Can a nursing home require private pay before Medicaid?

Can a nursing home require private pay before Medicaid?

Short answer: A Medicaid-certified nursing home cannot require a resident to stay private pay for a set time or waive the right to Medicaid as a condition of admission or continued stay.

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

Federal rules for Medicaid-certified facilities prohibit them from:

  • requiring residents or applicants to waive their right to Medicaid;
  • requiring oral or written assurance that the resident is not eligible for, or will not apply for, Medicaid;
  • requiring a third-party guarantee of payment as a condition of admission or continued stay;
  • charging or soliciting gifts or donations as a condition of admission for Medicaid residents.

So an admission agreement that says “you must pay privately for two years before applying for Medicaid” is not enforceable at a certified facility.

What facilities can do:

  • decide how many beds are certified for Medicaid;
  • decline to admit a new resident when they have no Medicaid bed available, as long as they do not discriminate in prohibited ways;
  • bill privately while a person is not yet eligible, and bill Medicaid once eligible.

If a facility pressures a resident to stay private pay, the long-term care ombudsman program can help.

Getting help

Every situation is different, and small facts can change the answer. If this question affects a real decision, especially with a spouse at home, a home, gifts or a trust, a Certified Medicaid Planner can apply your state’s rules to your situation. As a rough guide, published fees for help with an application range from about $500 to $6,000, and hourly help from about $150 to $600.

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

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