The states pay a portion of all Medicaid costs. Medicaid is the program that pays for nursing homes when you can't because you don't have the money. (The other program is Medicare (confusing isn't it) which pays for your medical expenses over 65.)
Medicaid costs are going up as people live longer and survive better. So the states, in a desperate attempt to reduce expenses are trying everything they can to reduce Medicaid costs.
Nursing homes are expensive and the states are trying to keep people out of them or in their homes. In addition, they are privatizing long term care with for profit companies.
So now start the games they will play. The states will do everything they can to keep you off Medicaid in the first place. When you do need long term care, they are giving it to for profit companies or privatizing it.
These companies get a set amount of money to care for you. So they have an incentive not to provide you with care and keep the money. In addition, they don't want the sick patients who will need a lot of care and cost a lot of money. Bottom line, the for profit companies are cutting corners, not providing care and trying to cherry pick the people they will cover...leaving the sickest who need care the most...out in the cold.
There is a great article in the New York Times today that covers this in depth.
It is not fair that you will have to fight to get what you are entitled to, but that is what is happening and it is going to get worse. Elder lawyers are going to be needed even more.