What exactly does Medicare cover for skilled nursing?

Medicare Part A covers a stay in a Medicare-certified skilled nursing facility after a qualifying three-night inpatient hospital stay, for a maximum of 100 days per benefit period. Days 1 through 20 are paid in full. Days 21 through 100 require a daily co-pay (around $217.50 per day in 2026, indexed annually). After day 100, Medicare pays $0 for the SNF stay, regardless of medical need. The benefit resets after 60 consecutive days out of the SNF and out of the hospital.

What happens on day 101?

If the patient still needs nursing-home level care, the family has three realistic options. Pay privately ($10,000 to $15,000+ per month in California). Apply for Medi-Cal long-term care (covers room, board, and nursing for eligible members). Move the patient home with IHSS, family care, and possibly hospice if appropriate. Most families end up at Medi-Cal long-term care, and starting that application before day 100 is critical because eligibility takes weeks to determine.

Did Medi-Cal really eliminate the asset limit?

Yes, for the non-MAGI Medi-Cal categories (aged, blind, and disabled, including long-term care), the asset limit was eliminated as of January 1, 2024. Members do not have to spend down assets to qualify. Income still matters, and members with income above the threshold pay a monthly share of cost to the nursing home before Medi-Cal pays. This is one of the biggest changes in California Medi-Cal in decades and is widely misunderstood.

What is share of cost?

If the member's monthly income exceeds the Medi-Cal long-term care income limit, the member pays the difference between their income and a small personal-needs allowance ($35 per month for a nursing-home resident in 2026) to the nursing home each month as their share of cost. Medi-Cal pays the rest. So a member with $4,000 monthly income in a nursing home pays roughly $3,965 of it to the facility each month and Medi-Cal covers the balance.

What about the spouse still living at home?

Spousal impoverishment rules protect the community spouse. In 2026 the at-home spouse can retain a Community Spouse Resource Allowance (CSRA) of up to about $157,920 in countable assets without affecting the institutionalized spouse's eligibility, plus the home, one car, and personal belongings. The at-home spouse also has a Minimum Monthly Maintenance Needs Allowance, currently around $3,948, of income they can keep. These figures index annually.

Will Medi-Cal take the house?

California limits Medi-Cal estate recovery to probate assets only, since a 2017 state law. A home that passes outside probate (through a living trust, joint tenancy with right of survivorship, a Transfer on Death deed, or to a surviving spouse) is generally protected from estate recovery. This is significantly more protective than estate recovery in most other states. Consult an elder law attorney for the specific household.

How do I choose a nursing facility?

Use Medicare Care Compare for the Five-Star Quality Rating (overall, health inspection, staffing, quality measures), filtered to your area. CDPH publishes California-specific deficiency reports. Visit the building twice (once announced, once unannounced if possible), pay attention to staffing on the floor, ask the same question of three different staff to test consistency, and look at the residents to gauge dignity and engagement. Five-star is a useful filter, not a guarantee.

Long-term skilled nursing: life after Medicare's 100 days

Long-term skilled nursing in California: what happens after Medicare's 100 days.

Medicare Part A pays for up to 100 days in a skilled nursing facility per benefit period, with co-pays starting day 21. After day 100, Medicare stops. Medi-Cal long-term care covers room, board, and nursing care for eligible Californians. Since 2024, Medi-Cal has no asset limit for the aged, blind, and disabled, though income tests and share-of-cost rules still apply. Spousal impoverishment rules protect the at-home spouse. California limits estate recovery to probate-only assets.

The Medicare SNF benefit, briefly

Medicare Part A pays for a stay in a Medicare-certified skilled nursing facility after a qualifying three-night inpatient hospital stay, up to 100 days per benefit period. The first 20 days are paid in full. Days 21 to 100 carry a daily co-pay (around $217.50 per day in 2026). Day 101 is the cliff. Medicare stops, the daily rate at the facility (around $11,000 to $15,000 per month in California in 2026) becomes the family’s responsibility, and the patient either pays privately, transitions to Medi-Cal, or moves home.

The benefit also ends earlier if the patient stops needing skilled care. A patient who plateaus in therapy at day 45 can be discharged from the SNF benefit at day 45. Medicare does not pay for “maintenance” care; it pays for measurable improvement or skilled medical management of a condition.

