Medicaid Pending Nursing Home Admission: What a Home Can Make You Sign

A Medicaid pending nursing home admission means your parent moves in while the state is still deciding the application, and federal rules limit what a certified home can ask of you. If you're sitting with a discharge date, an undecided application and an admission packet you haven't read yet, this is a hard week. The most important limit is this one: a certified home can't require you to personally guarantee your parent's bill as a condition of admission.1

In This Guide

• What "Medicaid Pending" Means for a Nursing Home Admission
• Will a Nursing Home Accept Medicaid Pending?
• What a Medicaid Pending Nursing Home Admission Agreement Can and Can't Ask You to Sign
• Who Pays the Nursing Home While Medicaid Is Pending?
• The Screening That Comes Before Admission
• How Long the Medicaid Decision Takes
• The Look-Back on Gifts and Transfers
• If Medicaid Is Approved
• If Medicaid Is Denied After Admission
• What to Do This Week
• Frequently Asked Questions
• Learn More

What "Medicaid Pending" Means for a Nursing Home Admission

"Medicaid pending" just means the application has been filed and the state hasn't decided it yet. It isn't an approval, and it isn't a promise that the months your parent spends in the home while you wait will be paid. A home that admits on a Medicaid pending basis is betting that the state will say yes. You're betting on the same thing, and it helps to know exactly where the rules protect you if the bet goes the other way.

The protections in this guide come mostly from 42 CFR 483.15, the federal rule on admission, transfer and discharge rights, and from parallel provisions in Section 1919 of the Social Security Act.1 That rule sits in a part of federal regulations that sets the requirements a home must meet to participate in Medicare as a skilled nursing facility or in Medicaid as a nursing facility. This guide calls those homes "certified."4

Will a Nursing Home Accept Medicaid Pending?

Not every nursing home takes Medicaid, so not every home will admit your parent on a Medicaid pending basis. A nursing home can voluntarily withdraw from Medicaid and keep operating.5 Federal law lets states and localities apply stricter admission standards to prohibit discrimination against people entitled to Medicaid.1 Ask your state Medicaid agency whether your state has such a standard and how it treats an application that's still pending, or start with your state's page in our nursing home Medicaid guide by state.

To build a list, start with the hospital. When a patient is going to a skilled nursing facility, the hospital must include in the discharge plan a list of available Medicare-participating skilled nursing facilities serving the patient's geographic area, and it must tell you that you're free to choose among them.6 Ask each home on that list whether it participates in Medicaid and will admit your parent while the application is pending. Our guide to hospital discharge planning explains what else to ask the hospital for.

Before you sign anything, confirm the home takes Medicaid at all. A home that has voluntarily withdrawn from Medicaid but keeps operating must tell each new resident, orally and in writing on a separate page, that it isn't participating in Medicaid for them and may transfer or discharge them when they can't pay, even if they later become eligible. It must also get a signed acknowledgment. If you're handed that page, keep looking for a home that participates in Medicaid.5

Once you have names, Medicare Care Compare gives each nursing home an overall Five-Star rating built from separate health inspection, staffing and quality measure ratings. The health inspection rating carries the most weight; the other two adjust the overall rating up or down, but a home with a one-star inspection rating can't be raised more than one star above it.7 Our guide to choosing a nursing home walks through what to compare.

What a Medicaid Pending Nursing Home Admission Agreement Can and Can't Ask You to Sign

This is the part that keeps adult children up at night: the admissions office slides a contract across the table and asks you to sign as the "responsible party." Federal rules draw a clear line here. A certified home must not request or require a third-party guarantee of payment as a condition of admission, expedited admission or continued stay. What it may request and require instead is that a representative who has legal access to your parent's income or resources sign a contract, "without incurring personal financial liability," to pay the home from your parent's income or resources.1

These rules come from 42 CFR 483.15 and Section 1919 of the Social Security Act.1

The ban on extra payments is worded for "a person eligible for Medicaid." If the home asks for a deposit while the application is still pending, ask it in writing what the deposit is for and when it comes back before you pay.1

Continuing care retirement communities follow a different rule. Subject to the spousal protections in Section 1924, an admission contract for a state-licensed continuing care retirement community or life care community can require residents to spend resources they declared at admission on their care before applying for Medicaid.1

Because the home may not request or require a third-party guarantee of payment, have any guarantor wording reviewed before you sign or pay.1 If the packet uses words like "guarantor" or "jointly responsible," cross them out or ask for the representative version, and read our guide on whether you're responsible for a parent's nursing home bill before you sign.

