Medicaid for Nursing Home Care: Eligibility, the 5-Year Look-Back, Spouses and Estate Recovery
Medicaid pays for nursing home care for people who meet their state's income and asset tests. Nursing facility services are a mandatory Medicaid benefit, so every state covers them, but each state sets much of its own eligibility rules within federal limits. Federal law adds rules that apply everywhere: a 60-month look-back on gifts, a cap on home equity, protections for a spouse who stays at home, a monthly share of your income paid toward the nursing home, and recovery from your estate after death. This page explains each one with the 2026 federal figures from CMS.
Does Medicaid Pay for Nursing Home Care?
Yes. Medicaid.gov lists nursing facility services among the mandatory benefits every state Medicaid program must cover (Social Security Act section 1905(a)(4)(A)). The catch is eligibility: you qualify through your state, based on your income and assets. For what nursing home care costs before Medicaid, see our guide to assisted living and nursing home costs.
Income and Asset Tests
Each state decides which income and asset limits apply to nursing home Medicaid, so the exact test depends on where you live. Certain Medicaid income and resource standards change each year with the Supplemental Security Income (SSI) federal benefit rate, and CMS publishes them. For 2026 the CMS chart lists:
- An SSI federal benefit rate of $994 a month for an individual.
- An SSI resource standard of $2,000 for an individual and $3,000 for a couple.
- An income cap limit, set at 300% of the SSI benefit rate, of $2,982 a month for an individual.
Ask your state Medicaid agency which of these standards it uses for nursing home coverage and what it counts as an asset. If you are married and only one spouse needs care, the spouse at home is protected by separate rules, covered below.
Your Home and the Home Equity Limit
Federal law bars Medicaid coverage of nursing facility services and other long-term care for a person whose equity interest in their home is above a set limit. The law started the limit at $500,000, lets a state choose a higher figure up to $750,000, and raises both figures each year with inflation. For 2026, CMS lists the home equity limits as:
- Minimum: $752,000
- Maximum: $1,130,000
The limit does not apply if your spouse, or your child who is under 21 or blind or disabled, is lawfully living in the home. The law also says nothing stops you from using a reverse mortgage or home equity loan to reduce your equity, and it requires a process to waive the limit in cases of demonstrated hardship.
The 60-Month Look-Back and Transfer Penalty
If you or your spouse give away assets or sell them for less than fair market value on or after the look-back date, you can be ineligible for Medicaid nursing home coverage for a period of time. For transfers made on or after February 8, 2006, the look-back date is 60 months before the date you are in a nursing home and have applied for Medicaid.
How long the penalty lasts. The number of months of ineligibility equals the total uncompensated value of everything transferred on or after the look-back date, divided by the average monthly cost to a private patient of nursing facility services in your state (or, if the state chooses, in your community) at the time you apply. Each state sets that divisor.
Hypothetical example. Say a parent gave a child $60,000 three years before applying, and the state's divisor is $10,000 a month. The penalty would be 6 months ($60,000 / $10,000). These figures are made up to show the math; your state's divisor and your own transfers decide the real result.
When the penalty starts. For transfers on or after February 8, 2006, the penalty starts on the later of the first day of the month of the transfer, or the date you would otherwise be eligible for Medicaid and receiving nursing home level care based on an approved application. So the penalty clock does not start until you would otherwise qualify.
Transfers that are not penalized. Federal law exempts some transfers, including:
- Your home, if title goes to your spouse; your child under 21, or blind or disabled; a sibling with an equity interest in the home who lived there for at least one year before you entered the facility; or a son or daughter who lived in the home for at least two years before you entered the facility and provided care that let you stay at home.
- Assets transferred to your spouse, or to another person for the sole benefit of your spouse.
- Assets transferred to a blind or disabled child, or to a trust for them, and to certain trusts for a disabled person under 65.
A lady bird deed is one tool some states treat differently under these rules. Because the look-back reaches five years and the penalty can start late, get advice before giving away money or property if nursing home care is possible.
What a Spouse at Home Keeps
Congress passed the spousal impoverishment rules in 1988 so the spouse who stays at home, called the community spouse, is not left with little or no income or resources. Two allowances protect them.
Assets: the community spouse resource allowance
As of the beginning of the first continuous period in a nursing home, the state totals the resources either spouse owns and computes a spousal share of one half. At application, all resources of either spouse count as available to the spouse in the nursing home, except the amount protected for the spouse at home. That protected amount is the greater of the state's minimum or the spousal share, capped at the federal maximum. For 2026, CMS lists:
- Minimum resource standard: $32,532
- Maximum resource standard: $162,660
A state can protect more than the minimum, up to the maximum. A fair hearing or a court order for support can also raise the amount.
Income: the monthly maintenance needs allowance
If the spouse at home has little income of their own, part of the income of the spouse in the nursing home can be set aside for them. CMS lists the 2026 figures as:
- Minimum monthly maintenance needs allowance, effective July 1, 2026: $2,705.00 in all states except Alaska and Hawaii, $3,381.25 in Alaska and $3,111.25 in Hawaii.
