Medicaid pays the nursing home directly, not you

When Medicaid covers your nursing home stay, the program sends payment straight to the facility. You do not receive a bill for the room, board, or basic nursing care that Medicaid covers. What Medicaid pays varies by state and by the type of care you need, but the facility bills Medicaid for your stay, and Medicaid pays them according to that state's rate schedule.

The amount Medicaid pays per day depends on the nursing home's license level (skilled nursing facility versus intermediate care), your state's Medicaid payment rate, and sometimes the specific services you require. States set their own daily rates, so a nursing home in one state may receive a different payment than an identical facility across the border. Most states pay between $150 and $300 per day for basic skilled nursing care, though some pay more and some less.

You will still owe money out of pocket for certain things Medicaid does not cover — personal care items, phone service, cable television, and any services beyond what the state's Medicaid plan includes. Your state's Medicaid program publishes a list of what is and is not covered, and the nursing home must give you this information before you move in.

Key Takeaways

  • Medicaid pays the nursing home directly for room, board, and basic care; you do not receive an invoice for these covered services.
  • Daily payment rates vary by state and are set by each state's Medicaid program, typically ranging from $150 to $300 per day for skilled nursing care.
  • You remain responsible for costs Medicaid does not cover, such as personal hygiene items, phone service, and services beyond your state's Medicaid plan.
  • Most states require you to spend down personal assets to a certain limit before Medicaid will pay, and you must report your income and resources during the process.
  • The nursing home must disclose all costs you are responsible for and cannot charge you for services Medicaid covers.

How states calculate what they pay per day

Each state's Medicaid program sets a daily rate for nursing home care based on factors including the facility's staffing levels, the cost of living in that region, and the complexity of care provided. Some states use a flat rate for all facilities; others adjust the rate based on the individual nursing home's costs. A few states tie payment to the facility's quality ratings or staffing ratios.

The rate you see published is what Medicaid will pay the nursing home for your care. It does not change based on your income or assets — Medicaid pays the same amount whether you are wealthy or poor. However, if your income exceeds a certain threshold (usually around $2,500 per month, though this varies by state), you may be required to contribute some of your income toward your care before Medicaid begins paying.

You can contact your state's Medicaid office or the nursing home's billing department to learn what rate your state pays. The nursing home should provide this information during the admission process, and you have the right to ask for it in writing.

What you pay out of pocket as a Medicaid resident

Even when Medicaid covers your nursing home stay, you are responsible for a personal needs allowance — a small monthly amount you must set aside for personal items. Most states require residents to keep between $30 and $100 per month for things like toiletries, clothing, haircuts, or a newspaper subscription. This money comes from your income or savings, and the nursing home cannot take it.

You also pay for anything beyond what your state's Medicaid plan covers. This typically includes cable television, phone service beyond a basic line, private room upgrades, and specialized therapies not listed in your state's covered services. Some facilities offer these as optional add-ons; others bundle them into the daily rate. Ask the nursing home in writing which services are covered by Medicaid and which you must pay for separately.

If you have Medicare in addition to Medicaid, Medicare may cover certain skilled nursing services for a limited time after a hospital stay. During that period, you may owe a copay to Medicare, not Medicaid. Once Medicare coverage ends, Medicaid takes over if you remain in the facility and meet your state's financial requirements.

Income and asset limits that determine Medicaid coverage

To receive Medicaid coverage for nursing home care, your income and assets must fall below your state's limits. Most states allow a single person to have no more than $2,000 in countable assets and monthly income below a certain threshold (often $1,500 to $2,500, depending on the state). Married couples typically have a higher asset limit for the spouse who remains at home.

Not all assets count toward the limit. Your primary home, one vehicle, and certain personal items are usually exempt. However, bank accounts, stocks, and other liquid assets do count. If you have too many assets, you must spend them down on care, medical expenses, or other allowed uses before Medicaid will pay for the nursing home.

Your income includes Social Security, pensions, and wages, but not all of it goes toward your care costs. Most states allow you to keep a small portion of your income for personal needs and medical expenses not covered by Medicaid. The rest goes to the nursing home, and Medicaid pays the difference between your income and the facility's daily rate.

