How Much Does Medicare and Medicaid Pay for Skilled Nursing Services?

Skilled nursing care isn’t just for the final chapters; it’s a lifeline for post-surgical recovery, rehabilitation, and long-term management. But the cost? That’s where things may get a little challenging. 

If you’ve found yourself asking questions about Medicaid skilled nursing, Medicare coverage, or what your loved one might actually pay out of pocket, you’re not alone. 

The good news? Help is out there, and yes, Medicaid and Medicare both play important roles. The key is understanding who pays for what and how it all works.

What Does Medicaid Skilled Nursing Cover?

Let’s start with the basics: Medicaid skilled nursing facility coverage is designed for folks who qualify both medically and financially. Medicaid steps in to cover the cost of nursing home care or in-home skilled services that meet medical necessity.
Here’s what’s typically covered under Medicaid:

• 24-hour skilled nursing care in a licensed facility.
• Room and board.
• Personal care assistance (bathing, dressing, grooming).
• Physical, speech, or occupational therapy.
• Medications, medical supplies, and equipment.
• Social and activity services in long-term care settings.

Medicaid’s goal here is to make sure people who need constant or recurring medical attention can get it, without draining their savings or burdening family caregivers.

Medicaid Requirements for Skilled Nursing Facility Admission

Qualifying for Medicaid skilled nursing facility coverage isn’t automatic. There’s a list of boxes that need to be checked on both the health and financial sides.

1. Medical Need: A doctor must confirm that the patient needs daily skilled care, like wound management or rehab therapy.
2. Functional Limitations: Patients typically need help with daily living tasks, like walking, eating, or toileting.
3. Financial Eligibility: Medicaid is income-based. Your assets and monthly income must fall under a set threshold, which varies by state.
4. State Assessment: Some states require an in-person review to verify care level needs and Medicaid eligibility.

If your loved one meets all four, they could be eligible for Medicaid-covered skilled nursing either in a facility or, in some cases, at home through a waiver program.

What Does Medicaid Pay for in a Nursing Home?

Once approved, Medicaid typically covers:

• Semi-private room and meals.
• Nursing and personal care.
• Prescribed medications.
• Medical supplies and therapies.
• Rehabilitative treatments.

It won’t usually cover things like a private room (unless medically necessary), luxury services, or personal comfort items. But for families worried about the financial hit, Medicaid provides a critical safety net.

Does Medicare Pay for Skilled Nursing, Too?

Yes, but only up to a point. 
Here’s how it works:

• You must have a qualifying 3-day inpatient hospital stay before entering a Medicare-approved skilled nursing facility (SNF).
• The SNF admission must be within 30 days of hospital discharge.
• You must need skilled nursing or therapy services daily.
• Services must be ordered by a doctor and performed by licensed professionals.

How much does Medicare pay for skilled nursing? 

• Days 1–20: 100% covered by Medicare Part A.
• Days 21–100: You’ll owe a daily copay of $209.50 per day in 2025.
• After Day 100, Medicare stops paying. You’ll need to cover the full cost or seek help from Medicaid.

So, if long-term care is needed, Medicare is only a short-term solution.

Can You Get Skilled Nursing Care at Home?

Yes! Many people are surprised that Medicaid skilled nursing care doesn’t have to happen inside a nursing facility. Thanks to Home and Community-Based Services (HCBS) waivers, Medicaid allows eligible patients to receive skilled medical care in their own homes or community-based settings. This approach supports independent living and helps families avoid institutional placement whenever possible.

Here’s what’s typically required to qualify:

• Medical justification from a doctor

A licensed physician must confirm that skilled care is medically necessary. This could include wound care, injections, IV therapy, or condition-specific nursing interventions. Without this certification, Medicaid won’t approve home-based skilled services.
 

• State-level approval

Each state runs its own version of HCBS waivers, so approval depends on local guidelines. There may be waiting lists or caps on the number of people served. You’ll usually need to go through an assessment to confirm eligibility for in-home care instead of nursing facility placement. More details can be found on your state Medicaid website.
 

• A licensed agency or provider enrolled in Medicaid

Care must be delivered by an approved provider who is officially enrolled in Medicaid. These agencies must meet federal and state requirements and demonstrate the ability to deliver medically necessary care in a home setting. You can search for Medicaid-participating providers through your state's Department of Health or Medicaid provider directory.
 

• A documented care plan

 The state will usually require a formal care plan outlining the type, frequency, and goals of the services provided. This ensures accountability and helps track health outcomes.

According to Medicaid, HCBS waivers are designed to offer flexibility and help people "receive services in their home or community rather than institutions or other isolated settings." For many families, this means the difference between uprooting a loved one and allowing them to age safely in place, with skilled support.

If you're trying to keep a loved one out of a nursing facility, these programs can be a genuine lifeline, offering clinical-level care without sacrificing comfort, dignity, or familiarity.

FAQ

Can you receive Medicaid skilled nursing without moving to a facility?

Yes, many states offer in-home skilled nursing through HCBS waivers. You’ll need to meet the same medical and financial criteria.

Does Medicare cover in-home skilled nursing?

Medicare may cover short-term in-home nursing if prescribed by a doctor after a hospital stay, but it doesn’t provide long-term support like Medicaid does.

How long will Medicaid pay for skilled nursing care?

As long as you remain eligible and meet care criteria, Medicaid can continue coverage indefinitely.

Do I have to spend all my savings to qualify for Medicaid?

Not necessarily. There are “spend down” and asset protection options that vary by state. A Medicaid planner or elder law attorney can help.

Can I have both Medicare and Medicaid?

Yes. If you're dual-eligible, Medicare pays first and Medicaid may cover what’s left, like copays and extended care.

Understanding how Medicaid skilled nursing works and how it differs from Medicare can make a world of difference when planning care. 

Medicaid steps in for the long haul, helping those who qualify get the support they need without breaking the bank. 

Whether your loved one needs a nursing facility or skilled care at home, knowing what’s covered (and what’s not) can save a lot of stress and dollars.

Contact BrightStar Care of Fairfax Today! 

BrightStar Care of Fairfax is here to provide you with the resources and support you need to take care of your loved one. We understand the challenges faced by caregivers and are committed to providing compassionate care that meets the needs of those we serve. 

If you would like more information about our services, please visit our website or call us today at (703) 267-2380. It will be a pleasure to meet you and your family, and we look forward to providing you with the care and support you need. Come visit us at 10517 Braddock Rd, Suite C, Fairfax, VA 22032. 

Hopefully, we’ll hear from you soon!