Why Do Assisted Living Facilities Evict?
Medicaid & Assisted Living Evictions – Quick Facts
Yes, but some states and federal HCBS rules provide limited protections against involuntary discharge.
In most states, yes—only a few require acceptance of Medicaid beneficiaries under HCBS programs.
No—unlike nursing homes, assisted living facilities are regulated at the state level only.
Don’t move immediately—review agreements, request documentation, and contact your local Ombudsman.
Why are Medicaid residents sometimes evicted?
Private pay residents generate higher revenue than Medicaid beneficiaries, so some assisted living providers are reluctant to keep or accept Medicaid residents. Average assisted living costs are around $5,900/month (Genworth 2024), and Medicaid reimbursement rates are typically lower than private-pay rates.
What federal protections exist for Medicaid-funded assisted living residents?
Since March 2023, the HCBS Final Rule requires that residents in Medicaid-funded HCBS programs (like 1915(c) waivers, 1915(i) state plan, 1915(k) Community First Choice, or 1115 demonstration waivers) receive eviction protections comparable to local landlord-tenant laws. These include:
- Written notice before discharge.
- The right to appeal an eviction decision.
These protections apply only to HCBS-funded assisted living, not to residents receiving Medicaid’s regular state plan services.
How do state-specific eviction protections compare?
Some states go further than federal rules. According to the Kaiser Family Foundation’s 2024 survey:
- About 50% of states require relocation assistance if fees cannot be paid.
- 9 states prohibit eviction if the resident is paying the state-specified room and board rate.
- 2 states protect residents receiving Medicaid home care via managed care if they pay the required rate.
- Kansas prohibits eviction for any reason.
Eviction Protections by State (2024)
| State | Must be Moved to New Arrangement if Cannot Pay | Cannot be Evicted if Paying State-Specified Rate | Cannot be Evicted if Receiving Managed Care & Paying Required Rate | Cannot be Evicted Under Any Circumstance |
|---|---|---|---|---|
| Arizona | ✔ | |||
| Arkansas | ✔ | |||
| California | ✔ | |||
| Colorado | ||||
| Connecticut | ✔ | |||
| Delaware | ✔ | ✔ | ||
| Illinois | ✔ | |||
| Kansas | ✔ | ✔ | ||
| Maine | ✔ | |||
| Maryland | ||||
| Massachusetts | ✔ | |||
| Michigan | ||||
| Minnesota | ✔ | ✔ | ✔ | |
| Mississippi | ✔ | |||
| Nebraska | ✔ | |||
| Nevada | ✔ | |||
| New Hampshire | ✔ | |||
| New Jersey | ✔ | ✔ | ✔ | |
| Oregon | ✔ | |||
| Rhode Island | ||||
| South Carolina | ✔ | |||
| South Dakota | ✔ | |||
| Texas | ✔ | |||
| Washington | ✔ | |||
| Wisconsin | ✔ |
What are the most common eviction reasons?
- Nonpayment: Not paying monthly fees—sometimes used improperly when residents switch from private pay to Medicaid.
- Care Needs Exceed Facility Capacity: Claimed inability to meet new care requirements (can be misused).
- Facility Closure or Repurposing: The residence stops offering assisted living.
- Behavioral Issues: Actions that endanger others or violate policies.
- Illegal Activity: Violations of local or state law.
Can facilities refuse new Medicaid residents?
Yes, in most states. Only Oklahoma and New Jersey require acceptance of HCBS Medicaid beneficiaries as new residents. Eight other states—Arkansas, Maine, Maryland, Nevada, New Mexico, Rhode Island, Texas, and Vermont (IDD only)—have similar requirements for facilities that receive Medicaid payments.
Warning: Some facilities try to require a “private pay period” before accepting Medicaid. This is prohibited and should be refused in any admission agreement.
