What Happened?

More than 14,693 nursing homes across the U.S. rely on Medicare and Medicaid to keep their doors open, according to a Congressional Research Service (CRS) report. As of July, 14,693 long-term care facilities with more than 1.5 million certified beds participated in one or both programs. Americans spent $229.7 billion on nursing home services in 2024. Medicare and Medicaid together covered $136 billion of that, or about 59 cents of every dollar spent. [](#ngr-84838881-1530-4ba0-90fd-9ea91cfa6e70)

Why Does it Matter to Me?

If you or a family member ever needs nursing home care, the odds are high that one of these two government programs will pay for most of it. As of July 2025, Medicaid was the primary payer for 63 percent of nursing home residents. Medicare covered 14 percent. Private pay and other sources covered the remaining 23 percent.

Medicare coverage for a nursing home stay comes with conditions. A patient generally must have spent at least three consecutive days in a hospital first. Medicare then covers up to 100 days of skilled nursing care per benefit period, but starting on day 21, patients owe $217 per day out of pocket. Medicaid kicks in for many people after their personal savings run out. States must cover nursing facility services for Medicaid enrollees age 21 and older, using health and functional criteria to determine who qualifies.

Both Sides, Now

The CRS report describes the current system without recommending changes. Congress has the power to alter Medicare and Medicaid payment rules, coverage requirements, and oversight standards for nursing homes through legislation. Supporters of the current federal oversight structure point to requirements covering resident rights, staffing levels, and quality of care that all participating facilities must meet. State agencies conduct certification surveys and unannounced inspections to enforce those rules. Federal law allows financial penalties for facilities that fall short.

Critics of nursing home regulation have argued that federal requirements can burden smaller facilities. Some advocates for residents counter that enforcement is inconsistent and that more oversight is needed, particularly for facilities with repeated violations. Facilities with a history of poor inspections can be placed in the Special Focus Facility program, which subjects them to additional federal scrutiny. The Centers for Medicare and Medicaid Services (CMS) published its most recent list of those facilities in August.

What Happens Next?

Congress is weighing potential changes to both Medicare and Medicaid as part of ongoing budget negotiations. Any cuts or restructuring to either program could affect how much nursing homes receive per resident, which facilities stay open, and what patients pay out of pocket. No specific nursing home legislation is scheduled for a floor vote. The CMS continues to update its Special Focus Facility list and conduct oversight under existing rules. Families researching nursing home options can check inspection records through CMS's care comparison tools.

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