- Maximum monthly maintenance needs allowance: $4,066.50.
- Community spouse monthly housing allowance, effective July 1, 2026: $811.50 in all states except Alaska and Hawaii, $1,014.38 in Alaska and $933.38 in Hawaii.
Both spouses get notice of these amounts and the right to a fair hearing if they disagree with how the state computed them.
How Much of Your Income Goes to the Nursing Home
Once you qualify, Medicaid does not let you keep all your income. The state works out how much you contribute each month toward your own care, and it reduces its payment to the nursing home by that amount. Medicaid.gov says the calculation applies only after eligibility has been established. From your total income the state deducts, in this order:
- A personal needs allowance for clothing and other personal needs, of at least $30 a month for an aged, blind or disabled person. States can set it higher.
- A monthly income allowance for a spouse at home, but only to the extent the income is actually made available to them.
- A family allowance for minor or dependent children, dependent parents or dependent siblings living with the spouse at home.
- Incurred medical expenses not paid by a third party, such as Medicare and other health insurance premiums, deductibles or coinsurance.
What remains is paid toward the cost of your care in the nursing home.
Estate Recovery After Death
For people who were 55 or older when they received Medicaid, states are required to seek recovery from the person's estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States may choose to recover for other Medicaid services too.
- States may not recover from the estate while a spouse, a child under 21, or a blind or disabled child of any age survives the enrollee.
- States must have procedures to waive recovery when it would cause undue hardship.
- States may place a lien on real property during the lifetime of an enrollee who is permanently in a facility, except when the spouse, a child under 21, a blind or disabled child, or a sibling with an equity interest lives in the home. The lien must be removed if the enrollee is discharged and returns home.
Federal law says the estate includes everything in your probate estate, and lets each state reach further, to assets passed through joint tenancy, survivorship, a life estate or a living trust. Our lady bird deed guide covers how that plays out for a home, and our long-term care insurance guide covers partnership policies, which can protect some assets.
2026 Federal Figures at a Glance
| Standard (CMS, 2026) | Amount |
|---|---|
| SSI resource standard, individual | $2,000 |
| Income cap limit (300% of SSI), individual | $2,982 a month |
| Community spouse resource standard, minimum | $32,532 |
| Community spouse resource standard, maximum | $162,660 |
| Minimum monthly maintenance needs allowance (from July 1, 2026, lower 48) | $2,705.00 |
| Maximum monthly maintenance needs allowance | $4,066.50 |
| Home equity limit, minimum | $752,000 |
| Home equity limit, maximum | $1,130,000 |
| Personal needs allowance, federal floor | $30 a month |
| Look-back period | 60 months |
Sources & Methodology
- 2026 SSI and spousal impoverishment standards, home equity limits: CMS, CMCS Informational Bulletin, Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026).
- Look-back, transfer penalty, exempt transfers, home equity limit, liens and estate recovery: 42 U.S.C. 1396p.
- Spousal resource and income rules, notice and fair hearing: 42 U.S.C. 1396r-5.
- Personal needs allowance and post-eligibility deductions: 42 CFR 435.725.
- Medicaid.gov: Estate Recovery, Spousal Impoverishment and Mandatory & Optional Medicaid Benefits.
- All sources retrieved November 7, 2026. Figures are the federal standards; your state's limits may differ within them. The look-back example is hypothetical.
FAQ
Does Medicaid pay for nursing homes?
Yes. Nursing facility services are a mandatory Medicaid benefit in every state. You must meet your state's income and asset tests to qualify.
What is the Medicaid look-back period for nursing home care?
60 months. Gifts or transfers for less than fair market value in the 60 months before you are in a nursing home and apply can make you ineligible for a period of time.
How is the transfer penalty calculated?
The value given away is divided by the average monthly cost to a private patient of a nursing facility in your state. The result is the number of months you are ineligible.
Can Medicaid take my house?
During your life, a state may place a lien on your home only if you are permanently in a facility and no spouse, child under 21, blind or disabled child, or sibling with an equity interest lives there. After your death the home can be part of estate recovery, but not while a spouse, a child under 21, or a blind or disabled child survives. A home equity interest above the state limit, at least $752,000 for 2026, blocks long-term care coverage unless a spouse or qualifying child lives there.
How much money can my spouse keep if I go into a nursing home?
For 2026, the federal range for the spouse at home is $32,532 to $162,660 in assets, depending on your state and your assets, plus an income allowance of at least $2,705.00 a month from July 1, 2026 (lower 48 states).
Do I have to give my income to the nursing home on Medicaid?
Most of it. After deductions for a personal needs allowance of at least $30 a month, a spouse or family allowance, and uncovered medical costs, the rest goes toward your care.
This article is general information, not legal, tax or financial advice. Medicaid rules differ by state, and the example above is hypothetical. For your own eligibility, transfers or estate questions, contact your state Medicaid agency or an elder law attorney.
