Getting Into a Medicaid Nursing Home

Finding a nursing home that will admit a person on Medicaid, or one who will soon need Medicaid, can be one of the hardest parts of a long-term care crisis. Beds that accept Medicaid may be limited, families often have only days to decide after a hospital stay, and admission paperwork can contain terms that are not in the resident’s interest. This guide explains how admission works, what federal law says nursing homes can and cannot require, and practical steps to improve the chances of getting a good placement.

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

The short version

A person needs to meet the state’s nursing-home level of care for Medicaid to pay. The state or its contractor does an assessment.
Federal law requires a Pre-Admission Screening and Resident Review (PASRR) for everyone entering a Medicaid-certified nursing home, to identify serious mental illness or intellectual disability.
Not every nursing home accepts Medicaid, and some have only a limited number of Medicaid-certified beds.
A Medicaid-certified nursing home cannot require a family member to guarantee payment, cannot require a resident to give up Medicaid rights, and cannot require a donation as a condition of admission.
People who enter as private-pay or Medicare residents and later switch to Medicaid in a Medicaid-certified bed generally cannot be discharged for that reason.

Step 1: Confirm the level of care

Medicaid pays for nursing home care only for people who need it. Each state sets its own level-of-care criteria, usually based on help needed with activities of daily living, medical needs, and cognitive impairment. A nurse or social worker from the state, a contracted agency or the hospital completes an assessment. See Nursing home level of care, explained.

Step 2: PASRR screening

Federal regulations (42 CFR 483.100 to 483.138) require that everyone admitted to a Medicaid-certified nursing home, regardless of how they pay, be screened before admission:

Level I screening identifies people who may have a serious mental illness or intellectual disability.
Level II evaluation, for those flagged, decides whether nursing home care is appropriate and what specialized services they need.

Hospitals usually start the PASRR before discharge. A delay in the screening can delay admission.

Step 3: Find nursing homes that accept Medicaid

Ways to find options:

Ask the hospital discharge planner or case manager for a list of facilities with open beds that accept Medicaid.
Use Medicare’s official Care Compare tool to search nursing homes by location and see quality ratings. See Using Care Compare.
Use the local Area Agency on Aging, or get help from a Certified Medicaid Planner who knows the facilities that accept Medicaid in the area.
Use the state’s long-term care ombudsman program for information about facilities in the area.
Visit in person when possible.

When calling, ask directly:

Do you accept Medicaid?
Do you have Medicaid beds available now?
Do you accept residents who are “Medicaid pending”?
If a resident starts as private pay, can they stay in the same room when they switch to Medicaid?

Step 4: Understand the admission agreement

Nursing home admission agreements can be long. Federal law (42 CFR 483.15(a)) sets important limits for Medicaid-certified facilities:

No third-party guarantee. The facility may not require a third party to guarantee payment as a condition of admission or continued stay. It may ask someone with legal access to the resident’s income or assets (such as an agent under a power of attorney) to sign to pay from the resident’s funds, without incurring personal liability.
No waiver of rights. The facility may not require residents to waive their right to apply for or receive Medicare or Medicaid, or to waive the facility’s liability for losing personal property.
No extra payments. The facility may not charge, solicit or accept a gift, money or donation as a precondition of admission, expedited admission or continued stay for a Medicaid-eligible resident.
Equal policies. Facilities must have identical policies on transfer, discharge and services for all residents regardless of payment source.

Before signing, families should:

sign as the resident’s agent or representative, not as a “responsible party” who promises to pay personally;
read any arbitration clause carefully; federal rules (42 CFR 483.70) say a facility cannot require an arbitration agreement as a condition of admission, and residents have a right to rescind within 30 days;
ask for a copy of everything signed.

Step 5: Apply for Medicaid at the right time

Many people enter a nursing home as private-pay or Medicare residents. The Medicaid application should be filed when the person is close to meeting the rules, so no months are lost. Some families file at admission; others after a period of private payment or planning. See How to apply and Applying for nursing home Medicaid.

“Medicaid pending” admissions

Some nursing homes admit people whose Medicaid applications are not yet approved, known as “Medicaid pending.” The facility takes the risk that the application may be denied. Families improve their chances by having the application ready, documents gathered and a clear picture of eligibility. See Medicaid pending.

Why some nursing homes prefer private-pay residents

Medicaid rates are usually lower than private rates. Some facilities limit the number of Medicaid beds or prefer residents who will pay privately for a time. Federal rules allow a facility to decide whether to participate in Medicaid and how many beds to certify, but once a resident is in a Medicaid-certified bed, the facility must follow Medicaid rules, including discharge protections.

Practical tips

Start early. If a hospital stay is likely to end in a nursing home, start looking right away.
Keep several options. Apply to more than one facility.
Be organized. Have a summary of the person’s income, assets, insurance and care needs ready.
Use a power of attorney. An agent can sign paperwork without delay.
Ask about waiting lists and check in regularly.
Consider location. A nursing home close to family makes visits and oversight easier.
Check quality with Care Compare and an in-person visit.

Hospital discharge pressure

Hospitals must give patients a discharge plan, and Medicare patients have the right to appeal a discharge they think is too early. Families may feel pressured to accept the first available bed. If a facility far away or with poor ratings is offered, ask the discharge planner about other options and keep looking for a transfer later if needed.

A simple example

Henry, 83, is in the hospital after a stroke. He has $45,000 in savings and needs nursing home care. The discharge planner gives his daughter a list of three facilities. She calls each and learns that one accepts Medicaid-pending admissions, one requires 60 days of private pay first, and one has no Medicaid beds. Henry enters the first facility under Medicare for rehabilitation. His daughter, acting under his power of attorney, signs the admission agreement as his agent, not as a guarantor. She works on a spend-down plan, and the Medicaid application is filed so that coverage starts when his Medicare days end and his assets are under the limit.

Getting help

A Certified Medicaid Planner can help families prepare a Medicaid application quickly, which can make it easier to find a nursing home willing to admit a Medicaid-pending resident. The state’s long-term care ombudsman program can help with admission agreement questions and residents’ rights.

Frequently asked questions

Can a nursing home refuse a Medicaid patient? A facility that does not participate in Medicaid, or that has no Medicaid beds available, can. A facility cannot discriminate in other ways prohibited by law.

Do I have to pay a deposit? Private-pay residents may be asked for a deposit. Medicaid-eligible residents may not be required to pay one as a condition of admission.

Should I sign as “responsible party”? Be cautious. Sign only as the resident’s agent or representative, and do not agree to pay from your own money.

Can a nursing home make me pay privately first? Some facilities ask for a period of private payment. Once the resident is in a Medicaid-certified bed and qualifies, the facility cannot discharge them for switching to Medicaid.

Documents to have ready

Having these ready can speed admission and the Medicaid application:

photo ID, Medicare and Medicaid cards, and any other insurance cards;
power of attorney and health care proxy documents;
a list of medications and doctors;
recent bank statements and income records;
information on any life insurance, annuities, property or trusts;
the hospital discharge summary and PASRR screening results.

Key terms

Level of care: the state’s standard for how much help a person needs to qualify for nursing home Medicaid.
PASRR: the federal pre-admission screening for serious mental illness and intellectual disability.
Medicaid-certified bed: a bed the facility has enrolled in Medicaid.

After admission, attend the first care plan meeting, usually held within a few weeks, to share the person’s routines and preferences.

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