Can a Nursing Home Discharge You When Medicare Stops Paying? (2026)

The end of Medicare coverage is not, by itself, a legal reason for a nursing home to discharge your parent. And while her Medicaid application is pending, CMS guidance to nursing home inspectors says she can't be discharged for nonpayment. Federal rules let a facility discharge a resident only on a short list of grounds, and Medicare running out isn't on it. But it isn't a free stay either: when Medicare stops paying, someone else has to pay, and that's where families get hurt.1

This guide goes deep on one moment: the money transition at the end of a Medicare rehab stay. For every federal discharge rule, the notice contents and how hearings work, start with our hub on nursing home discharge rights.

In This Guide

• Two Decisions Are Happening at Once
• When Medicare Stops Paying for Rehab
• Can She Stay After Medicare Stops Paying?
• While Her Medicaid Application Is Pending
• If Medicaid Is Denied
• If a Discharge Notice Arrives
• What to Do This Week
• Frequently Asked Questions
• Learn More

Two Decisions Are Happening at Once

If you've been handed a Medicare notice and told in the same breath that Mom has to "pay or go," it can feel like one decision with one deadline. It's really two. The first is a coverage decision: is Medicare still paying, and will Medicaid pay next? The second is a discharge decision: may the nursing home make her leave? Each one has its own notice, and federal rules give each its own appeal, so you may need to file both.2

Federal Medicaid rules list a dispute over Medicaid coverage and a dispute over a nursing facility's decision to transfer or discharge a resident as separate grounds for a state fair hearing, at 42 CFR 431.220(a)(1) and (a)(2). On the Medicare side, the fast appeal goes to a quality improvement organization and decides whether covered services should end; the discharge still needs one of the federal grounds, a written notice and its own appeal.2,3,1

Each cell above comes from the federal notice and hearing rules: the NOMNC timing and fast-appeal deadline, the separate hearing grounds, and the discharge notice and appeal protections in 42 CFR 483.15.1,3,2

When Medicare Stops Paying for Rehab

Most families don't know the clock is running until the paperwork arrives. Medicare Part A covers skilled nursing facility care on a short-term basis only: up to 100 days per benefit period. Under Original Medicare, days 21 through 100 carry a daily coinsurance of $217 in 2026, and Medicare pays nothing after day 100. A Medicare Advantage plan may charge copayments even during the first 20 days, so check with the plan. Medicare doesn't pay for long-term custodial care, ongoing help with activities of daily living when that's the only care someone needs. Our guides to skilled nursing facility costs and skilled vs custodial care walk through that math in detail.4

The signal that coverage is ending is the Notice of Medicare Non-Coverage. CMS's instructions say the facility must deliver the Notice of Medicare Non-Coverage (NOMNC) at least two calendar days before Medicare-covered services end. It's a coverage notice. It tells you Medicare is about to stop paying; it isn't a notice that she has to leave.1

If you think she still needs skilled care, you can ask the QIO for a fast appeal, following the NOMNC's instructions no later than noon the day before the termination date on the notice. If the QIO decides her services should end, she still won't owe for skilled nursing services provided before the coverage end date on the NOMNC. Medicare.gov adds the edge right after: "If you continue to get services after the coverage end date, you may have to pay for those services." Missing the deadline isn't the end of the road: under 42 CFR 405.1202(b)(4) the QIO will still accept a late request and decide as soon as possible, but the liability protection doesn't apply. Our Medicare fast appeal guide covers the steps.3

Can She Stay After Medicare Stops Paying?

This is the question that keeps families up at night, and federal rules start from her side. The nursing home must permit each resident to remain and may not transfer or discharge her unless one of the listed grounds applies, under 42 CFR 483.15(c)(1)(i). Medicare ending isn't one of those grounds.1

CMS tells state inspectors what it expects in its surveyor guidance (State Operations Manual Appendix PP, F627, Transmittal 232, effective April 25, 2025). When a resident's Medicare coverage may be ending and she still needs long-term care, that guidance says the facility should offer her the ability to remain, which may include:

• the option to stay by paying privately for a bed; and
• for a Medicaid-eligible resident, the help she needs to apply for Medicaid.

The same guidance tells the facility to explain two hard edges along with that help. If Medicaid is denied, she would be responsible for payment for all days after Medicare payment ended. And if she's found eligible but no Medicaid bed becomes available in the facility, or the facility participates only in Medicare (a "SNF only" facility), she would be discharged to another facility with available Medicaid beds if she wants Medicaid to pay for her stay.1

So a move can be real, and it helps to hear that plainly now rather than in a hallway later. A move to a facility with a Medicaid bed still runs through the federal discharge rules, which a nursing home in Medicare or Medicaid must apply identically to all residents regardless of who pays. CMS's guidance tells surveyors that a facility's Medicare and Medicaid certification status can affect whether a discharge for nonpayment is justified.5

If the facility wants to move her off the Medicare unit to another room in the same building rather than discharge her, see our guide to whether a nursing home can move her to another room.

One more line in the guidance matters if she says she isn't ready to go home. When a resident admitted for short-term Medicare rehab says she's not ready to leave and the facility proceeds with discharge anyway, CMS tells the survey team to investigate whether the discharge breaks the rules and should not have occurred.1

While Her Medicaid Application Is Pending

Waiting on a Medicaid decision while the bills pile up is one of the most anxious stretches a family goes through. You may be watching a private-pay balance grow and wondering whether one missed payment means she has to leave. Here's what protects her during the wait, and what doesn't.

