Nursing Home Discharges and Evictions

Yes, nursing home evictions happen. Federal law calls them “involuntary transfers and discharges,” and they are one of the most common complaints that long-term care ombudsman programs receive. But residents of Medicaid- and Medicare-certified nursing homes have strong federal protections. A nursing home may discharge a resident only for specific reasons, must give written notice, and must explain how to appeal. This guide explains those rules, the most common situations, and what families can do.

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

The short version

A certified nursing home may discharge or transfer a resident against their wishes only for one of six reasons listed in federal regulations.
The facility generally must give 30 days’ written notice, with exceptions for emergencies, and send a copy to the long-term care ombudsman.
The resident has a right to appeal through a state hearing. In most cases the resident cannot be discharged while a timely appeal is pending.
Switching from private pay to Medicaid in a Medicaid-certified bed is not a lawful reason to discharge a resident.
“Hospital dumping,” where a facility refuses to readmit a resident after a hospital stay, is generally treated as a discharge and has the same protections.

The six allowed reasons

Under 42 CFR 483.15(c)(1), a facility must permit a resident to stay unless:

the transfer or discharge is necessary for the resident’s welfare, and the resident’s needs cannot be met in the facility;
the resident’s health has improved enough that they no longer need the facility’s services;
the safety of individuals in the facility is endangered because of the resident’s clinical or behavioral status;
the health of individuals in the facility would otherwise be endangered;
the resident has failed to pay (or have Medicare or Medicaid pay) after reasonable and appropriate notice; a resident who becomes eligible for Medicaid after admission may be charged only allowable Medicaid charges; or
the facility ceases to operate.

The facility must document the reason in the resident’s record. For reasons 1 and 2, the resident’s doctor must document it; for reason 1, the documentation must explain what needs cannot be met, what the facility tried, and what the receiving facility offers. For reason 4, any doctor may document it.

Notice requirements

Before a transfer or discharge, the facility must:

notify the resident and their representative in writing, in a language and manner they understand;
send a copy to the state’s long-term care ombudsman program;
include the reason, the effective date, the location the resident is going to, the right to appeal and how to do so, and contact information for the ombudsman and, for residents with disabilities or mental illness, the state protection and advocacy agency.

Notice must generally be given at least 30 days before the discharge. It may be given “as soon as practicable” when the health or safety of people in the facility is at risk, the resident’s health has improved enough to allow a faster move, an urgent medical need requires transfer, or the resident has lived there less than 30 days.

The right to appeal

A resident can challenge a discharge through the state’s fair hearing process. Federal rules (42 CFR 483.15(c)(1)(ii)) say the facility may not discharge the resident while the appeal is pending, unless failing to discharge would endanger the health or safety of the resident or others, which the facility must document.

Steps families usually take:

Read the notice carefully, noting the deadline to appeal.
File the appeal right away, in writing if possible, and keep a copy.
Contact the long-term care ombudsman for help.
Gather records: the care plan, doctor’s notes, incident reports and payment records.
Attend the hearing, in person or by phone, and explain why the discharge is not justified or the proposed location is not safe.

Common situations

“We do not take Medicaid” after admission

If a resident was admitted to a Medicaid-certified bed as private pay and then qualifies for Medicaid, the facility generally cannot discharge them for that reason. A facility that has only some beds certified may try to move the resident to a certified bed within the facility. Families should ask about bed certification before admission.

Nonpayment while Medicaid is pending

A pending Medicaid application is not “failure to pay” in most cases. The resident should keep paying the expected patient liability and keep the facility informed. If Medicaid is denied, the facility may give notice, but the resident can still appeal both the denial and the discharge.

“Difficult” behavior

Facilities sometimes cite behavior, often related to dementia, as a reason to discharge. Federal rules require facilities to care for residents with dementia and to try care-planning approaches. A claim that safety is endangered must be documented. Families can ask for a care plan meeting to address the behavior.

Refusal to readmit after a hospital stay

When a resident goes to the hospital, some facilities refuse to take them back. Federal rules on bed holds and readmission apply (see Bed-hold policies). A refusal to readmit is generally treated as a discharge requiring notice and appeal rights.

Discharge to an unsafe place

A facility must provide sufficient preparation and orientation for a safe and orderly discharge, and the discharge plan must address where the resident will go. Discharging a resident to a homeless shelter, a hotel or a family member who cannot provide care can be challenged.

The role of the long-term care ombudsman

Every state has a long-term care ombudsman program, established under the federal Older Americans Act, that advocates for residents of nursing homes and other long-term care settings. Ombudsman services are free and confidential. They can explain residents’ rights, help resolve complaints and support residents through appeals. The facility must post the ombudsman’s contact information and include it in discharge notices.

A simple example

Agnes, 91, has dementia and lives in a nursing home on Medicaid. After she becomes agitated and strikes a staff member during bathing, the facility gives her daughter a 30-day discharge notice citing safety. Her daughter files an appeal within the deadline and calls the ombudsman. At a care plan meeting, the team learns that Agnes is frightened by showers in the morning. The facility changes her bathing schedule and approach, and her behavior improves. The facility withdraws the notice.

Discharges from assisted living are different

Assisted living facilities are regulated by states, not by these federal nursing home rules, and residents usually have fewer protections. See Assisted living evictions.

How to reduce the risk of a discharge

Choose a facility with Medicaid-certified beds and confirm the resident will stay in the same bed when switching to Medicaid.
Keep up with patient liability payments.
File a complete Medicaid application on time and respond to all requests.
Attend care plan meetings and raise concerns early.
Keep written records of conversations with staff.
Know the bed-hold policy before any hospital trip.

Getting help

The ombudsman program is the first stop for residents’ rights questions. Legal aid organizations in many areas help with discharge appeals, especially for low-income residents. If the discharge is tied to a Medicaid denial or a payment dispute, a Certified Medicaid Planner can help resolve the eligibility issue that triggered it.

Frequently asked questions

Can a nursing home evict someone for being on Medicaid? Not if they are in a Medicaid-certified bed in a certified facility. That is not one of the six allowed reasons.

How long do we have to appeal? It depends on the state. The notice must say. Act right away.

Can the resident stay during the appeal? Usually yes, unless the facility documents that staying would endanger health or safety.

Does the facility have to find a new place? The facility must plan a safe discharge and say where the resident is going. It cannot simply send someone out with nowhere to go.

Key terms

Involuntary discharge: a move out of the facility the resident did not choose.
Transfer: a move to another facility or setting, such as a hospital.
Long-term care ombudsman: a free, confidential advocate for residents.
Fair hearing: the state appeal process for challenging a discharge or a Medicaid decision.

What to keep in a discharge file

the discharge notice and envelope (showing the date received);
the admission agreement;
the care plan and recent care conference notes;
any incident reports the facility shared;
payment records and Medicaid notices;
notes of every conversation, with dates and names;
copies of the appeal request and any hearing notice.

An organized file makes it easier for the ombudsman, a legal aid attorney or a hearing officer to see what happened.

If the resident is hospitalized when the notice arrives, ask the hospital social worker to contact the facility and the ombudsman before discharge planning goes further.

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