If you or a family member can’t afford nursing home care, you won’t be turned out on the street. Federal law protects residents from immediate eviction, and Medicaid exists specifically to cover long-term care for people who have exhausted their resources. But the path from “can’t pay” to “covered” involves some painful financial steps, and understanding them ahead of time can save you thousands of dollars and enormous stress.
The national median cost for a semi-private nursing home room is $9,581 per month in 2025. A private room runs $10,798. At those prices, most families simply cannot pay out of pocket for long, and most end up relying on Medicaid within a few years. Here’s what that process actually looks like.
Medicare Covers Less Than You Think
Many people assume Medicare will handle nursing home costs. It won’t, at least not for long. Medicare only covers skilled nursing facility care, and only when you meet a specific set of conditions: you need a prior hospital stay of at least three consecutive inpatient days, you must enter the facility within about 30 days of discharge, and a doctor must certify that you need daily skilled care like IV medications or physical therapy. This isn’t coverage for long-term residential care. It’s short-term rehabilitation.
Even when you qualify, the coverage window is tight. Medicare pays the full cost for days 1 through 20 (after a one-time deductible of $1,736 in 2026). From days 21 through 100, you pay a co-pay of $217 per day. After day 100, Medicare pays nothing at all. Once someone needs ongoing custodial care, like help with bathing, eating, and getting dressed, Medicare is out of the picture entirely.
How Medicaid Becomes the Safety Net
Medicaid is the primary payer for long-term nursing home care in the United States. To qualify, you need to meet both income and asset limits, which are strict. In most states, the income cap for nursing home Medicaid is $2,901 per month (300% of the federal SSI benefit level in 2025), and the asset limit is just $2,000 per person. Your home, one vehicle, and certain personal belongings are typically exempt from the asset count, but nearly everything else, including savings accounts, investments, and additional property, counts against you.
If your assets exceed $2,000, you’ll need to “spend down” before Medicaid kicks in. That means using your money to pay for care, medical expenses, or other approved costs until your countable assets fall below the threshold. This is where many families feel the financial pain most acutely. Retirement savings, second properties, and other assets you expected to pass on to your children may need to be liquidated first.
The Look-Back Period and Gift Penalties
You might think you can simply give away your assets to family members before applying for Medicaid. States anticipated this. When you submit a Medicaid application for long-term care, the state reviews all financial transactions from the previous 60 months (five years). Any assets you gave away or sold below fair market value during that window trigger a penalty period: a stretch of time during which Medicaid will not pay for your care, even if you now have no money left.
The penalty is calculated by dividing the total value of gifted assets by your state’s average monthly cost of nursing home care. If you gave away $100,000 and your state’s divisor is $10,000 per month, you’d face a 10-month penalty period with no Medicaid coverage. During that time, you’re responsible for paying the full cost of care yourself. This catches many families off guard, particularly those who transferred a home to an adult child a year or two before needing care.
What Happens to Your Home
Your primary residence is usually exempt from Medicaid’s asset count while you’re alive, meaning you don’t have to sell it to qualify. But after you die, the state can and will seek repayment. Every state is required to operate a Medicaid Estate Recovery Program, which allows it to recoup the cost of care it paid on your behalf from your estate. In practice, this often means the family home gets sold to repay the state.
There are important exceptions. The state cannot recover from your estate if you’re survived by a spouse, a child under 21, or a child of any age who is blind or disabled. Similarly, while you’re alive, the state cannot place a lien on your home if your spouse, a minor child, a disabled child, or a sibling with an equity interest in the property still lives there. These protections matter enormously for families trying to preserve a home for a surviving spouse or dependent.
Protections for a Healthy Spouse
If one spouse enters a nursing home and the other remains at home, Medicaid doesn’t require the healthy spouse to become impoverished. The “community spouse” is allowed to keep a portion of the couple’s combined assets, known as the Community Spouse Resource Allowance. In 2025, this ranges from a minimum of $31,584 to a maximum of $157,920, depending on the state and the couple’s total resources. The community spouse also keeps their own income and, in many cases, a portion of the nursing home spouse’s income to maintain their household.
This is one area where planning ahead makes a significant difference. An elder law attorney can help structure assets so the community spouse retains as much as legally allowed, which can mean the difference between keeping and losing the family home.
You Can’t Be Immediately Evicted
If you’re already in a nursing home and run out of money, federal law provides real protections. A facility cannot simply wheel you out the door. Before any involuntary discharge, the nursing home must provide written notice at least 30 days in advance. That notice must include a valid reason for the discharge, a specific proposed date, and the exact location of an appropriate alternative residence.
The facility is also required to attempt to resolve the problem before issuing a discharge notice. If you’ve applied for Medicaid and your application is still pending, the nursing home cannot discharge you for nonpayment while you wait for a decision. You also have the right to appeal any discharge notice within 30 days of receiving it, and the facility cannot remove you while that appeal is being reviewed. The notice must also be sent to your state’s Long-Term Care Ombudsman, an independent advocate who can help you fight an improper discharge.
In practice, most nursing homes that accept Medicaid will transition you from private pay to Medicaid coverage once you’ve spent down your assets. They’d rather keep a Medicaid-funded resident than deal with the legal and logistical burden of a contested discharge.
Can Your Children Be Forced to Pay?
This is one of the most common fears families have, and the answer is complicated. Twenty-seven states still have “filial responsibility” laws on the books, colonial-era statutes that technically require adult children to pay for an indigent parent’s care. In practice, these laws are rarely enforced, but “rarely” is not “never.”
In a notable 2012 Pennsylvania case, a man was ordered to pay $93,000 for his mother’s nursing home care even though he had never signed any agreement accepting financial responsibility. The nursing home successfully relied on the state’s filial responsibility law to collect. Some states have narrower versions of these laws: Arkansas limits liability to adult mental health care, Connecticut’s law only applies when the parent is under 65, and Nevada requires a written agreement before liability can attach.
The more common risk isn’t a filial responsibility lawsuit. It’s that an adult child signed paperwork during the admission process that made them a “responsible party” for the bill. Read nursing home admission documents carefully. There’s a legal difference between being a contact person and being a financial guarantor, and facilities sometimes blur that line.
Alternatives If You’re Not Yet in a Facility
If nursing home care isn’t yet urgent, less expensive options may stretch your resources further. Medicaid home and community-based services can fund in-home aides, adult day programs, and assisted living in many states, often at a fraction of the cost of a nursing home. These programs typically have waiting lists, so applying early matters.
Veterans and their surviving spouses may qualify for the VA’s Aid and Attendance benefit, which provides a monthly pension supplement to help cover care costs. Long-term care insurance, if purchased years before it’s needed, can also fill the gap, though premiums have risen sharply in recent years and the window to buy a policy closes once health problems develop.
For families facing this situation right now, an elder law attorney or your state’s Medicaid office can walk you through the specific rules in your state. Asset limits, look-back rules, and estate recovery policies vary enough from state to state that general guidance only gets you so far. The sooner you start the process, the more options you’ll have.