If you are reading this, someone you love needs nursing home care and the money is not there. You may have been told there are no options. That is not true.
The United States has a public safety net that covers nursing home care for people who cannot pay for it. The system is difficult to navigate, slow to respond, and not designed around the urgency you are feeling right now. But it exists, and it works, and approximately 63% of all nursing home residents in this country have their care paid for through public programs. Most of them were not born poor. They arrived at this point the same way your family may have — through the accumulated cost of aging, illness, and a healthcare system that costs more than almost anyone can sustain.
Here is what is available, how to access it, and what to do in the next 72 hours.
The first thing to know: a nursing home cannot turn you away because you can't pay
Federal law provides protections that many families do not know exist. If your family member is already in a nursing home or is being discharged from a hospital to one, two rules matter immediately:
A nursing home cannot discharge or transfer a resident solely because they have run out of money — provided the resident is applying for or has applied for Medicaid. Federal regulations at 42 CFR § 483.15(c) limit the grounds for involuntary discharge to medical necessity, the resident's welfare, the safety of other residents, or nonpayment — but nonpayment does not apply when a Medicaid application is pending. The facility must continue providing care during the application process.
Hospitals cannot discharge a patient to the street because they lack nursing home funding. Hospital discharge planning must include identifying appropriate placement and helping arrange payment. If a hospital is pressuring your family to accept discharge without a viable care plan, you have the right to appeal through Medicare's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) — the hospital is required to give you this information.
These protections do not solve the financial problem permanently. They buy time. And time is what you need to activate the programs described below.
Medicaid: the primary safety net for nursing home care
Medicaid is the program that pays for long-term nursing home care when personal resources are exhausted. It covers room, board, nursing care, medications, therapy, and personal care — with no time limit. Understanding the application process and timeline is critical when money has already run out.
You may qualify right now
If your family member has $2,000 or less in countable assets (the limit in most states) and income below approximately $2,982 per month (2026), they likely qualify for Medicaid nursing home coverage. The asset limit is for countable resources — bank accounts, investments, CDs. It does not include the primary home (up to an equity limit of $752,000 to $1,130,000 depending on the state), one vehicle, personal belongings, prepaid burial arrangements, or a small burial fund.
Social Security income, pension income, and other monthly payments are not barriers to eligibility — they are counted as income, and most of that income will go to the nursing home as the resident's contribution toward care. But having income does not prevent qualification. In medically needy states (including North Carolina, New York, California, Pennsylvania, and 21 others), excess income is simply applied to the cost of care. In income-cap states (including Florida, Texas, Georgia, and 22 others), income above $2,982/month requires a Miller Trust — a straightforward legal document that an elder law attorney can prepare, often for $500 to $1,500.
Apply immediately — do not wait
The single most important step is to file the Medicaid application as soon as possible. Here is why:
Retroactive coverage. Medicaid can cover up to three months of nursing home costs before the application date (reduced to 60 days for non-expansion enrollees starting in 2027). Every day of delay potentially loses a day of retroactive coverage.
Processing time is 45 to 90 days. Medicaid applications are not approved instantly. The sooner you file, the sooner coverage begins. Filing with incomplete documentation is better than waiting until everything is perfect — submit what you have and provide additional documents as they are gathered.
Medicaid pending status protects the resident. Once an application is filed, the resident has "Medicaid pending" status. The nursing home cannot evict the resident during this period, and once approved, Medicaid reimburses the facility retroactively.
Contact your state Medicaid office or local Department of Social Services to begin the application. In North Carolina, applications are processed through the county Department of Social Services. Many hospitals and nursing homes have social workers who can help initiate the process — ask for this help explicitly.
For complete Medicaid eligibility rules, spousal protections, and the look-back period, see: Does Medicaid Pay for Nursing Home Care?
VA benefits: if the person is a veteran or the spouse of one
If the person needing care served in the military during a wartime period — or is the surviving spouse of someone who did — benefits may be available that many families never learn about.
