Short answer: Medicare pays first for a qualifying skilled nursing facility stay: for 2026, $0 per day for days 1 to 20 after the $1,736 deductible and $217 per day coinsurance for days 21 to 100, with Medicaid covering that cost sharing for someone with full Medicaid or QMB. When skilled care ends or day 100 passes, Medicaid nursing facility coverage pays if the person qualifies.
Medicare first. Part A covers short-term skilled nursing facility care only after a medically necessary inpatient hospital stay of at least three days in a row (observation time does not count), and only while daily skilled care is needed. For 2026: days 1 to 20 cost $0 after the $1,736 Part A deductible; days 21 to 100 cost $217 per day; day 101 and beyond, Medicare pays nothing. The 100 days are a maximum, not a promise.
Medicaid wraps around. For someone with full Medicaid or QMB, Medicaid covers Medicare deductibles and coinsurance, so the $217 per day is not billed to them.
Medicaid long-term care. Custodial care (help with bathing, dressing, eating) is not a Medicare benefit at all. Once skilled coverage ends, a Medicaid-certified nursing facility is paid by Texas Medicaid, with the resident paying their co-payment from income and keeping the $75 per month personal needs allowance. Someone who will need long-term care should apply for Medicaid before the Medicare days run out, since eligibility takes time.