Medicaid is the primary payer for long-term nursing home care in the United States, covering about 62% of all nursing home residents. Unlike Medicare, Medicaid covers custodial care indefinitely — but eligibility requirements are strict.
Medicaid vs. Medicare for Nursing Home Care
| Medicare | Medicaid | |
|---|---|---|
| What it covers | Skilled nursing care only | Skilled + custodial care |
| Time limit | Up to 100 days per benefit period | No limit (as long as eligible) |
| Income requirement | None | Yes — must meet income limits |
| Asset requirement | None | Yes — typically $2,000 limit |
| Who uses it | Short-term post-hospital recovery | Long-term nursing home residents |
Missouri Medicaid Eligibility for Nursing Home Care
Missouri’s Medicaid program (MO HealthNet) covers nursing home care for residents who meet both financial and medical criteria:
Financial Eligibility
- Income: Must be below Missouri’s income limit (approximately $2,742/month in 2025 for an individual). Income above this limit may still qualify through a “spend-down” or Miller Trust (Qualified Income Trust).
- Assets: Countable assets must be below $2,000 for a single person. Exempt assets include your primary home (if you intend to return or a spouse lives there), one vehicle, personal belongings, and pre-paid funeral arrangements.
- Spousal protections: If one spouse enters a nursing home, the community spouse may keep up to $148,620 in assets (2025 Community Spouse Resource Allowance) and a minimum monthly income allowance.
Medical Eligibility
You must require a “nursing facility level of care” — meaning you need assistance with multiple activities of daily living or have significant medical/cognitive needs. A physician must certify medical necessity.
Medicaid Spend-Down: How It Works
Most families have too many assets to qualify for Medicaid immediately. “Spending down” to Medicaid eligibility means using assets to pay for nursing home care until assets reach the $2,000 threshold. This can take months or years depending on your starting asset level.
A Medicaid planning attorney can help you legally protect assets through strategies like:
- Paying off a mortgage or making home improvements
- Purchasing an annuity for the community spouse
- Transferring assets to a spouse (subject to look-back period rules)
- Setting up a Medicaid-compliant trust
Medicaid Look-Back Period
Missouri Medicaid reviews all asset transfers made within 60 months (5 years) before the Medicaid application. Gifts or transfers made below fair market value during this period can result in a penalty period during which Medicaid will not pay for care. Early planning — ideally 5+ years before nursing home placement — can prevent these penalties.
How to Apply for Missouri Medicaid for Nursing Home Care
- Contact Missouri DSS Family Support Division at (855) 373-9994
- Apply online at mydss.mo.gov
- The nursing home’s social worker can assist with the application process
- Processing takes 45–90 days; the nursing home typically covers care during the pending period
Frequently Asked Questions
Q: Can Medicaid take your house when you go into a nursing home?
A: Not while you’re alive. However, after your death, Missouri may pursue Medicaid Estate Recovery to recoup costs paid on your behalf. A home is generally exempt during your lifetime if a spouse or dependent child lives there.
Q: How long does it take to get Medicaid for a nursing home?
A: In Missouri, Medicaid applications take 45–90 days to process. Applications can be submitted up to 3 months before nursing home placement to establish a start date.
Q: What if my parent’s income is too high for Medicaid?
A: Missouri allows the use of a Qualified Income Trust (Miller Trust) to qualify for Medicaid when income exceeds the limit. An elder law attorney can set this up.
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April 19, 2026