Who Pays the Nursing Home While Medicaid Is Pending?

While the application is pending, the agreement rules above still apply: the home may not request or require a third-party guarantee of payment as a condition of admission or continued stay, so have any guarantor wording reviewed before you sign or pay.1 If your parent has been paying privately and applies once savings run low, CMS tells inspectors that "conversion from a private pay rate to payment at the Medicaid rate does not constitute non-payment."1

If your parent is coming straight from a hospital, Medicare may cover part of a skilled nursing stay, generally after a qualifying inpatient stay of at least three consecutive days (the discharge day doesn't count) and once a doctor or other provider decides your parent needs daily skilled care. Under Original Medicare that's up to 100 days per benefit period, with a daily coinsurance of $217 in 2026 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. Medicare doesn't pay for long-term custodial care.8

If your parent is married and the other spouse still lives at home, federal spousal impoverishment rules apply. The state counts the resources of both spouses as available to your parent, but only above a community spouse resource allowance kept for the at-home spouse, and after approval a monthly income allowance for the at-home spouse can be deducted from your parent's income before the rest goes toward care, to the extent that income is actually made available to the at-home spouse.9 For 2026, the federal community spouse resource standards are a minimum of $32,532 and a maximum of $162,660, and those figures don't cap the allowance itself: a fair hearing or court order can set it higher.10 Our guide to spousal impoverishment rules explains how the at-home spouse's share is worked out.

Once your parent is eligible for Medicaid, the home may charge only what Medicaid allows, and a Medicaid-participating provider must accept the Medicaid payment, plus any required cost sharing, as payment in full.1,11 The home must also post, and give you orally and in writing, information on how to apply for Medicaid and how to get refunds for earlier payments the benefits cover. Ask for that information on admission day, and keep every receipt for what your parent pays while the application is pending.1

The Screening That Comes Before Admission

Preadmission Screening and Resident Review, the federal Medicaid PASRR requirement, applies to people with mental illness or an intellectual disability who apply to a Medicaid-certified nursing home, whoever is paying. At Level I, the state's program must identify everyone suspected of having a serious mental illness or an intellectual disability; Level II evaluates and determines whether nursing home services and specialized services are needed.12

There's one carve-out families leaving a hospital should know. Preadmission screening isn't required for an "exempted hospital discharge," which needs all three: your parent goes straight from acute inpatient hospital care to the nursing home, needs nursing home care for the condition treated in the hospital, and has a doctor who certified before admission that the stay is likely to be under 30 days. If a parent admitted as an exempted hospital discharge turns out to need more than 30 days of nursing home care, the state mental health or intellectual disability authority must conduct a resident review within 40 calendar days of admission.12

How Long the Medicaid Decision Takes

Waiting is the hardest part, so here are the outer limits. Under 42 CFR 435.912, the state's decision may not take longer than 90 days for someone applying on the basis of disability, and 45 days for everyone else. Those limits bend in "unusual circumstances," for example when an applicant or examining doctor delays a required step, or during an emergency beyond the agency's control, and the agency must document the reason for any delay. It can't use the time limit as a waiting period or as a reason to deny.2

Answer every request from the agency quickly: an applicant's delay or failure to take a required action is one of the unusual circumstances that can stretch the time limit.2

If your parent can't manage the paperwork, a power of attorney or guardian is treated as an authorized representative, and the state must also let your parent name someone to help with the application. Our guide to becoming a Medicaid authorized representative explains how.13