How to find out what your state pays

Contact your state's Medicaid office directly — the phone number is on your Medicaid card or on your state's Medicaid website. Ask for the current daily rate for skilled nursing facility care in your region. Some states publish this rate online; others require you to call.

You can also ask the nursing home itself. By law, the facility must disclose the Medicaid rate it receives and must provide a written estimate of all costs you will owe. Request this in writing before you move in, and keep a copy for your records.

If you are comparing nursing homes, remember that a higher Medicaid rate does not always mean better care. Check the facility's inspection reports, staffing levels, and resident reviews through your state's health department website. The Medicaid payment covers basic care; quality varies by facility regardless of the daily rate.

What happens if the nursing home's costs exceed what Medicaid pays

Nursing homes sometimes operate at a loss on Medicaid residents because the state's daily rate does not cover all their expenses. When this happens, the facility cannot bill you for the difference — that is illegal. Medicaid residents cannot be charged more than what Medicaid pays plus your personal needs allowance and any optional services you choose.

If a nursing home is losing money on Medicaid care, the facility may reduce services, cut staff, or close its Medicaid beds. Some facilities accept fewer Medicaid residents and prioritize private-pay patients. This is a real problem in many states where Medicaid rates have not kept pace with inflation, and it can make it harder to find a bed as a Medicaid resident.

You cannot be evicted because Medicaid is your payer instead of private insurance or out-of-pocket funds. However, you should monitor your facility's financial health and staffing levels. If you notice a decline in care or staff turnover, report it to your state's long-term care ombudsman, who investigates complaints on behalf of residents.

Medicaid coverage for specialized care and therapies

Medicaid covers basic skilled nursing care — wound care, medication management, catheter care, and monitoring by a nurse. Physical therapy, occupational therapy, and speech therapy are covered if they are medically necessary and ordered by a doctor. However, the number of therapy sessions and the duration of coverage vary by state and by your specific condition.

Some specialized services — such as dialysis, chemotherapy, or ventilator care — may be covered by Medicaid, but the nursing home must have the equipment and staff to provide them. Not all facilities offer these services, so if you need specialized care, confirm before admission that the home can provide it and that Medicaid will pay for it in that state.

Dental care, hearing aids, eyeglasses, and podiatry are often not covered by Medicaid nursing home benefits, even though they may be covered if you live in the community. Ask your state's Medicaid office which services are included in the nursing home benefit and which you must pay for separately.

Frequently Asked Questions

Does Medicaid pay for a private room in a nursing home?

Medicaid typically covers only a semi-private room. If you want a private room, you usually pay the difference between the semi-private rate and the private room rate out of pocket. Some states allow this cost to come from your personal needs allowance if the difference is small, but most require you to pay it separately.

What if I run out of money while in a nursing home on Medicaid?

Medicaid continues to pay the nursing home for your care as long as you remain financially may be able to access. Your income and assets are reviewed periodically, but the program does not stop paying because you have no money left. The nursing home cannot discharge you for this reason.

Can a nursing home refuse to accept Medicaid?

Nursing homes can choose not to participate in Medicaid at all, but if they do participate, they cannot refuse to admit you based on Medicaid being your payer. They also cannot charge you more than the Medicaid rate plus your personal needs allowance and optional services. If a facility violates this, report it to your state's Medicaid office or long-term care ombudsman.

Does Medicaid pay for nursing home care if I am married?

Yes, but your spouse's income and assets may affect your may be able to access. Most states protect a portion of assets and income for the spouse who remains at home, allowing that spouse to keep a certain amount without it counting against your Medicaid coverage. The exact amounts vary by state, so contact your state's Medicaid office for details about your situation.

How long does Medicaid pay for nursing home care?

Medicaid covers nursing home care for as long as you need it and remain financially and medically may be able to access. There is no time limit. However, your may be able to access is reviewed periodically, and if your income or assets increase above the limit, you may lose coverage until you spend down again.