Aid and Attendance is a tax-free monthly pension benefit of up to $2,874 per month (2026, veteran with one dependent) or $1,558 per month (surviving spouse). It requires wartime-era service (at least 90 days active duty with one day during a recognized wartime period), other-than-dishonorable discharge, a medical need for assistance with daily activities, and a net worth below $163,699 (a far more generous limit than Medicaid's $2,000).
A veteran or surviving spouse with minimal assets and a need for nursing home care will almost certainly meet the financial threshold. The medical threshold is met by anyone in a nursing home.
VA nursing home programs provide direct care — potentially at no cost — for veterans with a service-connected disability rating of 70% or higher, or those who need care for a service-connected condition. Community Living Centers (VA-run facilities), State Veterans Homes, and contract nursing homes are additional pathways.
Application takes 3 to 6 months to process, but benefits are retroactive to the filing date. File as soon as possible. Veterans Service Organizations — the American Legion, VFW, DAV, and state veterans service offices — provide free assistance with applications and can dramatically improve the speed and accuracy of the process.
VA and Medicaid can be received simultaneously. A veteran on Medicaid who also receives Aid and Attendance has more total support available. The programs are not mutually exclusive.
For the complete guide to VA benefits for nursing home care, including eligibility details and application forms, see: Nursing Home Care for Veterans: A Guide to VA Benefits
What to do in the next 72 hours
If someone needs nursing home care now and there is no money to pay, this is the immediate action plan:
Day 1: File the Medicaid application. Contact the county Department of Social Services (or equivalent in your state). If the person is in a hospital, ask the hospital social worker to help. If they are at home, call Medicaid directly. Do not wait for every document to be ready — file the application to establish the date and submit supporting documentation as it becomes available.
Day 1: Ask about Medicaid pending admission. If the person needs to be admitted to a nursing home, call facilities in your area and ask whether they accept Medicaid and whether they will admit a patient with a Medicaid application pending. Not all facilities accept Medicaid, and among those that do, some limit the number of Medicaid beds. Ask directly.
Day 1: Check veteran status. If the person or their deceased spouse served in the military, check eligibility for VA benefits. Contact your state's Department of Veterans Affairs or a local Veterans Service Organization. Locate the DD-214 (discharge papers) — if it has been lost, request a copy from the National Personnel Records Center at archives.gov/veterans/military-service-records.
Day 2: Gather financial documents. Medicaid will require bank statements (60 months of history in most states), income documentation (Social Security award letter, pension statements), property deeds, vehicle titles, insurance policies, and records of any asset transfers. Start gathering these now. If the person is incapacitated, you will need a power of attorney or guardianship to access their financial records.
Day 3: Consult an elder law attorney. Many elder law attorneys offer free or low-cost initial consultations. Even in crisis situations, there may be legitimate strategies to accelerate eligibility or protect remaining assets. If a Miller Trust is needed (in income-cap states), an attorney can prepare one quickly. If there are asset protection opportunities — exempt asset conversions, spousal protections, caregiver child exemptions — an attorney can identify them. The National Academy of Elder Law Attorneys maintains a directory at naela.org.
If the cost of an attorney is itself a barrier, legal aid organizations in most states provide free assistance with Medicaid applications and elder law issues. Contact your state bar association's lawyer referral service or the Legal Services Corporation at lsc.gov.
Hill-Burton facilities: a federal obligation most people have never heard of
In 1946, Congress passed the Hill-Burton Act, which provided federal funding for hospital and nursing home construction across the country. In exchange for that funding, participating facilities agreed to provide a certain amount of free or reduced-cost care to people who could not afford to pay. Those obligations are ongoing.
Approximately 170 facilities nationwide still carry Hill-Burton obligations. They are required to provide free care to individuals with income below 200% of the federal poverty level and reduced-cost care for those below 300% FPL (the nursing home threshold). For 2026, 300% FPL for an individual is approximately $59,160 per year.
Hill-Burton care is not widely publicized — many facilities with active obligations do not prominently advertise the program. You can search for obligated facilities near you using the federal facility finder at hrsa.gov/get-health-care/affordable/hill-burton/facilities. If a facility on the list is a nursing home or has a nursing home component, contact them directly and ask about Hill-Burton obligations for long-term care.
