Nursing Home Costs by State

Nursing home care is one of the largest expenses an older adult can face. A month in a nursing home can cost about half as much in some states as in others, and prices differ from one town to the next within a state as well. For Long-Term Care Medicaid, cost matters in two ways. It decides how fast a person’s savings run out while they pay privately, and it is the basis for each state’s penalty divisor, the figure used to turn gifts made during the look-back into a penalty period. This guide explains what nursing homes cost, what drives the price, how Medicaid fits in, and how to read the state-by-state figures.

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

The short version

• Average private-pay nursing home costs range from roughly $7,200 to more than $16,000 a month in 2026, depending on the state.
• Each state’s penalty divisor is usually based on the average private-pay cost of nursing home care in that state, which makes it a useful public benchmark. The full table is below.
• A private room usually costs more than a semi-private room. Medicaid pays for a semi-private room.
• Medicaid pays nursing homes its own Medicaid rate, which is usually lower than the private rate. A resident on Medicaid does not pay the difference.
• Actual prices differ by facility, region and level of care, so families should ask each nursing home for its current rates in writing.

Why the cost matters so much

Most people who enter a nursing home for the long term do not stay only a few weeks. Many stay for months or years, and Medicare does not pay for that kind of custodial care. That leaves three main ways to pay: the person’s own income and savings, long-term care insurance if they bought it years earlier, and Long-Term Care Medicaid once they qualify. For most families, the path runs through the first and ends with the third.

At $10,000 or more a month, even a comfortable retirement nest egg can disappear within a year or two. That is why families often ask two questions at once: “How much will this cost?” and “When will Medicaid start paying?” The answers are connected. The higher the monthly cost, the faster savings fall toward the state’s asset limit, and the sooner the person may qualify. At the same time, money spent in the wrong way, or given away, can delay Medicaid and leave a gap no one has planned for.

Understanding cost is also the first step in comparing options. A family that knows the real monthly figure for nursing home care can weigh it against care at home, assisted living, adult day programs and help from relatives. See Alternatives to nursing homes.

What a nursing home’s daily rate includes

Nursing homes usually quote a daily rate. The basic rate usually covers:

• a room (semi-private or private) and meals, including special diets;
• nursing care and supervision around the clock;
• help with bathing, dressing, eating, toileting and other daily activities;
• routine supplies and personal hygiene items;
• housekeeping and basic laundry;
• activities, social services and care planning.

Extra charges may apply for items such as personal phone or television service, salon services, special supplies, private-duty aides and outside medical care. For residents on Medicaid, federal rules limit what can be charged on top of the Medicaid rate. Items the Medicaid rate already covers cannot be billed again to the resident or the family. See What nursing home Medicaid covers.

When comparing facilities, it helps to turn every quote into a monthly figure. Multiply the daily rate by about 30.4, the average number of days in a month. A home that quotes a modest-sounding daily rate can still cost well over $100,000 a year.

What drives the cost

• Location. Labor and real estate costs make care more expensive in some states and in cities. Northeastern and West Coast states, and Alaska, tend to be at the high end. Parts of the South and the Plains tend to be at the low end.
• Room type. Private rooms cost more than semi-private rooms, often by a noticeable amount each day.
• Level of care. Specialized dementia units, ventilator care, wound care or other complex medical needs may cost more.
• Staffing. Wages are the largest part of a nursing home’s budget. Facilities with more nursing staff per resident usually charge more.
• Ownership, size and age of the building. Newer buildings with more private space often charge more. Larger facilities may spread costs differently than small ones.
• Local demand. Where few beds are available, prices tend to be higher.

Costs have generally risen faster than general inflation over time, mostly because of staffing costs. A figure that was accurate two years ago is likely to be too low today.

2026 penalty divisors by state

The table below lists each state’s 2026 penalty divisor, as published by the state Medicaid agency and summarized in our state guides. In most states the divisor is the state’s average monthly (or daily) private-pay cost of nursing home care, so it is a good public benchmark for what a month of care costs. A few states use a facility’s own rate or regional figures instead of a single statewide number. Divisors change on different dates in different states, often once a year.

Daily figures can be converted to monthly figures by multiplying by about 30.4 (the average number of days in a month).

How to read the divisor as a cost estimate

The divisor is an average. It blends expensive and inexpensive facilities, cities and rural areas, and in many states it is calculated from cost reports that are a year or more old by the time the figure takes effect. A particular nursing home may charge noticeably more or less than its state’s divisor. In a large state with very different regions, the gap between a city facility and a rural one can be wide, which is why a few states publish regional divisors.

Even so, the divisor is the best free, public figure available in every state. It is useful for rough planning: estimating how long savings will last, comparing states when a family is deciding where a parent should live, and understanding the size of a possible look-back penalty. For an actual budget, families should use the specific facility’s written rate.

How cost affects a private-pay stay

Knowing the monthly cost helps families estimate how long savings will last.

Example. Margaret is single. She has $120,000 in savings and $2,500 a month in income from Social Security and a small pension. Her nursing home charges $11,000 a month. Her monthly shortfall is $8,500. Her savings would last about 14 months ($118,000 above a $2,000 asset limit, divided by $8,500). After that, she would apply for Medicaid, and most of her $2,500 income would go to the nursing home each month as her share of cost.

That example leaves out several things that often change the picture. Margaret may be allowed to buy an irrevocable funeral arrangement, pay off debts, replace worn-out items or make home repairs. Those are lawful ways to spend down that leave her better off than paying the nursing home for an extra month. If she is married, the rules change a great deal, because her husband would be able to keep a share of the couple’s assets and some of her income. See How the Medicaid spend-down works and Spend-down examples.

