What Every Long-Term Care Professional Needs to Know About 2026 Medicaid & Medicare Changes
Big changes to Medicare and Medicaid are here in 2026.
Disclaimer: These rules and regulations are always subject to change rapidly in the current changing political environment. Always check to see if there have been additional changes and in what way. For now, I am trying to bring the most current that I can find according to researching along with tools to help you check and adjust. Links to sources below.
Here are a few bullet points that you can review and discuss with your team to make sure that you are aware of them and adjust how your facility addresses them for your staff and residents. For additional check offs, download our check off list to stay as up to date as possible on Indiana’s specific changes and requirements.
Medicare Part B premiums hit a new milestone — the standard monthly premium for Medicare Part B has risen to $202.90 in 2026, up $17.90 from 2025 — the first time it has exceeded $200. The annual Part B deductible has also increased to $283, up from $257.
Prescription drug costs are changing — starting January 1, 2026, Medicare began using newly negotiated prices for a group of commonly used and expensive prescription drugs under the Medicare Drug Price Negotiation Program. The most a resident will have to spend out of pocket on prescription drugs covered by Medicare Part D is now capped at $2,100.
The minimum staffing rule repeal — this is a big one for LTC professionals. CMS repealed the minimum staffing standards for long-term care facilities, with regulations effective February 2, 2026. This removed the previous requirement for nursing homes to provide 3.48 total nurse staff hours per resident per day and 24/7 RN coverage.
Prior authorization is expanding — if your facility is in one of the pilot states, you may need prior approval for certain procedures or medical equipment, with the goal of preventing unnecessary care — though some worry it could lead to delays. If something is urgent, ask about expedited review options.
Medicaid income thresholds have shifted — the individual income limit for those requiring long-term care has risen to $2,982 per month. If a resident has income above this limit, they may still qualify by using a Qualified Income Trust.
What to do right now — a practical checklist for administrators, nurses, and social workers to respond to these changes in their facilities can be downloaded and or printed off by logging into our Wise Academy membership page.
I hope that reviewing these changes will lead you to investigate and make sure that your team is aware and on board so that everyone can feel better informed to help your families and residents.
-Amanda
Internet Research Resources & References: ElderLawAnswers, Federal Register, Hickman Lowder