This is not a comprehensive solution — the number of obligated nursing homes is small and their geographic distribution is uneven. But for families in areas with an obligated facility, it represents a legal right to care that exists independent of Medicaid.
Nonprofit and faith-based nursing homes
Nursing homes operated by religious organizations and nonprofit entities sometimes offer what private, for-profit facilities do not: charitable care programs, sliding-scale fees, and endowment-funded beds for residents who cannot pay.
Catholic Charities, Lutheran Services of America, the United Methodist Church, Jewish Family Services, and other faith-based organizations operate skilled nursing facilities across the country. Many of these have formal charity care policies — written programs that allocate a percentage of beds or a portion of the operating budget to residents who do not qualify for Medicaid but cannot afford private pay. Others make case-by-case determinations based on the resident's circumstances.
Contact these organizations directly. Ask specifically: do you have a charity care program? Do you have beds available for residents who cannot pay? What is the application process? The answer varies by facility, by region, and by the organization's financial position — but asking costs nothing and the answer may change everything.
PACE: comprehensive care designed to avoid nursing homes
The Program of All-Inclusive Care for the Elderly (PACE) is not a nursing home payment program — it is an alternative to nursing home placement entirely. But for families with no money and a loved one who may not need 24-hour institutional care, it deserves serious consideration.
PACE provides medical care, adult day services, home care, prescription drugs, meals, transportation, and social services through a coordinated interdisciplinary team. Participants must be 55 or older, live in a PACE service area, and be certified as needing a nursing home level of care.
For Medicaid-eligible participants — which includes most people with no money — PACE is free. No premiums, no copays, no deductibles. The program covers everything, and its entire purpose is keeping people out of nursing homes while providing the same level of comprehensive care.
PACE is not available everywhere — approximately 155 organizations operate in 33 states — but where it exists, it is the single most comprehensive free care option available. Find PACE programs at medicare.gov/care-compare by searching for PACE plans in your area.
Medicaid home and community-based waivers
If the person needing care could remain at home or in a community setting with the right support, Medicaid HCBS waivers may provide it. These waivers fund personal care services, home health aides, adult day care, respite care, home modifications, and other support services that allow people to avoid or delay nursing home placement.
Eligibility requirements are generally the same as Medicaid nursing home coverage — the person must meet income and asset limits and require a nursing home level of care. The difference is that care is delivered in the home or community rather than an institution.
The limitation is wait lists. Many states have significant waiting lists for HCBS waivers — sometimes months or years. Applying early is essential even if the immediate plan is nursing home placement, because a waiver slot that opens later may allow the person to transition back to a community setting.
Contact your state Medicaid office and specifically ask about HCBS waivers for long-term care. In North Carolina, the relevant programs include the CAP/DA (Community Alternatives Program for Disabled Adults) waiver.
Social Security: what it can and cannot do
Social Security benefits cannot cover nursing home costs — the average monthly benefit of approximately $2,076 in 2026 covers roughly 20% of the median semi-private room rate. But Social Security income is important in two ways for families with no money:
It contributes to the cost of care under Medicaid. When a person is on Medicaid in a nursing home, nearly all Social Security income goes to the facility as part of the patient liability contribution. This is not optional — but it means the person's Social Security is already being applied toward care. The resident retains only the Personal Needs Allowance ($30 to $200 per month depending on the state).
SSI recipients face a reduction. If the person receives Supplemental Security Income (SSI) rather than retirement benefits, SSI is reduced to $30 per month when Medicaid covers more than 50% of care for stays exceeding 90 days. This is the federal personal needs allowance, and it is all the SSI recipient has for personal expenses.
Social Security cannot be garnished by a nursing home to collect unpaid bills. If a family member is being pressured to pay a nursing home bill from their own Social Security — rather than the resident's — they are not legally obligated to do so unless they signed a personal guarantee at admission. Read admission contracts carefully, and do not sign personal financial responsibility clauses.
