What Nursing Home Medicaid Covers

Once a resident qualifies for Long-Term Care Medicaid, what exactly does it pay for in the nursing home, and what might still cost extra? Federal rules answer much of this. They list services a Medicaid-certified nursing home must provide as part of its daily rate and items it may charge for separately. This guide explains those rules, the resident’s share of cost, and how other medical care is covered.

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

The short version

Medicaid pays the nursing home a daily rate that covers room, meals, nursing care, help with daily activities, routine supplies, basic laundry, activities and social services.
The resident pays most of their monthly income toward the bill as their patient liability, and keeps a personal needs allowance for personal items.
A Medicaid-certified nursing home must accept Medicaid plus the resident’s share as payment in full for covered services.
The nursing home may charge for extra items the resident requests that Medicaid does not cover, such as a private phone or television, salon services beyond basic grooming, or a private room that is not medically needed, but only with notice.
Doctor visits, hospital care and prescription drugs are covered separately, mostly by Medicare for people who have it, with Medicaid filling gaps.

Services included in the daily rate

Federal regulations (42 CFR 483.10(f)(11)) say that, during a Medicaid-covered stay, a nursing home may not charge a resident for these categories of items and services:

Nursing services, around the clock.
Food and nutrition services, including special diets ordered by a doctor.
An activities program.
Room and bed maintenance.
Routine personal hygiene items and services, including soap, shampoo, toothbrush and toothpaste, denture cleaner, deodorant, razors and shaving cream, tissues, lotion, towels and washcloths, incontinence care and supplies, over-the-counter drugs, hair and nail hygiene services, bathing assistance and basic personal laundry.
Medically related social services.
Hospice services elected by the resident and paid by Medicare or Medicaid.

Nursing homes must also provide or arrange services such as rehabilitation therapy, pharmacy services, dental services (helping residents get routine and emergency dental care), and assistance with transportation to medical appointments in many cases.

Items the nursing home may charge for

The same regulation lists items a nursing home may charge to the resident’s own funds if the resident requests them, they are not required by the care plan, the resident is told in advance there will be a charge, and Medicare or Medicaid does not pay. Examples include:

a personal telephone, including a cell phone;
a television, radio or computer for personal use;
personal comfort items, such as snacks and novelties;
cosmetic and grooming items and services beyond what Medicaid covers;
personal clothing and reading material;
gifts bought for others;
flowers and plants;
social events and entertainment outside the regular activities program;
privately hired nurses or aides;
a private room, unless it is therapeutically required (for example, for infection control).

Residents usually pay for these from their personal needs allowance, or family members pay.

Medicaid does not pay the whole bill. Each month, the resident contributes most of their income, such as Social Security and pensions, to the nursing home. This is called the patient liability (or share of cost). It is figured by starting with gross income and subtracting allowed deductions:

the personal needs allowance, which ranges from $30 to $200 a month depending on the state in 2026 (see Personal needs allowance);
an allowance for a spouse at home, if their own income is low (see MMMNA);
in some cases, an allowance for dependent family members;
health insurance premiums, such as Medigap or Part D premiums the resident pays;
certain medical expenses not covered by Medicaid;
in some states, a home maintenance allowance for a short time if the resident is expected to return home.

Medicaid pays the nursing home the rest of its Medicaid rate. See Patient liability: what you pay the nursing home.

“Payment in full”

A nursing home that takes Medicaid must accept the Medicaid payment plus the resident’s patient liability as payment in full for covered services (42 CFR 447.15). It cannot:

bill the family the difference between the private rate and the Medicaid rate;
require a gift, donation or extra payment as a condition of admission or continued stay for a Medicaid resident (42 CFR 483.15(a)(4));
charge for any item or service that Medicaid has paid for.

If a nursing home asks for extra money for covered services, the family can question the charge in writing. The state’s long-term care ombudsman program helps residents resolve billing disputes like this one.

Medical care outside the nursing home’s rate

Most nursing home residents on Medicaid also have Medicare. For them:

Doctor visits are paid mainly by Medicare Part B, with Medicaid covering coinsurance if the person qualifies.
Hospital stays are paid by Medicare Part A.
Prescription drugs are covered by a Medicare Part D plan. Full-benefit dual eligibles automatically qualify for Extra Help, which keeps drug costs low.
Medical equipment, such as wheelchairs, may be provided by the nursing home or covered by Medicare or Medicaid depending on the item.
Dental, vision and hearing coverage varies by state.

For residents without Medicare, Medicaid pays for these services directly.

Short absences and bed holds

If a resident goes to the hospital or leaves for a visit, what happens to their bed depends on the state’s bed-hold policy and whether Medicaid pays to hold the bed. Federal rules also give residents the right to return to the first available semi-private bed if the hold period is exceeded. See Bed-hold policies.

Transitions from private pay or Medicare

Many residents start as private-pay or Medicare-covered patients and then switch to Medicaid. A Medicaid-certified nursing home generally cannot discharge a resident just because their payment source changes to Medicaid, if they are in a Medicaid-certified bed. Some facilities have only part of their beds certified for Medicaid, so ask about this before admission. See Nursing home discharges and evictions.

A simple example

Evelyn, 89, lives in a nursing home on Medicaid. Her income is $1,900 a month. Her state’s personal needs allowance is $70, and she pays a $50 monthly premium for a dental plan. Her patient liability is $1,900 – $70 – $50 = $1,780. Medicaid pays the rest of the nursing home’s daily rate.

Evelyn uses her $70 to get her hair styled once a month (beyond basic grooming), buy snacks and pay for a newspaper. Her daughter pays for her cell phone. The nursing home cannot charge Evelyn for her shampoo, incontinence supplies, laundry or activities, because those are included.

Common billing problems

Charges for items that are part of the daily rate, such as incontinence supplies.
Requests for a “deposit” or “donation” from a Medicaid resident.
Billing family members as guarantors of payment.
Charging the private rate while a Medicaid application is pending and then not refunding the overpayment after approval.
Errors in the patient liability amount.

Residents and families can ask for an itemized bill, raise concerns with the business office, and contact the long-term care ombudsman. Disputes about the patient liability amount can be appealed through a fair hearing.

Getting help

Families who understand what Medicaid covers can avoid paying for things they do not owe. A Certified Medicaid Planner can review the patient liability calculation, help make sure allowable deductions are claimed and help with applications and renewals.

Frequently asked questions

Does Medicaid pay for a private room? Only if it is medically necessary, or if no semi-private room is available. Otherwise a family may pay the difference if the state allows it. See Private rooms on Medicaid.

Does Medicaid pay for personal clothing? No. Residents use their personal needs allowance, or family members help.

Does the nursing home have to provide a wheelchair? Nursing homes must provide basic equipment needed for care. Custom wheelchairs may be covered separately by Medicare or Medicaid.

What if the resident’s income goes up? The patient liability goes up too. Changes must be reported.

Key terms

Daily rate (per diem): the amount Medicaid pays the nursing home for each day of care.
Patient liability: the resident’s monthly contribution from income.
Personal needs allowance: the amount a resident keeps each month for personal items.
Payment in full: the rule that a Medicaid nursing home must accept Medicaid plus the patient liability, with no extra billing for covered services.

A short checklist for families

Ask the business office for a written list of what the daily rate includes.
Ask for an itemized monthly statement.
Compare the patient liability on the bill with the amount on the Medicaid notice.
Keep receipts for any insurance premiums or medical costs that could be deducted.
Report income changes promptly.

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