A nursing home can refuse to take a patient back after a hospital stay or therapeutic leave, but only in a narrow set of situations spelled out in federal law. Under 42 CFR ยง 483.15, a facility that participates in Medicare or Medicaid must readmit a resident who still needs its level of care and remains eligible for coverage, unless one of a few specific exceptions applies. Even then, the facility has to follow strict notice and documentation rules, and a resident who believes the refusal was wrong has real ways to fight back.
The Only Legal Reasons a Facility Can Refuse
Federal regulations limit refusals to four grounds. Anything outside these is not a lawful basis for keeping a resident out.
The Resident’s Needs Exceed What the Facility Can Provide
If the resident’s condition changed during hospitalization and the nursing home genuinely cannot deliver the care now required, it can refuse readmission. This is the most commonly cited reason and the one most often stretched beyond what the rule allows. The regulation requires that the resident’s needs cannot be met in the facility at all, not that meeting them would be inconvenient or costly.
A facility invoking this reason must document three things in the medical record: the particular needs it cannot address, the steps it took to try to meet them, and the name of a receiving facility that can provide the necessary care. Missing any of the three puts the refusal on shaky legal ground and often decides an appeal.
Safety of Other Residents
A facility can refuse if the resident’s clinical or behavioral status would endanger other people in the building. The assessment has to be individualized and based on current medical evidence, not on assumptions or old incidents that have been resolved. If a modified care plan, room reassignment, or extra staffing would reduce the risk, the facility may be required to try those steps before refusing.
Health Has Improved Enough to Leave
If the resident’s health improved during hospitalization to the point where nursing facility-level care is no longer needed, the facility can decline to take them back. As a standalone reason this is rare. Most people leaving a hospital are not in better shape than when they entered the nursing home. Ask to see the physician documentation if a facility relies on it.
Nonpayment
A facility can refuse a resident who has failed to pay after reasonable notice. This applies when the resident did not submit paperwork needed for Medicare, Medicaid, or third-party coverage, or when a payer denied the claim and the resident refuses to pay privately. Nonpayment cannot be used against someone with a Medicaid application still pending or who is actively cooperating with billing. Once a resident becomes Medicaid-eligible, the facility can charge only what Medicaid allows.
What the Facility Must Do Before Refusing
A refusal to readmit is treated as an involuntary discharge, and federal law lays out procedural steps the facility cannot skip.
Written Notice at Least 30 Days in Advance
The nursing home must provide written notice of the discharge at least 30 days before the effective date. The notice must state the reason, explain the appeal rights, give contact information for the state’s Long-Term Care Ombudsman, and identify where the facility proposes to send the resident.
There are exceptions to the 30-day timeline. Notice can be given “as soon as practicable” when the health or safety of others is at immediate risk, when urgent medical needs require faster action, when the resident’s health improved enough for an earlier move, or when the resident has lived in the facility fewer than 30 days. The written notice with the same content is still required. “As soon as practicable” does not mean no notice.
A Consultation With the Hospital
If the nursing home has concerns about taking the resident back, it cannot simply refuse and leave the person in a hospital bed. It must request a consultative process with the hospital within 24 hours of being told the resident is ready for discharge. The hospital has to participate, give the facility access to the resident, and share records. The whole process must wrap up within three business days. If the nursing home still concludes it cannot take the resident back, it then has to follow the formal discharge procedures, including the 30-day written notice and the documentation requirements.
An Expired Bed-Hold Does Not Cancel the Right to Return
Families often hear that the bed-hold period has ended and assume readmission is now up to the facility. It is not. When a resident comes back within the bed-hold period, the facility must give them their previous room. When a resident comes back after the hold has expired, the readmission right still applies. What changes is the room assignment: the resident loses the guarantee of the specific bed and instead gets the next available semi-private bed. For Medicaid-eligible residents, this right to the next available bed applies no matter how long the hospital stay lasted.
One boundary worth noting. These federal readmission protections are tied to Medicare or Medicaid eligibility. Private-pay residents not enrolled in either program may not have the same federal guarantees, though state law and the admission agreement may still protect them.
How to Push Back on a Refusal
The process is designed to favor the resident when the facility has not followed the rules. Speed matters more than anything else.
Demand the Written Notice
Ask for the formal written notice of discharge. It must state the specific reason for refusal, the effective date, and the appeal rights. If the facility has not provided this, it has already violated federal requirements. Keep copies of everything.
Contact the Long-Term Care Ombudsman
Every state runs a Long-Term Care Ombudsman program with staff and trained volunteers who advocate directly for nursing home residents. The ombudsman can investigate the refusal, mediate with the facility, and walk you through your rights. The Administration for Community Living’s website lists each state’s program.
File a Complaint
Contact your state’s health department or the agency that licenses nursing facilities. These agencies investigate violations of federal and state rules, including improper discharges and refusals to readmit. You can also file directly with the Centers for Medicare & Medicaid Services.
Appeal the Decision
The appeal route depends on the resident’s coverage, and the timing windows are short.
For Medicare beneficiaries receiving skilled nursing care, the facility must issue a Notice of Medicare Non-Coverage before ending the covered stay. To trigger a fast appeal, file with the Quality Improvement Organization (the BFCC-QIO) by noon the day before the listed termination date. If the QIO sides with the resident, coverage continues. Missing that deadline leaves 60 days to request a standard review, but the resident may be responsible for costs during the gap.
For Medicaid residents facing an involuntary discharge, the appeal is a fair hearing through the state. If the hearing is requested promptly after the notice, the nursing home generally cannot force the resident out while the appeal is pending. Wait too long and the facility may proceed with the discharge, with the appeal continuing from wherever the resident lands.
In both tracks, residents who act within the first few days after receiving notice are in a much stronger position than those who wait, because the right to stay in the facility during the appeal turns on filing quickly.