For the full analysis of how Social Security interacts with nursing home costs, see: Does Social Security Cover Nursing Home Costs?
What families should not do
Crisis creates pressure to make fast decisions. Some of those decisions can make the situation worse.
Do not give away assets to qualify for Medicaid faster. Medicaid's 60-month look-back period means that any gifts or below-market transfers made within the past five years will trigger a penalty period during which Medicaid will not cover care. A family that gives away $50,000 to meet the $2,000 asset limit creates a penalty that leaves the applicant with no money and no Medicaid coverage for months. If assets need to be spent down, spend them on legitimate expenses — medical bills, home repairs, debt payments, prepaid burial arrangements — not gifts.
Do not hide assets. Medicaid applications require full financial disclosure, and the 60-month review of bank statements, tax returns, and property records is thorough. Hiding assets is fraud, and it results in denial of the application, potential criminal penalties, and the loss of the time spent on the application. If there are assets that need to be addressed — retirement accounts, partial interests in property, small inheritances — an elder law attorney can help structure them legally.
Do not sign a personal financial guarantee at the nursing home. Federal law prohibits nursing homes from requiring a third party to guarantee payment as a condition of Medicaid-funded admission. If you are signing admission paperwork for a family member, read every document carefully. You may be asked to serve as the resident's "responsible party" — which involves administrative and communication duties — without being financially liable. The distinction matters. Do not agree to personal financial responsibility for the bills.
Do not assume no one will help. Hospital social workers, nursing home social workers, county departments of social services, Area Agencies on Aging, and legal aid organizations all exist specifically to help families in this situation. The system is fragmented and difficult to navigate — but there are people within it whose job is to help you navigate it. Ask for help. Be specific about what you need. Follow up.
A word about dignity
The financial system around nursing home care is, by almost any measure, broken. It requires families to impoverish themselves before public help becomes available. It pays nursing homes at rates that barely cover the cost of care. It reduces a person's entire monthly income to a personal needs allowance that has not increased at the federal level since 1987.
None of that diminishes the person who needs care, or the family that is trying to provide it.
An analysis of 12,079 verified Google reviews from 312 nursing and care facilities found that the reviews written by families navigating Medicaid transitions and financial hardship are among the most emotionally raw in the entire dataset. They describe not just the stress of the financial situation, but the fear that their loved one will receive lesser care because of how the bill is being paid. That fear is not always unfounded — but the data also shows that many facilities provide excellent care to Medicaid residents, and that the quality markers NursingHomeIQ tracks — staffing levels, inspection results, food quality, responsiveness — are available regardless of payment source.
The person who enters a nursing home on Medicaid deserves the same quality of care as the person who pays $15,000 a month out of pocket. Federal law requires it. The data shows that some facilities deliver on that requirement and others do not. NursingHomeIQ exists to help you tell the difference — because the decision you are making right now, under the hardest possible circumstances, deserves better information than a star rating.
Immediate resources:
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Your county Department of Social Services (for Medicaid applications)
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National Academy of Elder Law Attorneys: naela.org
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Legal Services Corporation (free legal aid): lsc.gov
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Hill-Burton facility finder: hrsa.gov/get-health-care/affordable/hill-burton/facilities
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PACE plan finder: medicare.gov/care-compare
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VA benefits: va.gov/pension/aid-attendance-housebound
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Military records: archives.gov/veterans/military-service-records
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Medicare discharge appeal (BFCC-QIO): medicare.gov/claims-appeals/your-right-to-a-fast-appeal
Related articles:
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Does Medicaid Pay for Nursing Home Care? — complete eligibility rules and spousal protections
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Nursing Home Care for Veterans: A Guide to VA Benefits — full VA benefits guide
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How to Pay for a Nursing Home: Your Options Explained — every payment source available
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Does Social Security Cover Nursing Home Costs? — how benefits apply under Medicaid
NursingHomeIQ provides information to help families navigate nursing home decisions. This article is for educational purposes and does not constitute legal or financial advice. Consult qualified professionals for guidance specific to your situation.