Nursing Homes in California: Costs & Medi-Cal (2026)

Few decisions land harder on a California family than moving a parent into a nursing home, and few cost more. A nursing home (also called a skilled nursing facility) is the most expensive setting CareScout's Cost of Care Survey 2025 prices in California: about $146,000 a year for a semi-private room and $182,135 for a private one.1

At that price, how the bill gets paid matters as much as which facility you choose. Nursing-facility care is a mandatory Medicaid benefit in every state's plan, unlike the home- and community-based services that waivers can cap.2

In This Guide

• Key Takeaways
• What a Nursing Home Is
• How to Check a Facility's Quality
• What a Nursing Home Costs in California
• Does Medi-Cal Pay for Nursing Homes?
• From Medicare to Medi-Cal: The 100-Day Transition
• How to Apply for Medi-Cal
• The Look-Back and Estate Recovery
• Frequently Asked Questions

What a Nursing Home Is

A nursing home, also called a skilled nursing facility or SNF, provides nursing care with 24-hour supervision, three meals a day, help with everyday activities, and rehabilitation such as physical, occupational, and speech therapy.8 That medical focus is the line that separates it from assisted living. In California, assisted living is licensed as a Residential Care Facility for the Elderly (RCFE), and an RCFE is non-medical: it may not accept or keep a resident who needs 24-hour skilled nursing, or one with a condition such as a stage 3 or 4 pressure sore or a feeding tube.9 A nursing home is where people with those medical needs go.

People arrive at a nursing home along two different paths, and they are worth keeping straight because they are paid for differently. The first is short-term rehabilitation, often after a hospital stay for a stroke, a fall, or surgery, where the goal is to recover and go home. The second is long-term custodial care, where someone needs ongoing nursing and supervision they can't safely get at home. Medicare helps with the short-term rehabilitation stay under specific conditions, but it does not pay for long-term custodial care.10 That is the stay families worry about paying for, and it is where Medi-Cal, California's Medicaid program, comes in.4

How to Check a Facility's Quality

Before you commit to a facility, check it three ways. Each shows you something the others don't.

Start with Cal Health Find, the public database run by the California Department of Public Health through its Center for Health Care Quality, which regulates California's nursing homes. For each facility, the database shows ownership, certification status (whether it accepts Medicare, Medi-Cal, or both), and its performance history: complaints, self-reported incidents, state enforcement actions, and deficiencies (the problems state licensing staff identify).3 You can search by ZIP code, city, or county, and file a complaint about a facility through the site.3 Look for a pattern of repeat deficiencies rather than reacting to a single old finding.

Next, check the federal star rating on Medicare Care Compare. The Centers for Medicare & Medicaid Services gives each nursing home an overall rating from 1 to 5 stars, where 5 means quality much above average and 1 means much below average.3 Alongside that overall rating, each home gets separate ratings for health inspections, staffing, and quality measures.3 Read the staffing rating on its own, not just the overall number. Medicare cautions that star ratings are no substitute for visiting, so go see the place yourself.3

Finally, know who to call when something seems wrong. The California Long-Term Care Ombudsman Program is the state's federally mandated advocate for people living in nursing homes and residential care communities: it investigates and resolves complaints made by or for residents, and its services are free and confidential.11 Anyone can contact the program with a concern, but the ombudsman represents the resident: when someone else files a complaint, the program finds out, as far as it can, what the resident wants and follows that direction.11

What a Nursing Home Costs in California

Nursing-home care is expensive, and California sits above the national median. According to CareScout's Cost of Care Survey 2025, the statewide medians were about $146,000 a year for a semi-private room and about $182,135 a year for a private room.1 Those are medians from an industry survey, not government rates and not maximums, so the figure at any one facility can land higher or lower.

The survey annualizes these figures on the basis of 365 days of care, from reported California rates of $400 a day for a semi-private room and $499 a day for a private room.1 To put them in context, the same survey put California assisted living, which CareScout notes is called a residential care facility in California, at a median of about $84,000 a year for a private one-bedroom.1 A semi-private nursing-home room costs well over half again as much, and a private room more than double. That gap is a reason to look hard at whether assisted living or in-home care can meet the need before choosing a nursing home, and a reason to look at Medi-Cal early rather than plan on paying privately for years.

Does Medi-Cal Pay for Nursing Homes?

Yes, and this is the most important thing to understand about paying for a California nursing home. Federal law makes nursing-facility care one of only two mandatory long-term care benefits in Medicaid, so it is part of every state's plan, Medi-Cal's included.2 Home- and community-based services are optional, and a state that offers them through a waiver can limit them to certain groups and cap enrollment, which is what produces waiting lists.2 California's Assisted Living Waiver is one example: DHCS says its slots are limited and there is a waitlist.4 The trade-off is that nursing-home Medi-Cal means living in a facility, not at home.

On the money side, Medi-Cal looks at two things: income, which sets what the resident pays toward care, and assets, which have a limit. Here is how each works in 2026.

