit.
Report changes. If income, assets or living arrangements change while the application is pending, tell the caseworker. See My finances changed while the application is pending.
Save every notice and envelope, since deadlines are often counted from the date on the notice.

A note on accumulated income

During a long pending period, a nursing home resident’s monthly income may build up in their bank account if it is not paid to the facility. Because assets are generally counted at the start of each month, that buildup can push the account over the asset limit. Paying the expected patient liability to the facility each month avoids this problem.

Questions to ask the caseworker

What is the status of the application, and what is still needed?
Was every document we sent received and accepted?
Is there a deadline for anything outstanding?
Is the case waiting on a medical or level-of-care decision?
Has a look-back review been completed, and are there questions about transfers?
What is the expected decision date?
Who should we contact if you are unavailable?

Write down the answers, the date and the person’s name. If an answer matters, follow up in writing.

Two example timelines

A simple case. Dorothy is widowed, has one checking account with $1,700, Social Security and a small pension, and no transfers in five years. Her son files on the day she enters the nursing home, attaching six months of statements, her award letters, her ID and Medicare card, and her prepaid funeral contract. The caseworker sends one request for the cash value of a small life insurance policy, which the son provides in four days. Dorothy is approved 32 days after filing.

A complex case. Ed and Mary are married. Ed enters a nursing home. They have three bank accounts, two IRAs, a rental property and a home, and over the past five years they gave each grandchild money for college. The application is filed in September. The state sends a first request in October for five years of statements and the rental lease, a second in November about the gifts and the rental property’s value, and a third in December about the IRAs. The family responds to each. In January the state approves Ed, calculates Mary’s resource allowance and imposes a short penalty for the gifts. The process takes about four months, which is typical for a case like this.

The difference between the two is not luck. It is the complexity of the finances and how complete the application was when it was filed.

Getting experienced help

A well-prepared application is the best way to shorten the wait. A Certified Medicaid Planner can assemble the application, anticipate verification requests and respond quickly when they come, often cutting weeks or months from the process. 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

Why is my application taking so long when the deadline is 45 days? Usually because the state is waiting for verification or reviewing transfers. Ask in writing what is outstanding.

Does the nursing home get paid for the waiting time if approved? Yes, for months the resident is found eligible, including retroactive months.

Can I call every day to check? Regular follow-up is fine; written follow-up is better, because it creates a record.

What if the caseworker says the application was never received? Send proof of filing (a confirmation number, a dated receipt or a copy of the cover letter) and ask that the original filing date be used.

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