Does Medicare Pay for Nursing Home Care in California? Medicare vs. Medi-Cal for Long-Term Care
Educational guide for California families facing a nursing home stay. This article is not legal advice and not a Medicare or Medi-Cal eligibility determination.
As of: October 14, 2026 (PT). Medicare cost-sharing changes every year, and California's Medi-Cal asset rules changed in 2026 with another change scheduled for 2027. Confirm current figures with Medicare.gov, DHCS, and your county Medi-Cal office.
At a glance
- Medicare SNF coverage is for skilled care (for example, daily skilled nursing or therapy), not long-term custodial care.
- A qualifying 3-day inpatient hospital stay is generally required. Time under "observation" does not count.
- 2026 SNF coinsurance: $0 for days 1 to 20; $217/day for days 21 to 100; all costs after day 100 (CMS).
- Medi-Cal can cover long-term nursing home care for people who qualify.
- Medi-Cal asset limit: $130,000 for one person plus $65,000 for each additional household member, through June 30, 2027. DHCS lists $21,000 for one person and $31,000 for two, plus $1,550 per additional member, starting July 1, 2027.
- 30-month lookback for nursing home care: transfers for less than value made on or after January 1, 2026 may delay coverage.
On this page
- At a glance
- Quick answer: does Medicare pay for nursing home care?
- What is the difference between skilled care and custodial care?
- How long does Medicare pay for skilled nursing care?
- What is Medicare's 3-day inpatient stay rule?
- How is Medicare Advantage different?
- When does Medi-Cal step in for nursing home care?
- What is the Medi-Cal 30-month lookback?
- Does Medi-Cal take your house?
- Should you plan ahead or wait for a crisis?
- How can CBM help?
- Frequently asked questions
- What sources does this guide rely on?
- How do I book a free 60-minute consultation?
Quick answer: does Medicare pay for nursing home care?
Only for short-term skilled care, and only under conditions. Original Medicare Part A can cover up to 100 days of skilled nursing facility (SNF) care per benefit period after a qualifying inpatient hospital stay of at least 3 days in a row. In 2026 you pay $0 for days 1 to 20 and $217 per day for days 21 to 100. After day 100, you pay all costs.
Medicare does not pay for long-term custodial care, such as help with bathing, dressing, and eating, when that is the main care you need. For many Californians, long-term nursing home care is paid privately, by long-term care insurance, or by Medi-Cal for those who qualify.
What is the difference between skilled care and custodial care?
Skilled care requires trained medical professionals: for example, intravenous medications, wound care, or physical therapy after surgery or a stroke. Medicare.gov describes SNF coverage as care for people whose doctor decides they need daily skilled care.
Custodial care (also called long-term care) is mostly non-medical help with activities of daily living, such as dressing, bathing, and using the bathroom. Medicare.gov states plainly: "Medicare doesn't pay for long-term care." Medigap policies generally do not pay for it either.
The same nursing home can provide both. What matters for Medicare is the type of care you need, not the building.
How long does Medicare pay for skilled nursing care?
Under Original Medicare Part A, SNF coverage is limited to 100 days per benefit period, and only while you continue to need and receive daily skilled care. What you pay in 2026, per CMS and Medicare.gov:
| Days in a benefit period | What you pay (2026) |
|---|---|
| Days 1 to 20 | $0 per day (after the Part A deductible, if not already paid during the hospital stay) |
| Days 21 to 100 | $217 per day |
| Day 101 and beyond | All costs |
The 2026 Part A inpatient deductible is $1,736. Medicare.gov notes you do not pay it again for SNF care if you already paid it for the hospital stay in the same benefit period.
"Up to 100 days" is a ceiling, not a promise. Coverage can end sooner if you no longer need daily skilled care.
What is Medicare's 3-day inpatient stay rule?
Medicare.gov says Medicare covers SNF care only after a qualifying inpatient hospital stay: a medically necessary inpatient stay of at least 3 days in a row, counting the day you are admitted as an inpatient but not the day you leave. Generally you must also enter the SNF within a short time (generally 30 days) of leaving the hospital.
Two practical points:
- Observation status does not count. Time in the emergency room or under observation before formal admission does not count toward the 3 days, even overnight. Ask hospital staff whether you are an inpatient or under observation.
- Some waivers exist. Medicare.gov notes that certain Accountable Care Organizations have an approved "3-Day Rule Waiver."
How is Medicare Advantage different?
If you are in a Medicare Advantage plan, rules can differ. Medicare.gov notes that Advantage plans may charge copayments during the first 20 days of SNF care. Plans may also use prior authorization and their own networks. Check your plan's Evidence of Coverage and call the plan before relying on any assumption.
When does Medi-Cal step in for nursing home care?