Income. Medi-Cal handles a nursing-home resident's income through a Share of Cost rather than a published dollar cutoff. DHCS's older Medi-Cal questions-and-answers guide describes the mechanic this way: all of the applicant's countable income, less $35, is their share of cost, and it works like a health-insurance deductible.5 The statute sets aside more than that $35, though. The $35 personal-needs floor comes from Welfare and Institutions Code section 14005.12, and it is one item on a list of allowances that also covers upkeep of the home and support for a spouse who stays in the community or for dependent family members.5

One of those deductions is the personal needs allowance: a resident on Medi-Cal in a nursing home keeps $35 a month of their own income for personal expenses, and the rest of their income, after the other allowances on that statutory list, goes to the facility as their Share of Cost, which works like a health-insurance deductible.5

Assets. California restored its asset limit for non-MAGI Medi-Cal, which includes nursing-home coverage, on January 1, 2026, after the asset test for those programs was suspended for 2024 and 2025. (The Pickle, Disabled Adult Child, and Disabled Widow/er programs stay exempt from the asset test until DHCS issues further guidance.)5 The limit is $130,000 for an individual and $195,000 for a couple, with another $65,000 allowed for each additional family member.6 That level is set to last only through June 30, 2027: starting July 1, 2027, DHCS says the limit drops to $21,000 for one person and $31,000 for two.5 Some assets don't count, including the home you live in and one vehicle, and married couples get federal spousal-impoverishment protections so the spouse staying in the community keeps a substantial share of the couple's resources and income.5

From Medicare to Medi-Cal: The 100-Day Transition

Some residents don't start out on Medi-Cal. They enter a nursing home after a hospital stay, with Medicare paying the first stretch, and only switch to Medi-Cal once Medicare's coverage ends. Knowing that clock matters, because applying too late can leave a gap where no one is paying.

Medicare Part A covers a skilled nursing facility stay only on a short-term, post-acute basis, and generally only after a qualifying inpatient hospital stay of at least three consecutive days, for skilled care related to that stay. Time under observation doesn't count toward the three days, though a Medicare Advantage plan, or a doctor in an approved Accountable Care Organization, may waive the rule.10 When it applies, Original Medicare covers up to 100 days per benefit period: $0 a day for days 1 through 20 once the $1,736 Part A deductible is paid (usually already paid during the qualifying hospital stay), then a daily coinsurance of $217 for days 21 through 100, and nothing after day 100. A Medicare Advantage plan may charge copayments during the first 20 days, so check with the plan.10 Medicare does not pay for long-term custodial care, ongoing help with daily activities when that is the only care needed, so once the skilled stay ends, the options are Medi-Cal for those who qualify, private long-term care insurance, or paying the full cost out of pocket.10

Because Medicare's share shrinks from day 21 and stops entirely after day 100, the safe move is to start the Medi-Cal application as soon as it's clear the stay will become long-term, not after Medicare stops. Medi-Cal also offers up to three months of retroactive coverage for medical bills in the months before you apply, as long as the resident would have been eligible then, which can help if the transition catches you late.12

How to Apply for Medi-Cal

You can apply for Medi-Cal four ways: online through BenefitsCal or Covered California, by phone at 1-800-541-5555 or through your local county office, in person at a county office near you, or by mail with an application downloaded from DHCS.12 The county must decide most applications within 45 days, or within 90 days when eligibility is based on disability, except in unusual circumstances such as a delay on the applicant's side.12 If you declare citizenship or a satisfactory immigration status and the county can't verify it electronically, you get a reasonable opportunity period, generally up to 90 days after you receive the notice, to resolve it, and benefits can't be delayed or denied for an otherwise-eligible applicant in the meantime.12 Have income and asset records, the resident's Medicare and Social Security information, and the facility's admission paperwork ready before you start.

The Look-Back and Estate Recovery

Two rules tend to worry families the most, and California's versions of both are unusual, so it is worth knowing where the state actually stands rather than assuming the harshest national version applies.

The first is the look-back, the period Medi-Cal reviews for gifts or below-value transfers when someone applies for nursing-home coverage. California is mid-transition. The asset test for nursing-home Medi-Cal and other non-MAGI programs did not apply from January 1, 2024 through December 31, 2025, so counties don't review transfers made in that window or calculate a penalty for them.5 California's look-back period is 30 months, and it is phasing in: beginning July 1, 2026, the number of months reviewed grows by one each month, until the full 30-month review applies to people applying or entering long-term care on or after July 1, 2028.5 That is shorter than the federal look-back of 60 months for transfers made on or after February 8, 2006.5 A penalty period isn't automatic: every case must be reviewed for undue hardship first, an applicant can rebut the presumption that a transfer was made to qualify for Medi-Cal by showing it was made for another reason, and the penalty restricts nursing-facility coverage rather than denying Medi-Cal outright. It does not apply to members enrolled in community-based Medi-Cal programs.5

The second is estate recovery, the state's right to recover what it spent on a beneficiary's care after they die. California's rules, rewritten by SB 833 for members who die on or after January 1, 2017, are narrow.7 The state recovers only against assets in the deceased member's probate estate, so property that passes outside probate is beyond its reach.7 Recovery covers only nursing-facility services, home- and community-based services, and related hospital and prescription drug services, for members 55 or older, and the state can make no claim at all when the member is survived by a spouse or registered domestic partner.7 Because the rules are specific and the dollar stakes are high, this is a good place to talk to an elder law attorney before transferring anything.

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.