When Medicaid pays for a parent's nursing home care, the parent usually pays most of their monthly income to the nursing home, and Medicaid pays the rest. Medicaid.gov calls this the post-eligibility calculation; many states call the amount "patient liability" or "share of cost." Certain amounts are protected first, including a personal needs allowance of at least $30 a month.
How is patient liability figured?
Medicaid.gov explains that the state takes the resident's total income and subtracts certain "protected amounts." What's left goes toward the cost of care. The protected amounts include:
- A personal needs allowance of at least $30 a month. States can set it higher.
- A monthly income allowance for a spouse at home, if the spousal rules apply and the money actually goes to the spouse.
- A family allowance, if other family members live in the household.
- Certain medical expenses not paid by insurance.
Medicaid.gov says this calculation applies only after Medicaid eligibility is set, and mainly to people in nursing facilities.
The state sends a notice with the monthly amount. That number is what the nursing home should bill your parent each month.
What medical expenses can be subtracted?
Under the federal rule at 42 CFR 435.725 (the version for most states), the state subtracts medical costs not paid by a third party, including:
- Medicare and other health insurance premiums, deductibles, and coinsurance.
- Necessary medical care that state law recognizes but Medicaid doesn't cover, within limits the state sets.
So if a parent pays a Part B premium or a supplemental insurance premium, that may lower the patient liability. Tell the Medicaid caseworker about every premium.
Many people with Medicaid also qualify for a Medicare Savings Program that pays the Part B premium. See Medicare Savings Programs.
What's protected for a spouse at home?
If one spouse is in a nursing home and the other lives at home, federal spousal rules protect some income and savings for the spouse at home. CMS's 2026 standards include:
| 2026 federal standard | Amount |
|---|---|
| Minimum monthly maintenance needs allowance (from July 1, 2026, most states) | $2,705.00 |
| Maximum monthly maintenance needs allowance | $4,066.50 |
| Community spouse resource standard (minimum to maximum) | $32,532 to $162,660 |
Alaska and Hawaii have higher minimum allowances. Each state applies these within federal limits, so ask your state Medicaid office for your exact figures.
What should the nursing home bill look like?
Each month, the bill should generally show:
- The patient liability amount from the state notice.
- Medicaid's payment for the rest of the approved rate.
- Any extras your parent chose that Medicaid doesn't cover, with prices agreed in advance.
It shouldn't show the facility's full private-pay rate for months Medicaid covered.
What if Medicare covered part of the month?
If your parent had a Medicare-covered skilled nursing stay after a hospital stay, Medicare pays first for those days. Days 1–20 cost $0 under Original Medicare, and from day 21 there's a daily coinsurance ($217 in 2026). Medicaid may cover that coinsurance for people with both programs. See the $217-a-day coinsurance and who covers it and dual eligible: who pays.
Ask the business office how it's handling patient liability for months when Medicare paid for some days. States handle this differently.