The Look-Back on Gifts and Transfers

The state will also check whether your parent gave away assets or sold them for less than fair market value. Under the federal rule, the look-back for nursing home care covers 60 months before the date your parent was both living in the home and had applied for Medicaid. A transfer for less than fair market value can make your parent ineligible for Medicaid nursing home coverage for a penalty period. California's rule differs: effective January 1, 2026, Medi-Cal uses a 30-month look-back for nursing home care and counts only transfers made on or after that date. Confirm your state's rule with your state Medicaid agency, and see how the look-back period works.14

If Medicaid Is Approved

Approval can reach backward. Under 42 CFR 435.915, the federal default is that the state must make Medicaid eligibility effective no later than the third month before the month of application, if your parent received covered services during that period and would have been eligible then. A Section 1115 waiver can shorten a state's window, and your state's Medicaid plan sets the date coverage takes effect, so confirm yours with your state Medicaid agency. For applications filed on or after January 1, 2027, federal law shortens Medicaid's retroactive window to one month before the application month for Affordable Care Act (ACA) Medicaid enrollees and two months for all other applicants. Our guide to Medicaid retroactive eligibility covers the details.3

After approval, your parent's income goes toward the cost of care after the personal needs allowance and other deductions. Federal law guarantees a personal needs allowance of at least $30 a month, and states may set it higher (Tennessee's is $70). See how the personal needs allowance works.3

If Medicaid Is Denied After Admission

A denial is frightening, but it doesn't mean your parent has to leave tomorrow. Federal rules allow a discharge for nonpayment only in narrow terms: when the resident doesn't submit the paperwork for third-party payment, or after Medicare or Medicaid denies the claim and the resident refuses to pay.1 The CMS guidance to inspectors says a resident can't be discharged for nonpayment while a Medicaid eligibility decision is pending.1

If the denial stands and your parent refuses to pay, the home can move to discharge for nonpayment after reasonable and appropriate notice. That ground applies to a stay that hasn't been paid for by your parent or under Medicare or Medicaid, so days Medicare already paid for aren't part of it. As at admission, the home may not request or require a third-party guarantee of payment as a condition of continued stay, so have any guarantor wording you signed reviewed before you pay.1 Our guide on whether you're responsible for a parent's nursing home bill covers what to check.

Your parent has the right to a fair hearing when a Medicaid claim is denied or not acted on with reasonable promptness.15 Federal rules require the state to allow a reasonable time to ask for one, no more than 90 days from the date the notice of action is mailed, and a state can set a shorter window: Georgia, for example, gives 30 days.16 Your deadline is the one your own state sets, which may be well short of 90 days, so ask for a hearing right away; our guide to appealing a Medicaid denial explains the steps.

If the home moves to discharge your parent, federal rules require it to notify your parent and your parent's representative in writing, and the notice generally must come at least 30 days before the discharge. That 30-day minimum has exceptions, and one fits a parent who has just moved in: when a resident hasn't lived in the home for 30 days, notice instead must be made "as soon as practicable" before the discharge. Either way, the notice must include a statement of your parent's appeal rights and the contact details for the state's Long-Term Care Ombudsman, and if your parent appeals the notice, the home may not discharge your parent "while the appeal is pending, pursuant to § 431.230," unless staying would endanger the health or safety of the resident or others in the home.1 Appeal the notice right away. Our guide on discharge when Medicare ends or Medicaid is pending covers that side.

What to Do This Week

If the home pushes back on any of this, the Long-Term Care Ombudsman Program can help. It operates in every state under the federal Older Americans Act, and it identifies, investigates and resolves complaints made by or on behalf of residents.17 The federal Administration for Community Living notes, "You can find your state's LTC Ombudsman." The National Consumer Voice for Quality Long-Term Care runs a directory where you click on your state for contact information.17 To reach your state's Medicaid agency, start with our guide to applying for Medicaid in your state.

Learn More

Find personalized help getting your parent into a nursing home while Medicaid is pending at brevy.com.

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.