How cost affects the look-back penalty

When someone applies for Long-Term Care Medicaid, gifts made in the previous 60 months are added up and divided by the state’s penalty divisor. The result is the number of months Medicaid will not pay, even though the person otherwise qualifies.

Example. A $50,000 gift:

• in a state with an $8,000 monthly divisor causes a penalty of about 6.3 months;
• in a state with a $15,000 divisor causes a penalty of about 3.3 months.

Higher-cost states produce shorter penalties for the same gift, because each month of care is worth more. In both cases, though, the family has to find a way to pay for those months. The penalty does not start until the person has applied and would otherwise qualify, so it often lands at the worst possible moment, when savings are already gone. See The five-year look-back and How the penalty period is calculated.

Medicaid rates vs. private rates

Medicaid pays nursing homes a set daily rate, determined by each state using its own formula. Many states adjust the rate for each resident’s care needs, and some add amounts for quality measures or special units. The Medicaid rate is generally lower than what private-pay residents are charged, sometimes by a wide margin.

Federal rules say a Medicaid-certified nursing home must accept the Medicaid payment plus the resident’s share of cost as payment in full (42 CFR 447.15). A nursing home cannot bill the family for the difference between its private rate and the Medicaid rate, and it cannot require a family member to guarantee payment as a condition of admission. A relative who signs as the resident’s representative agrees to use the resident’s own money properly, not to pay from their own pocket.

The resident’s share of cost, often called patient liability, is based on income, not on the facility’s price. A resident pays most of their monthly income to the nursing home, keeps a small personal needs allowance, and may be able to set aside money for a spouse at home and for health insurance premiums. Medicaid pays the rest. Two residents with the same income pay the same share whether their nursing home is one of the most or least expensive in the state. See Patient liability.

The gap between private pay and Medicaid

The difference between private and Medicaid rates explains some things families notice. Nursing homes often prefer private-pay residents, and some limit how many Medicaid beds they have. A facility can choose not to participate in Medicaid at all. If a person enters a facility as a private-pay resident and later runs out of money, it matters a great deal whether that facility accepts Medicaid and whether the person can keep the same bed.

Before admission, families should ask directly whether the facility is Medicaid-certified and what happens when a private-pay resident switches to Medicaid. A facility that is certified cannot discharge a resident simply because their payment source changes from private pay to Medicaid once they are in a Medicaid bed. See Getting into a Medicaid nursing home and Nursing home discharges and evictions.

Other costs families may face

• Medicare coinsurance. During a Medicare-covered rehabilitation stay, days 21 to 100 carry a daily coinsurance ($217 in 2026), which a Medigap policy or Medicaid may pay.
• Personal items. Residents on Medicaid pay for clothing, haircuts and personal items from their personal needs allowance.
• Private room differences. A family can sometimes pay extra for a private room, but only under strict rules. See Private rooms on Medicaid.
• Bed holds. If a resident goes to the hospital, holding the bed may involve a charge or a limited number of Medicaid-paid days. See Bed-hold policies.
• Medication and outside care. Usually covered by Medicare Part D, Medicare Part B or Medicaid.
• The cost to the spouse at home. Even with spousal protections, the household loses most of the resident’s income. Planning for the at-home spouse’s budget matters.

Comparing nursing homes

Price is only one factor. Families should also look at quality ratings, inspection reports, staffing levels, location and whether the facility accepts Medicaid. A facility close to family members who can visit often makes a real difference to quality of life. See Using Care Compare to check quality.

Questions to ask about cost

• What is the private daily rate for a semi-private room and a private room?
• What is included in the daily rate, and what costs extra? Can we see the list of extra charges?
• How often do rates go up, and how much notice is given?
• Does the facility accept Medicaid, and can a resident stay in the same room when they switch to Medicaid?
• What deposit, if any, is required for private-pay residents, and is it refundable?
• How are extra charges billed and explained?
• Is there a bed-hold charge during a hospital stay?

How families pay for these costs

Most families combine sources over time: Medicare for a short rehabilitation stay, savings and income for a while, possibly long-term care insurance or VA benefits, and then Long-Term Care Medicaid. See How nursing home care is paid for.

Because a few months of private payment can cost tens of thousands of dollars, the timing of a Medicaid application and the use of lawful planning strategies matter a great deal. Applying too early can lead to a denial; applying too late can mean months of private payment that were not necessary. A Certified Medicaid Planner can help a family estimate how long savings will last, what can lawfully be protected, and when to apply.

Frequently asked questions

Why is the penalty divisor different from my nursing home’s price? The divisor is a statewide (or regional) average set by the state, often from older cost data, while each nursing home sets its own private rate.

Are costs going up? Nursing home costs have generally risen each year, mostly because of wages, and many states update their divisors annually.

Is home care cheaper than a nursing home? For a few hours a day, usually yes. For round-the-clock care, home care can cost as much as or more than a nursing home.

Does Medicaid pay more in expensive states? Medicaid rates vary by state and facility, but the resident’s share is based on their income, not the nursing home’s price.

Can a nursing home charge my family the difference once Mom is on Medicaid? No. A Medicaid-certified facility must accept Medicaid’s payment plus the resident’s share of cost as payment in full for covered services.

Related guides

• How nursing home care is paid for
• How the penalty period is calculated
• Spend-down examples
• Private rooms on Medicaid
• State guides

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