What Medicaid Covers in a Skilled Nursing Facility

When a loved one needs long-term care in a skilled nursing facility, families are often confronted with overwhelming costs and confusing Medicaid eligibility rules. In Florida, the average cost of a private room in a nursing home exceeds $10,000 per month—far more than most families can afford to pay out-of-pocket for any significant length of time. For many, Medicaid becomes the only viable way to cover these expenses.

At Shalloway & Shalloway, P.A., we help families throughout West Palm Beach understand what Medicaid pays for in a skilled nursing facility and how to navigate the process of qualifying for benefits. Below we explain what Medicaid covers in a nursing home, what it doesn’t, and how you can plan ahead to protect your assets while ensuring your loved one receives the care they need. For strategic advice and skilled legal assistance tailored to your particular situation, contact our office to speak with an experienced and dedicated West Palm Beach Medicaid planning attorney.

Medicaid and Long-Term Care Coverage

Medicaid is a joint federal and state program that provides healthcare coverage for people with limited income and assets. In Florida, Institutional Care Program (ICP) Medicaid covers long-term care in skilled nursing facilities for those who meet strict financial and medical eligibility requirements.

Once approved, Medicaid pays for a broad range of services in the nursing home that are essential for daily living and medical support. These services are not limited to short-term rehabilitation. They also apply to residents who need ongoing custodial care due to chronic illness, disability, or age-related decline.

What Medicaid Covers in a Skilled Nursing Facility

Medicaid provides comprehensive coverage in a skilled nursing facility, including both medical and personal care services. Here’s what the program typically pays for:

• Room and board: This includes a semi-private room, meals, and housekeeping.
• Nursing care: Registered nurses and licensed practical nurses provide 24-hour care, including medication administration, wound care, and chronic disease management.
• Rehabilitation services: If ordered by a physician, Medicaid covers physical therapy, occupational therapy, and speech therapy.
• Personal care assistance: Aides assist with bathing, dressing, grooming, toileting, and mobility.
• Medical supplies and equipment: Medicaid pays for items such as adult diapers, walkers, wheelchairs, and hospital beds when medically necessary.
• Social and recreational activities: Facilities are required to provide social interaction opportunities and therapeutic activities as part of the care plan.
• Routine physician and dental care: Medicaid covers regular doctor visits and some dental services, although dental coverage is limited compared to other benefits.
• Medications: Most prescription drugs needed for treatment in the facility are covered under Medicaid’s managed care or fee-for-service structure.

These services are designed to ensure residents receive high-quality care and supervision in a secure environment. Medicaid funding also covers the development and ongoing evaluation of a personalized care plan, which outlines the medical and personal care services needed by the resident.

What Medicaid Does Not Cover

While Medicaid covers most essential services in a skilled nursing facility, it does not pay for everything. Certain personal items and optional amenities may fall outside of coverage. These may include:

• Private rooms, unless medically necessary
• Televisions, telephones, or internet service (unless the facility provides them as part of the standard package)
• Cosmetic or elective medical treatments
• Special dietary supplements, unless prescribed
• Personal clothing and grooming items

Residents or their families may choose to pay for these items out-of-pocket or through a Personal Needs Allowance, which is a small amount of income Medicaid allows the resident to keep for personal use.

Income and Asset Rules in Florida

To qualify for Medicaid coverage in a nursing home, the applicant must meet both medical and financial criteria. In 2025, the income limit for an individual is $2,901 per month, and the asset limit is $2,000. However, having income above the limit doesn’t necessarily disqualify someone, as Florida allows the use of a Qualified Income Trust (QIT) to redirect excess income in a way that maintains eligibility.

For married couples, special rules protect the “community spouse” (the spouse not entering care) by allowing them to retain a portion of the couple’s income and assets. These protections are designed to prevent impoverishment of the healthy spouse while allowing the ill spouse to receive care.

Planning Ahead to Protect Your Assets

Medicaid planning often involves more than just meeting the current income and asset limits. For instance, families need to be aware of the five-year look-back period. Medicaid will review financial transactions from the past five years to determine if any assets were given away or transferred for less than fair market value. If so, a penalty period may apply, delaying eligibility.

To avoid costly mistakes, it’s best to consult with an experienced elder law attorney before applying. Legal tools such as Medicaid Asset Protection Trusts, Lady Bird Deeds, and spend-down strategies can help structure your finances in a way that protects assets while ensuring eligibility.

Let Shalloway & Shalloway Guide You Through the Process

Applying for Medicaid is not a simple formality. It’s a legally and financially complex process that, if done incorrectly, could lead to delays or denials in coverage. At Shalloway & Shalloway, P.A., we work closely with clients in West Palm Beach to develop effective Medicaid strategies that meet legal requirements, protect the family’s financial interests, and ensure timely access to quality care.

Whether you’re planning for the future or facing an immediate need for long-term care, we’re here to help. Contact us today to schedule a consultation and learn how Medicaid can help cover the cost of skilled nursing care without sacrificing everything you’ve worked so hard to build.