Who Qualifies for Nursing Home Medicaid?

Nursing home Medicaid is the most widely available form of Long-Term Care Medicaid. Every state must cover nursing facility care for adults who qualify, and there are no waitlists for the program itself. But the rules are strict. This guide explains who qualifies, what the state looks at, what happens after approval and what to do once you learn a parent or spouse is eligible.

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

The requirements in brief

To qualify for nursing home Medicaid, an applicant generally must:

be 65 or older, blind or disabled;
need nursing home level of care under the state’s criteria;
have countable assets at or under the state’s limit, often $2,000 for a single person in 2026;
meet the state’s income rule, either directly, through a Qualified Income Trust, or through a medically needy spend-down;
have no unresolved transfer penalty from gifts in the past 60 months;
have home equity under the state’s limit, unless a spouse or protected child lives in the home;
be a resident of the state and a U.S. citizen or eligible non-citizen;
be in, or about to enter, a Medicaid-certified nursing facility.

The Eligibility overview explains each test.

The medical test

The applicant must need the level of care a nursing home provides. States look at help needed with activities of daily living, cognitive impairment, behavior and skilled nursing needs. See Nursing home level of care.

The financial tests

Assets

The state counts cash, bank accounts, investments, many retirement accounts, cash value of some life insurance and property other than the home. Exempt assets usually include the home (within the equity limit), one car, personal belongings and a qualifying burial fund. See Asset limits by state.

Income

In income cap states, gross income must be at or under $2,982 a month in 2026, or the person must use a Qualified Income Trust.
In medically needy states, a person with higher income qualifies once their medical bills, including nursing home costs, use up the excess. For a nursing home resident, this usually happens every month.

See The medically needy pathway.

The look-back

The state reviews transfers made in the 60 months before the application. Gifts or sales below fair market value can cause a period of ineligibility. See The five-year look-back.

Married applicants

If the applicant is married and the spouse lives at home, the spouse can keep:

the Community Spouse Resource Allowance, between $32,532 and $162,660 in 2026 depending on the state;
the home, one car and personal belongings;
their own income, plus part of the applicant’s income if the spouse’s income is below the MMMNA ($2,705 minimum from July 1, 2026).

See Married couples and Medicaid.

After approval: what the resident pays

Approval does not mean the nursing home is free. Each month, the resident pays most of their income to the nursing home as their patient liability, after these deductions:

a personal needs allowance (at least $30 a month under federal law; most states allow more);
an allowance for a spouse at home, if any;
an allowance for other dependent family members at home, if any;
health insurance premiums and certain medical costs not covered by Medicaid.

Medicaid pays the nursing home the rest of its Medicaid rate. See Patient liability.

“I’m eligible. Now what?”

Once approved, several things happen and some need attention:

The approval notice gives the start date and the monthly patient liability. Check both.
Paying the nursing home. The resident or their representative pays the patient liability to the facility each month.
Medicare premiums. The state usually begins paying the Part B premium. Social Security deposits will rise, and the patient liability will rise to match.
Retroactive refunds. If the person paid privately for months that Medicaid later covered, the nursing home should refund the difference between what was paid and the patient liability for those months.
Moving the CSRA. For married couples, assets protected for the spouse at home should be transferred into the spouse’s name within the time the state allows.
Keeping assets under the limit. The resident’s bank balance must stay under the limit. The personal needs allowance and any refunds can build up over time.
Reporting changes. Changes in income, assets or living arrangements must be reported, usually within a short deadline.
Renewals. Eligibility is reviewed periodically, usually once a year. Respond to renewal notices on time.
Estate recovery. The state may seek repayment from the estate after death. See Estate recovery.

Choosing a nursing home

A person approved for Medicaid can live in any nursing home that accepts Medicaid and has a bed available. Points to consider:

Not every facility accepts Medicaid. Some accept it only for some beds.
Private-pay first. Some facilities admit people who pay privately and later convert to Medicaid. Ask about the facility’s policy before admission.
No forced private pay. Federal rules prohibit a Medicaid-certified facility from requiring a third-party guarantee of payment as a condition of admission, or requiring residents to waive their right to Medicaid.
Transfer and discharge protections. Federal law limits when a nursing home can discharge a resident, and residents can appeal.

A worked example

Arthur, 89, is a widower who has been in a nursing home paying privately for four months. He has $1,950 a month in income and $5,800 left in savings. His state uses a $2,000 asset limit, the income cap and a personal needs allowance of $50.

Medical test: Arthur has advanced Parkinson’s disease and needs help with all ADLs. He meets level of care.
Income: $1,950 is under the $2,982 cap.
Assets: $5,800 is over the limit. He spends $3,900 on the nursing home bill and a new wheelchair cushion. He now has $1,900.
Look-back: No gifts.
Application: His son applies, and Arthur is approved.
Patient liability: $1,950 minus $50 = $1,900 a month, until the state starts paying his Part B premium, which changes the numbers.

Arthur keeps $50 a month for personal needs, and Medicaid pays the rest of the nursing home’s rate.

Common questions

Can my parent go straight from the hospital to a nursing home on Medicaid? Yes, if they qualify. Many people start under Medicare for rehab and then move to Medicaid. Apply as early as possible.

What if my parent has a home? It is often exempt while they intend to return, or if a spouse or protected relative lives there, subject to the equity limit. See The home exemption.

What if we already gave money to the children? Gifts in the past five years may cause a penalty. Some can be cured by returning the money. See Curing a transfer.

How long does approval take? States are generally expected to decide within 45 days, or 90 days when a disability determination is needed, but delays happen. Missing documents are the most common cause.

Can the nursing home evict my parent while the application is pending? Federal law limits discharges for nonpayment while a Medicaid application is pending in good faith. Ask the facility to note the pending application.

Steps to take

Check level of care with the doctor or discharge planner.
Inventory income and assets and check the state guide.
Gather five years of financial records.
Talk with a Certified Medicaid Planner (CMP) before spending down or transferring anything.
Apply in the first month every test is met. See How to apply.

Paperwork the state usually asks for

proof of identity, age and residency;
Social Security and pension award letters showing gross amounts;
bank and investment statements, often for the full 60-month look-back;
life insurance policies with cash values;
deeds, vehicle titles and burial contracts;
health insurance cards and premium statements;
for married couples, the same records for the spouse at home;
a power of attorney or guardianship papers if someone is applying on the person’s behalf.

Missing or late documents are the most common reason for delays and denials. Keep copies of everything submitted, with the date it was sent.

If the application is denied

Read the notice carefully. It will give the reason and the deadline to request a fair hearing. Many denials are for missing paperwork and can be fixed by submitting the documents or reapplying. If the denial is based on assets, income or a transfer penalty, get help quickly, because hearing deadlines are short.

Staying eligible over time

The resident’s account should be checked every few months. Personal needs money that is not spent can slowly build up past the asset limit. Spending it on clothing, haircuts, a television or other personal items keeps the balance in range.

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