Start with the rule a facility would have to use. Under 42 CFR 483.15(c)(1)(i)(E), a nursing home may discharge a resident who has failed, after reasonable and appropriate notice, to pay for (or have paid under Medicare or Medicaid) her stay. The regulation limits that ground: nonpayment applies if the resident doesn't submit the necessary paperwork for third-party payment, or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay.1

Then comes the line most worth knowing. CMS's current surveyor guidance states: "The resident cannot be discharged for nonpayment while a determination on the resident's Medicaid eligibility is pending." That's a strong, citable line to quote to a facility, and it's what inspectors are told to look for. It is CMS guidance in the State Operations Manual, though, not words in the regulation itself, so don't call it "federal law" when you use it.1

If the facility treats moving her from its private rate to the Medicaid rate as a failure to pay, the same guidance says "conversion from a private pay rate to payment at the Medicaid rate does not constitute non-payment." It also puts the burden on the facility to notify the resident of a change in payment status, and says the facility should make sure she has the help she needs to submit any third-party paperwork. Surveyors are told to examine a nonpayment discharge where there's no evidence the facility offered her the chance to pay privately or apply for Medicaid.1

And once Medicaid comes through, the regulation protects her bill too. For a resident who becomes eligible for Medicaid after admission, the regulation says the facility may charge her only allowable charges under Medicaid.1

The hardest part is often the wait itself, because the days keep adding up while nobody knows yet who will pay for them. Under 42 CFR 435.912, "except as provided in paragraph (e)," a state may take no more than 45 days to decide a Medicaid application, or 90 days for someone applying on the basis of disability. Paragraph (e) excuses unusual circumstances, for example when the applicant delays or fails to take a required action. The agency also can't use those time standards as a waiting period or as a reason to deny. If the application sits too long, federal rules give her a right to a fair hearing when a claim isn't acted on with reasonable promptness.6,2

That's why the reach-back matters to a family that's already paying. Once she's found eligible, federal law requires Medicaid to cover services furnished in or after the third month before the month of application, if she was eligible when she got them, so care from before you applied can still be covered. The exact start date inside that window isn't fixed: the state plan sets it, so don't assume coverage begins on the first day of the third month. A state's window can also be shorter under an approved demonstration waiver, and for applications made on or after January 1, 2027, federal law shortens the window to two months before the application month for most applicants. Confirm your state's rule with its Medicaid agency, and see our guide to Medicaid for nursing home care by state.7

If Medicaid Is Denied

A denial letter lands like a second blow. Take a breath, because you still have moves, but go in clear-eyed about where the federal protection runs out.

The federal regulation and CMS's guidance don't address, in these passages, a Medicaid denial that's under appeal. On the regulation's own words, nonpayment can apply after the third party denies the claim and the resident refuses to pay. Some websites say a resident can't be made to move while a Medicaid denial is being appealed. That isn't a federal rule you can rely on.1

What you can do is use both appeal routes at once:

• Appeal the Medicaid denial. A denied claim for eligibility is a ground for a state fair hearing under 42 CFR 431.220(a)(1), and the federal Medicaid statute, at section 1902(a)(3), requires that hearing for anyone whose claim is denied.2
• Appeal any discharge notice, separately. A resident who believes a nursing facility has wrongly decided she must be transferred or discharged has her own hearing right under 431.220(a)(2).2 While that discharge appeal is pending, the facility may not discharge her, unless keeping her would endanger the health or safety of her or others and the facility documents the danger.1

Ask the ombudsman, and a legal aid office or elder law attorney, whether your state's rules add anything for a resident whose denial is on appeal.

If a Discharge Notice Arrives

A real discharge looks different from a Medicare notice. Federal rules allow it only for one of six reasons listed in 42 CFR 483.15(c)(1)(i):1

1. her needs can't be met in the facility and the move is necessary for her welfare;
2. her health has improved enough that she no longer needs the facility's services;
3. the safety of people in the facility is endangered by her clinical or behavioral status;
4. the health of people in the facility would otherwise be endangered;
5. she has failed, after reasonable and appropriate notice, to pay (or have paid under Medicare or Medicaid) for her stay; or
6. the facility is closing.

Before discharging her, the facility must notify her and her representative in writing, in a language and manner they understand, with the reasons, and must send a copy to the Long-Term Care Ombudsman Program. The notice generally comes at least 30 days before the move. A nursing home's discharge notice can come as soon as practicable in a few listed situations under 42 CFR 483.15, including when the resident has lived in the facility for fewer than 30 days, which can describe a short rehab stay.1

The notice must state her appeal rights: who receives the appeal, with their mailing and email address and phone number, and how to get an appeal form and help filling it out. It must also give the ombudsman office's contact details. Once she appeals, the facility may not discharge her while the appeal is pending, except where failing to discharge would endanger the health or safety of her or others and the facility documents that danger.1

If the pressure is coming as hallway conversations rather than paperwork, our guide to a pressured nursing home discharge covers what to ask for in writing.

What to Do This Week

You don't have to solve all of this today. Work through it in this order.

Learn More

Find personalized help sorting out which notice you have and getting her Medicaid application moving at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.