Could you have a $250,000 IRA account and still qualify for Medicaid?

The answer is "that depends".

In the case of a couple, one of who needs NH care, there is a substantial amount of assets that can be retained by the "community spouse".

There are Medicaid Waiver programs (those that keep the patient at home with Medicaid paid help coming in) which have no asset means test, from what I understand. The limit for those programs is on income, not assets.