What Medi-Cal long-term care covers

Medi-Cal’s long-term care benefit pays for room, board, nursing care, ADL assistance, medication, and routine medical supplies in a CDPH-licensed nursing facility, indefinitely, for eligible members. There is no time limit, no co-pay beyond the share of cost, and no requirement that the patient be improving. The benefit is designed for residents who need 24-hour nursing oversight that cannot be safely provided at home.

The 2024 asset-limit elimination changes the playbook

Until 2023, Medi-Cal applicants had to demonstrate countable assets below a very low threshold (originally $2,000 for an individual). Many California families spent down or sheltered assets through an elder law attorney to qualify. As of January 1, 2024, the asset limit for non-MAGI Medi-Cal categories, including long-term care, was eliminated. Members can own assets of any value and still qualify for Medi-Cal long-term care based on categorical and income criteria.

Income still matters. A member with significant monthly income (pension, Social Security, IRA distributions) will pay a monthly share of cost equal to income minus the personal-needs allowance, with Medi-Cal paying the rest of the facility bill. For most California seniors with typical retirement income, the share of cost is several thousand dollars per month, and the facility cost often exceeds the share of cost by another several thousand.

Spousal protections

When one spouse enters long-term care and the other stays at home, federal spousal impoverishment rules protect the community spouse. The at-home spouse keeps:

The home, regardless of value, as long as the at-home spouse lives there.
One car, regardless of value.
Personal belongings and household goods.
A Community Spouse Resource Allowance of countable assets, up to about $157,920 in 2026 (indexed annually).
A Minimum Monthly Maintenance Needs Allowance of income, around $3,948 per month in 2026.

These rules let the at-home spouse continue living a normal life without being impoverished by the institutionalized spouse’s nursing-home stay.

California's narrow estate recovery

Most states recover Medi-Cal costs after the member’s death from any asset the member owned. California limits recovery to probate assets only, since a 2017 state law. A home that passes through a living trust, joint tenancy with right of survivorship, a Transfer on Death deed, or directly to a surviving spouse is generally outside probate and outside recovery. This is meaningfully more protective than most states and changes the calculation for California families considering long-term Medi-Cal.

An elder law attorney can confirm the specific titling and recommend adjustments before the member enters long-term care. The cost of a one-time consultation ($300 to $1,000) is small compared with the value of the home.

How to transition from Medicare day 100 to Medi-Cal

Start the Medi-Cal long-term care application by day 60 of the Medicare stay at the latest. The application takes weeks to process. Starting late means paying privately at $400 to $500 per day while waiting.
Submit through the county Department of Social Services or the local county Medi-Cal office. The facility’s social worker usually helps.
Provide documentation: identity, Social Security, immigration status (if applicable), proof of California residence, income statements, asset statements (still required even though no asset limit), and the medical certification of need for long-term care.
Once approved, the facility bills Medi-Cal directly and the member pays only the monthly share of cost.

How to choose a facility

Use Medicare Care Compare to filter by Five-Star Quality Rating. Avoid one-star and two-star facilities unless there is no alternative. Read the CDPH deficiency reports for any facility under consideration. Visit twice and pay attention to staffing, smell, noise, the demeanor of staff with residents, and the appearance of residents who are not actively being engaged with.

Ask the facility administrator: what is your staffing ratio on the day shift and the night shift, what is your annual staff turnover rate, what is your average length of stay, do you accept Medi-Cal residents at admission or only after Medicare conversion, and do you have a Medi-Cal bed available now.

Common misconceptions to clear up

“Medicare will cover the nursing home if my parent still needs care after day 100.” It will not. Medicare ends at day 100 regardless of medical need.

“Medi-Cal will take my parent's house.” Not while a spouse lives there, and California limits recovery to probate assets, which good titling usually avoids.

“We have to spend down to $2,000 to get Medi-Cal.” Not since 2024. The asset limit was eliminated for the aged, blind, and disabled Medi-Cal categories.

“The facility will move my parent if we run out of money.” A facility cannot involuntarily discharge a Medi-Cal-eligible resident because they have transitioned from private pay to Medi-Cal. The facility can decline to admit a Medi-Cal applicant in the first place, which is why some families choose Medi-Cal-friendly facilities from the start.

Related services and next steps

This guide explains coverage and eligibility, not medical advice. Talk to a licensed clinician about care decisions. California Care Compass does not place referrals on Services & Treatments pages.