Bed-Hold Policies

When a nursing home resident goes to the hospital or leaves for a family visit, a natural worry is whether their room will still be there when they come back. That depends on the nursing home’s bed-hold policy and the state’s Medicaid rules. Some states pay nursing homes to hold a Medicaid resident’s bed for a set number of days; others do not. Federal law also gives residents a right to return. This guide explains how bed holds work and what families should do before and during an absence.

Figures change periodically. Double-check current amounts before relying on them.

The short version

A bed hold keeps a resident’s bed reserved while they are temporarily away, such as during a hospital stay or a therapeutic leave (a home visit).
States decide whether Medicaid pays for bed holds, for how many days, and under what conditions. Some states pay for none.
A certified nursing home must give written notice of its bed-hold policy and the state’s policy at admission and again at the time of a transfer (42 CFR 483.15(d)).
If the absence lasts longer than the bed-hold period, a Medicaid resident who still needs nursing home care has the right to return to their previous room if available, or to the first available semi-private bed (42 CFR 483.15(e)).
If Medicaid does not pay, the family may choose to pay privately to hold the bed.

What a bed hold is

Nursing homes are paid by the day. When a resident is away, the facility may want to fill the bed. A bed hold is an agreement, paid for by Medicaid, by the resident or family, or by both, to keep the specific bed open until the resident returns.

There are two main types of leave:

Hospital leave, when the resident is admitted to a hospital.
Therapeutic (or home) leave, when the resident visits family, attends an event, or tries out a return home.

States often treat them differently, with separate day limits.

How state policies differ

States choose whether to pay for bed holds and set their own rules. Common variations include:

No payment. Some states do not pay for bed holds at all.
Limited days. Some pay for a set number of hospital days per stay or per year, and a separate number of therapeutic leave days per year.
Occupancy rules. Some pay only if the nursing home’s occupancy is above a set percentage, on the theory that a nearly empty facility does not need payment to keep a bed open.
Reduced rates. Some pay a portion of the daily rate.
Doctor’s orders. Therapeutic leave may need to be in the care plan or ordered by a doctor.

Each state guide notes the state’s policy where it is published.

Federal notice rules

Under 42 CFR 483.15(d), before a resident is transferred to a hospital or goes on therapeutic leave, the facility must give written information to the resident and their representative that explains:

how long the state’s Medicaid plan will hold the bed, if at all;
the facility’s own bed-hold policy, including any charges;
the resident’s right to return after the bed-hold period ends.

At the time of a transfer, the facility must give a written notice that specifies the bed-hold policy. In an emergency transfer, the notice must be given within a reasonable time.

The right to return

Under 42 CFR 483.15(e), a facility must have a policy that permits a resident whose hospitalization or therapeutic leave exceeds the bed-hold period to return:

to their previous room, if available; or
immediately upon the first availability of a semi-private bed, if the resident still requires the services the facility provides and is eligible for Medicare skilled nursing care or Medicaid nursing facility services.

If the facility decides not to readmit the resident, it must comply with the discharge rules, including notice and appeal rights. See Nursing home discharges and evictions.

Paying privately to hold the bed

When Medicaid does not pay, or the days run out, families can usually pay the facility to hold the bed. The facility must explain the charge in advance. This is a personal choice: paying can guarantee the same room and roommate, while not paying still preserves the right to the next available semi-private bed. Families should weigh the cost against how important the specific room is to the resident.

Money paid to hold a bed comes from the resident’s or family’s funds. It is generally treated as payment for a service, not a gift.

What happens to the patient liability during an absence

When a resident is in the hospital for part of a month, the patient liability may still be owed to the nursing home for that month, or adjusted, depending on state rules and whether Medicaid pays a bed hold. Hospital stays covered by Medicare do not usually change the patient liability owed to the nursing home for days the resident was there. Families should ask the facility and the caseworker how a long absence affects the month’s bill.

Before an absence: a checklist

Ask the facility for its written bed-hold policy and the state’s policy.
Note how many days Medicaid will pay, if any, and how many have already been used this year.
For a planned home visit, make sure it is in the care plan or ordered by a doctor if the state requires it.
Decide in advance whether the family would pay privately to hold the bed if needed.
Keep copies of every notice.

During a hospital stay

Tell the nursing home how the resident is doing and when discharge is expected.
Ask the hospital discharge planner to coordinate with the nursing home.
If the nursing home says it will not take the resident back, ask for that in writing, contact the long-term care ombudsman, and ask the hospital not to discharge to an unsafe place.

A simple example

Frank lives in a nursing home on Medicaid in a state that pays for up to 10 hospital bed-hold days per stay. He is admitted to the hospital with pneumonia and stays 14 days. Medicaid pays to hold his bed for 10 days. His daughter decides not to pay privately for the last four days. When Frank is ready to leave the hospital, his old room has been filled, but under federal rules he must be readmitted to the first available semi-private bed. A bed opens two days later, and he returns. In the meantime, the hospital keeps him until the bed is available, as arranged by the discharge planner.

Getting help

The long-term care ombudsman program can help when a facility refuses to readmit a resident. A Certified Medicaid Planner can explain how a long absence affects Medicaid eligibility or the patient liability, especially if a resident might return home for good.

Frequently asked questions

Does Medicare pay for bed holds? No. Medicare does not pay to hold a nursing home bed.

What if the resident wants to go home for a holiday? Therapeutic leave is often allowed, sometimes with a day limit. Check the state’s policy and the care plan.

Can the facility give the bed away during the bed-hold period? Not if the bed hold is paid by Medicaid or privately; the bed is reserved.

What if no semi-private bed opens up? The resident has a right to the first available one. If the facility refuses readmission, it must follow discharge notice and appeal rules.

Key terms

Bed hold: reserving a resident’s bed while they are temporarily away.
Therapeutic leave: a planned absence, such as a home visit, that is part of the care plan.
Hospital leave: an absence because the resident was admitted to a hospital.
Readmission: the resident’s return to the facility after an absence.

Common mistakes

Not asking about the bed-hold policy until the resident is already in the hospital.
Assuming Medicare will pay to hold the bed.
Leaving the hospital without confirming the nursing home will readmit the resident.
Paying privately to hold a bed without getting the charge in writing.
Not calling the ombudsman when a facility refuses readmission.

Bed holds and planned returns home

Some residents use therapeutic leave to test whether they can return home for good. If a trial visit goes well and the resident decides to move home permanently, the Medicaid program changes from nursing home coverage to community coverage, and the income and asset rules may change too. A resident who kept a home under the intent-to-return rule may be able to move back there. Planning the transition with the facility’s social worker and the caseworker avoids gaps in coverage. Families should also ask whether a waiver slot or Money Follows the Person support is available before the resident gives up the nursing home bed.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.