Medi-Cal, California's Medicaid program, can cover long-term nursing home care for people who meet its income, asset, and other rules. Medicare.gov notes that while Medicare does not cover long-term care, you may be eligible for it through Medicaid.
DHCS says Medi-Cal began counting assets again on January 1, 2026 for certain groups, including people 65 or older, people with a disability, and people living in a nursing home. Per the DHCS Asset Limit FAQ:
- Through June 30, 2027: $130,000 for one person, plus $65,000 for each additional person in the household (up to 10 people).
- Starting July 1, 2027: $21,000 for one person, $31,000 for two people, plus $1,550 for each additional person (up to 10 people).
DHCS lists the main home where you live, your main vehicle, household items, and retirement funds when you are receiving regular payments as examples of assets that are not counted. Married couples and registered domestic partners may have additional spousal protections. These figures do not tell you whether you qualify. For more detail, see our guide to Medi-Cal lookback and asset limits.
What is the Medi-Cal 30-month lookback?
DHCS says that when a person moves into a nursing home, Medi-Cal looks at assets given away in the 30 months before entering the facility. Transfers made before January 1, 2026 are not counted. Transfers made on or after January 1, 2026 may cause a penalty that delays long-term care coverage.
DHCS lists examples that can be treated differently, including transfers to a spouse, to someone helping a spouse, or to a blind or disabled child, and sales for full value. Do not give away or retitle property based on an online article. The date, value, recipient, and program category all matter.
Does Medi-Cal take your house?
Not during life in the way many people fear, and the answer after death depends on the facts. DHCS says your home generally does not count against you if you plan to return to it, or if your spouse, partner, or a dependent relative lives there.
After death, California limits Medi-Cal estate recovery to certain long-term care related payments and to assets in the probate estate. Property that passes by trust, survivorship, or transfer on death is generally outside that limited estate under DHCS's current description. See our guide to Medi-Cal estate recovery. A properly funded living trust may help avoid probate for trust assets; it is not a guarantee.
Should you plan ahead or wait for a crisis?
Planning ahead usually gives families more options. Once a parent is already in a nursing home, decisions are often made under time pressure. Useful steps include:
- Make sure a durable power of attorney and advance health care directive are in place so someone can act. See our DPOA and health care directive guide.
- Gather statements, deeds, insurance, and records of any gifts or transfers since January 1, 2026.
- Ask whether the stay is inpatient or observation, and what Medicare will cover.
- Get advice before moving money or changing title.
How can CBM help?
CBM Estate & Trust Law helps California families with elder law and Medi-Cal planning conversations, along with estate planning. Carmen B. Marquez has practiced estate planning since 2001, and the firm was founded in 2012. Carmen speaks Spanish. CBM does not offer probate services.
Frequently asked questions
Will Medicare pay for assisted living?
Generally no. Medicare.gov says Medicare does not pay for long-term care, which includes most non-medical help with daily activities in assisted living or a nursing home. Some medical services you receive there may still be covered.
What happens on day 101?
Under Original Medicare, you pay all SNF costs after day 100 in a benefit period. Families then usually pay privately, use long-term care insurance, or apply for Medi-Cal if eligible.
Does Medicare cover the first 100 days in full?
No. In 2026, days 1 to 20 cost $0 (after the deductible, if not already paid), and days 21 to 100 cost $217 per day. Coverage can also end sooner if daily skilled care is no longer needed.
Does observation status count toward the 3-day rule?
No. Medicare.gov says time under observation before formal inpatient admission does not count, even if you stay overnight.
Does Medi-Cal take my house?
Your main home generally is not counted for eligibility if you plan to return or a spouse or dependent relative lives there, per DHCS. Estate recovery after death is limited to the probate estate under DHCS's current description. Review your situation with counsel.
Can I plan if Mom is already in a nursing home?
Often there are still options, but they are fact-specific. Transfers on or after January 1, 2026 may trigger a penalty. Get advice before moving assets.
How do I get help with my family's situation?
Book a free 60-minute consultation with CBM. /contact · (805) 915-4793 · Trusts@cbm.estate
What sources does this guide rely on?
- CMS, 2026 Medicare Parts A & B Premiums and Deductibles (Nov. 14, 2025).
- Federal Register, CY 2026 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts.
- Medicare.gov, Skilled nursing facility care.
- Medicare.gov, Long-term care.
- DHCS, Asset Limit Frequently Asked Questions.
- DHCS, Estate Recovery Program.
How do I book a free 60-minute consultation?
Free 60-minute consultation
/contact · (805) 915-4793 · Trusts@cbm.estate
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Attorney advertising. This guide is general educational information about California law as of the date above. It is not legal advice, does not create an attorney-client relationship, and may not reflect later changes in statutes, forms, or agency guidance. Results depend on your facts; no outcome is guaranteed. CBM Estate & Trust Law (Carmen B. Marquez, P.C.) practices in California only.