Medicaid Pays for Most Nursing Home Days: Every State, and What It Means for Your Estate

Disclaimer: General educational research only — not legal, tax or financial advice. Rules differ by state and by family. Talk to an estate planning attorney in your state before you act.

Estate Planning Data & Research → Medicaid Nursing Home Days by State

Most families assume Medicare covers a long nursing home stay. It doesn’t: Medicare pays for short skilled stays, and Medicaid pays for most of the days people actually spend in nursing homes. Medicaid can later seek repayment from the estate, which often means the home.

This page shows who paid for nursing home resident days in every state and D.C., from the cost reports nursing homes file with the Centers for Medicare & Medicaid Services (CMS).

Planning ahead can protect a home that heirs expect to inherit. See how a trust and a will differ.

Key findings

• Medicaid covered 56.0% of nursing home resident days in 2023 (247,559,783 of 442,109,056 days at 14,696 facilities). Medicare covered 10.4%, and other payers, mostly private pay, insurance and managed care, 33.6%.
• Medicaid’s share is highest in West Virginia (81.2%), Mississippi (74.3%), Alaska (73.0%), Oklahoma (69.7%), Louisiana (69.2%) and Connecticut (67.8%).
• It is lowest in Vermont (28.0%), Ohio (41.4%), Iowa (44.4%), California (46.2%) and Kansas (47.0%). In Vermont, Ohio and Iowa, some Medicaid days may be reported as “other” (see the note below).
• Medicaid paid for more than half of resident days in 36 of the 51 jurisdictions (50 states and D.C.).

Who pays for nursing home days, by state

Source: CMS Skilled Nursing Facility Cost Report public use file, 2023 (data.cms.gov), Worksheet S-3 total inpatient days by Title XIX (Medicaid), Title XVIII (Medicare) and other. “Other” includes Title V and all other payers. Sorted by Medicaid share.

A note on Vermont, Ohio and Iowa

CMS’s cost report instructions ask facilities to split days among Title V, Title XVIII (Medicare), Title XIX (Medicaid) and other, but they don’t say where Medicaid managed-care days belong. Vermont, Ohio and Iowa have the lowest Medicaid shares here, and their “other” shares (59.8%, 51.9% and 49.2%) are well above the national 33.6%. Each state delivers some Medicaid nursing home coverage through managed care or a managed-care-style program, so some Medicaid-paid days may be reported as “other.” Their figures were similar in the 2022 reports (27.4%, 42.4% and 43.5%), so the pattern is consistent, but the true Medicaid share in those states is likely higher than shown. Other states that use managed care for nursing home coverage may be affected to a smaller degree.

Why this matters for your estate

• Medicaid estate recovery. States must seek repayment of nursing home costs from the estates of many Medicaid recipients 55 and older. See Medicaid estate recovery by state.
• The home is often the main asset. See Medicaid home equity limits by state.
• Documents first. A power of attorney and health care proxy let someone you trust handle a Medicaid application if you can’t. See the incapacity gap.

Related: nursing home capacity by state · nursing home staffing by state · who owns nursing homes

Methodology

CMS Skilled Nursing Facility Cost Report public use file for 2023 (updated Oct. 5, 2026), downloaded Oct. 15, 2026. Days are summed across all facilities in each state that reported total days above zero (14,696 facilities). Shares are of total inpatient days. Cost reports follow each facility’s fiscal year, so periods differ slightly, and reports may be revised.

What this doesn’t measure. Spending in dollars, residents’ assets, how many residents ever repay Medicaid, or facilities that don’t file Medicare cost reports.

Frequently asked questions

Does Medicare pay for long-term nursing home care?

Generally no. Medicare covers up to 100 days of skilled care after a qualifying hospital stay. It paid for 10.4% of resident days in 2023.

Who pays for most nursing home days?

Medicaid, at 56.0% of days nationally.

Can Medicaid take my house after I die?

States must seek repayment from the estates of many recipients, and the home is often included. Rules and exemptions vary by state.

Is this legal advice?

No. Talk to an estate planning attorney in your state.

Sources

Public-domain government sources only. Fetched 2026-10-15.

Data

• CMS, Skilled Nursing Facility Cost Report (2023 file): https://data.cms.gov/provider-compliance/cost-report/skilled-nursing-facility-cost-report
• CMS Provider Reimbursement Manual, Part 2, Chapter 41 (Form CMS-2540-10), Worksheet S-3 instructions: https://www.cms.gov/files/document/r11p241i.pdf

Cite this data

You’re welcome to reuse the table with a link back to this page. The underlying government data is public.

Published October 15, 2026 by Family Estate Guide. Data vintage: CMS SNF Cost Report 2023. Editorial standards.