A nursing home cannot evict you straightforward for owing money, but the process is more complicated than that
A nursing home cannot throw you out the door because you owe a bill. Federal law requires that a facility give you written notice and a chance to pay or make a plan before discharge. However, the facility can eventually discharge you if payment remains unpaid and no resolution is reached — and the rules differ depending on whether you pay with your own money, Medicaid, or Medicare.
The key difference is this: if you are a private-pay resident (paying with your own funds or private insurance), the nursing home has more power to discharge you for non-payment. If you are on Medicaid, the rules are stricter and the facility must follow specific steps. If Medicare is covering your stay, you have different protections altogether.
Key Takeaways
- Federal law requires a nursing home to give you written notice at least 30 days before discharge for non-payment, and you have the right to dispute the discharge.
- Private-pay residents can be discharged for unpaid bills after proper notice, but Medicaid residents have stronger protections that make discharge harder.
- If you cannot pay, tell the facility social worker when ready — many homes have financial information programs, payment plans, or can help you transition to Medicaid.
- You can file a complaint with your state's nursing home ombudsman or health department if you believe the discharge is illegal or improper.
How the 30-day notice requirement works
Before a nursing home can discharge you for any reason, including non-payment, federal regulations require the facility to give you written notice at least 30 days in advance. This notice must state the reason for discharge, the date it will take effect, and your rights. You are may have access to to receive this notice in a language you understand, and the facility must document that you received it.
During those 30 days, you have the right to dispute the discharge. You can ask for a meeting with the facility administrator, bring a family member or advocate, and present your case. If you have a plan to pay — even a partial payment plan — the facility must consider it. The facility cannot discharge you while your dispute is being reviewed, though this protection has limits depending on your payment source.
Private-pay residents and discharge for non-payment
If you are paying the nursing home directly with your own money or private long-term care insurance, the facility has the legal right to discharge you for unpaid bills after following the 30-day notice process. This is a contract dispute: you agreed to pay a certain amount, and if you do not, the home can end the agreement.
However, the facility must still follow the law. They cannot discharge you without notice, cannot do it in a way that abandons you without a safe discharge plan, and cannot discharge you to the street. The notice must give you time to find another facility, arrange transportation, and transfer your medical records. If you are in the middle of a hospital stay or acute medical crisis, the discharge may be delayed until it is medically safe.
Before discharge happens, the facility's social worker should be helping you explore options: Can family members help pay? Can you transition to Medicaid? Can you move to a less expensive facility? Many private-pay residents do not realize they may be Medicaid-may be able to access, and the social worker's job includes helping you find out.
Medicaid residents have stronger protections
If Medicaid is paying for your care, the nursing home cannot discharge you for non-payment of the Medicaid co-payment (called a "patient responsibility amount"). Medicaid is the payer of record, and the state guarantees payment. The facility agreed to accept Medicaid rates when they became a Medicaid provider, and they cannot punish residents for the state's payment schedule.
A Medicaid facility can still discharge you, but only for specific reasons: you need a higher level of care that the facility cannot provide, your behavior is dangerous to yourself or others, or you have not paid a non-Medicaid portion of your bill (such as a private room upgrade or services not covered by Medicaid). Even then, the 30-day notice rule applies, and you have the right to dispute the discharge.
If a Medicaid nursing home tries to discharge you because of unpaid Medicaid co-payments, this is illegal. Report it to your state's Medicaid agency and your nursing home ombudsman when ready.
Medicare coverage and temporary stays
Medicare covers up to 100 days in a nursing home after a hospital stay of at least three days, but only if the care is skilled nursing (wound care, physical therapy, medication management). Medicare does not cover custodial care — help with bathing, dressing, and daily living — after those 100 days end.
If you run out of Medicare coverage and cannot pay privately, you will need to transition to Medicaid or leave the facility. The nursing home must give you notice when your Medicare coverage is ending and help you understand what happens next. If you disagree that your care is no longer "skilled," you can appeal the Medicare decision — and while the appeal is pending, you may stay in the facility without paying.
What to do if you cannot pay
The moment you know payment will be a problem, contact the facility's social worker or business office. Do not wait until you are behind. Many nursing homes have financial information programs, payment plans, or connections to charitable organizations that help residents. Some facilities will reduce your bill if you pay a lump sum, or will work out a monthly payment you can actually afford.
Ask the social worker whether you are Medicaid-may be able to access. Many people over 65 with limited income and assets may have access to for Medicaid, even if they did not think they would. Medicaid rules vary by state, but the social worker should know your state's rules and can often help you start the process. If you become Medicaid-may be able to access while in the facility, Medicaid can cover your care going forward, and the facility cannot discharge you for the unpaid private-pay portion (though you may owe it as a debt).
If the facility is threatening discharge and you believe it is illegal or improper, contact your state's long-term care ombudsman. This is a free advocate whose job is to protect nursing home residents. They can investigate your complaint and push back on the facility on your behalf.
How to file a complaint if discharge seems illegal
Every state has a Long-Term Care Ombudsman program, funded by the federal government. The ombudsman is independent of the nursing home and the state health department. You can call them to report illegal discharge threats, and they will investigate at no cost to you.
You can also file a complaint with your state's Department of Health or the agency that licenses nursing homes. If a facility is discharging residents illegally to avoid Medicaid payments or is not following the 30-day notice rule, the state can fine them and take away their license.
Keep copies of all notices, bills, and communications with the facility. If you end up in a dispute, these documents are your proof of what happened and when.
Frequently Asked Questions
Can a nursing home discharge me when ready if I stop paying?
No. Federal law requires at least 30 days' written notice before discharge for non-payment. The facility must give you time to pay, make a plan, or find another place to live. when ready discharge without notice is illegal, even if you owe money.
What if I become Medicaid-may be able to access while I owe private-pay bills?
Once Medicaid starts paying, the facility cannot discharge you because of unpaid Medicaid co-payments. You may still owe the private-pay debt, but the facility must keep you as a resident. The debt can be collected through other means, but it cannot be the reason for discharge.
Can the nursing home refuse to admit me if I cannot pay upfront?
A facility cannot refuse to admit you solely because you cannot pay in advance, especially if you are Medicaid-may be able to access or will become may be able to access. However, they can require a deposit or payment plan as a condition of admission. If you are Medicaid-may be able to access, the facility must accept Medicaid as payment.
What happens if I am discharged — where do I go?
The nursing home must provide a safe discharge plan. This means they must help you find another facility, arrange transportation, and transfer your medical records. They cannot discharge you without a plan in place. If you have nowhere to go, ask the social worker about temporary placement, community resources, or family support options.
Can I appeal a discharge decision?
Yes. You have the right to dispute the discharge during the 30-day notice period. Ask for a meeting with the facility administrator, bring an advocate or family member, and present your case. If the facility proceeds with discharge despite your dispute, you can file a complaint with the ombudsman or state health department.