Facility Resources
Supporting clearer conversations around Medicaid eligibility.
If you're a family member looking for guidance, start with Pathways.
Why This Exists
Families often ask Medicaid questions at moments when decisions already feel urgent. This site was created to explain common eligibility misunderstandings in a clear, structured way so conversations can begin with better information, fewer assumptions, and less confusion.
When families ask about Medicaid, staff can show them this page and let them start with the question that sounds closest to what they are hearing.
How the Main Site Is Organized
The main site is organized around the Medicaid questions families ask most often, including whether assets must be spent down, whether income is too high, and whether medical eligibility is required. Each pathway is intended to provide orientation first, so families can better understand the issue in front of them before deciding what kind of help may be needed.
This resource is designed so staff do not need to interpret Medicaid rules or give legal guidance themselves.
How We Keep the Process Predictable
When families receive clear information early, decisions tend to become more orderly and less reactive. Our role is to help bring structure to situations that often feel uncertain at the outset.
- Structured review to identify key facts and priorities first
- Support with retroactive coverage and appeals when appropriate
- Consent-based updates so communication remains clear and coordinated
- Coordinated internal workflow across legal, planning, and case support
Pathway Reference Poster
We provide a printed reference poster with QR codes linked to the main pathway questions on the site. It is intended to give families quick access to clear explanations when the same concerns arise repeatedly. We are also happy to provide and install a copy upon request.
Current Eligibility Snapshot
Effective January 1, 2026
For quick reference, 2025 and 2026 figures are shown side by side. Figures should be confirmed before action is taken.
The home may be treated differently depending on the situation.
Medicaid
| Figure | 2025 | 2026 |
|---|---|---|
| Medicaid Single Income Cap | $2,901 | $2,982 |
| Medicaid Couple Income Cap (if both eligible) | $5,802 | $5,964 |
| Protected Resource Amount Minimum | $31,584 | $32,532 |
| Protected Resource Amount Maximum | $157,920 | $162,660 |
| Spousal Monthly Needs Allowance | $3,948 | $4,066.50 |
| Personal Needs Allowance | $75 | $75 |
| Transfer Penalty Divisor | $242.13/day | $262.37/day |
Medicare Quick Reference
| Figure | 2025 | 2026 |
|---|---|---|
| Part B Monthly Premium | $185 | $202.90 |
| Skilled Nursing Facility Copayment (per day) | $209.50 | $217 |
| Hospital Stay Deductible (first 60 days) | $1,676 | $1,736 |
| Hospital Copayment, Days 61–90 (per day) | $419 | $434 |
| Hospital Copayment, Days 91–150 (per day) | $838 | $868 |
| Part B Annual Deductible | $257 | $283 |
Educational Availability
We are available to provide brief educational sessions for staff on common Medicaid misconceptions, general eligibility updates, and related process questions.
A Coordinated Team Approach
Medicaid planning often involves legal, financial, medical, and administrative questions at the same time. Our team works in a coordinated way to maintain clear documentation, consistent communication, and steady follow-through throughout the process.
In some situations, it may help to suggest speaking with a Medicaid planning attorney:
- Medicare coverage is ending or entering copay days, and the family may soon need to begin paying out of pocket—especially if it does not appear the person will be able to safely return home
- the family is considering long-term care for a loved one and has concerns about how care will be paid for
- the family is expressing questions or concerns like those addressed in the Medicaid Pathways, such as whether they have to spend everything, what happens when Medicare ends, or whether the person qualifies medically
In these situations, a short conversation can help the family understand what to clarify first and how to avoid rushed or unnecessary decisions.