Nursing home bed hold: will the bed still be there after a hospital stay?

Differs by stateBed-hold rules by state

Arizona

Under Arizona's Medicaid State Plan, payment may be made to reserve a nursing facility bed while a member is away to visit family or friends, to prepare for discharge to community living, or for a hospital admission. For adults 21 and older the limit is 9 therapeutic leave days and 12 bed hold days per contract year; for those under 21, a total of 21 days. Therapeutic leave must be provided for in the member's plan of care, and prior authorization from the program contractor's (or regional behavioral health authority's) designee is required.

California

If the resident chooses to hold the bed, Medi-Cal pays for up to 7 bed-hold days for each physician-ordered stay in an acute care hospital. It also pays for leave-of-absence days, such as visits with relatives or friends: up to 18 days a year for most residents (different limits apply to residents with developmental disabilities and in certain mental health programs), and up to 12 more days a year may be approved if they are in line with the resident's care plan. If a home refuses to readmit a resident after a hospital stay, the resident may appeal, and the refusal is handled like an involuntary transfer.

Florida

Florida Medicaid pays to hold a bed only when the resident is expected to return: up to 8 days for each medically necessary hospital stay, and up to 16 days of therapeutic leave per state fiscal year (July 1 to June 30). Leave must be in the plan of care and approved by a physician. Medicaid does not pay for leave days once the home is told the resident will not return, and the coverage policy also limits payment based on how many of the home's Medicaid-certified beds were filled in the previous quarter. Separately, state law says a home must tell a Medicaid resident, within 24 hours of a hospitalization, that the bed will be reserved for a single hospital stay for as long as Medicaid pays, up to 15 days, unless the state determines the resident will not need the bed or cannot return, or that the home's occupancy rate ensures a bed will be available.

Georgia

Georgia Medicaid pays a nursing home for the days it holds a resident's bed during a hospital stay, up to 7 days per hospitalization, when the resident is expected to return to the nursing home. During home visits, payment continues for up to 8 days per calendar year. A day means an overnight stay away from the home. The home and the resident may arrange to hold the bed longer than 7 days. Under state rules, a resident who goes to a hospital may return to the facility immediately on discharge if the bed was paid for during the absence (same room); if not paid for, the resident gets the first available bed, ahead of any waiting list.

Illinois

Illinois Medicaid has not paid to hold beds in homes licensed under the Nursing Home Care Act since July 1, 2012. The one exception is home visits by residents assessed with a traumatic brain injury, in homes that meet occupancy and Medicaid-share thresholds. Under the rule that a home may not refuse to keep a resident because of Medicaid, a resident who receives or has applied for Medicaid is still counted as a resident during a hospital stay totaling 10 days or less; if the home refuses to readmit the person after such a stay, the state recovers the extra hospital cost from the home.

Indiana

Indiana law bars Indiana Medicaid from paying a nursing facility to reserve a bed while a resident is away for a hospital stay or therapeutic leave. The state's provider manual says the one exception is members under hospice care, and that residents may choose to pay for a bed hold if the home offers it. Under Indiana's licensing rule, a Medicaid-certified home must readmit a resident whose absence goes past the bed-hold period to the first available semiprivate bed, if the resident needs its services and is eligible for Medicaid nursing facility care.

Iowa

Iowa Medicaid rules allow bed-hold days of up to 18 days per calendar year for overnight visits or vacation (more if the physician's plan of care says extra days would be rehabilitative) and up to 10 days per calendar month for hospital stays, but pay for these absences at zero percent of the home's rate, except special population and state-operated homes, which receive 42 percent. When a resident who has not been discharged is away overnight, the resident, family or friends may pay to hold the bed. Under state licensing rules, a home must ask whether the resident wants the bed held and must hold it as long as payments are made under the contract.

Kansas

Kansas Medicaid rules make payment available to reserve a nursing facility bed while a resident is in a hospital for an acute condition, up to 10 days per hospital stay, if the resident intends to return and the hospital provides a discharge plan. Payment is also available for therapeutically indicated home visits with relatives and friends and for state-approved therapeutic or rehabilitative programs, up to 18 days per calendar year (including travel), if the plan of care provides for the absence; more days can be requested for severe hardship. Residents on planned temporary stays are excluded. Before a hospital transfer or leave, the home must tell the resident in writing how long the bed is held, any cost, and that the resident will be readmitted to the first available comparable room if the hold period runs out.

Maine

MaineCare pays to hold a bed for up to 7 days (counted by midnights) per inpatient hospital stay, as long as the resident is expected to return. Residents admitted for an expected stay of less than 30 days do not qualify. MaineCare also pays for up to 20 therapeutic overnight leaves in a state fiscal year when leave is part of the plan of care. Family or friends may pay to hold the bed beyond the covered hospital days, at no more than the usual rate for a semi-private room.

Massachusetts

MassHealth pays a nursing facility to reserve a bed for up to 20 consecutive days while a MassHealth member is on medical leave (a hospital inpatient or observation stay), if the regulation's conditions are met; the bed may not be occupied while reserved. After a leave of 20 days or fewer, the home must let the member return unless the member no longer needs its services. If the hospital stay is longer than 20 days, or the bed-hold conditions are not met, the home must immediately readmit the member to the next available bed in a semiprivate room, unless the member no longer requires the home's services. MassHealth also pays for nonmedical leave of up to 10 days per 12-month period, if the regulation's conditions are met, including a written authorization from the attending physician or primary care provider in the member's record.

Michigan

Michigan Medicaid pays a nursing home to hold a bed for up to 10 days when a resident on Medicaid is admitted to the hospital for emergency treatment, only if the home's occupancy is 98% or more on the day the resident leaves, the attending physician expects the resident to return within 10 days, and the resident does return within 10 days. If the hospital stay is longer than 10 days, Medicaid pays for none of the leave days. It also pays for up to 18 days of physician-approved therapeutic leave in a 365-day period if the home reserves the bed, the resident's written plan of care provides for visits outside the home, and the resident returns. After a longer absence, state law gives the resident the option to return to the next available bed.

Minnesota

Minnesota Medical Assistance pays for leave days (hospital leave or therapeutic leave, such as a home visit or vacation) at 30 percent of the home's payment rate for the resident, and only when the home's occupancy, counting bed-hold days, is at least 96 percent. The home must hold a reserved bed for a resident on paid leave. State rules limit paid hospital leave to 18 consecutive days for each separate episode of medically necessary hospitalization, and paid therapeutic leave to 36 days per calendar year for nursing facility residents (72 days in a facility licensed to serve persons with physical disabilities). A home that takes Medical Assistance may not refuse, for more than 24 hours, to take back a resident returning from a hospital stay to the same bed or a bed certified for the same level of care, in accordance with a physician's order.

Missouri

Missouri Medicaid pays a home its per-diem rate for hospital leave days (to reserve the bed) only if the home is licensed and certified, the stay is 3 days or less for a condition that cannot be treated as an outpatient, the hospital plans the resident's return, and the home's occupancy was at least 97% of Medicaid-certified beds the prior quarter. Leave days, including visits with friends or relatives, are covered up to 12 days in each half of the year if in the plan of care and prescribed by a physician; each hospital leave day counts as two. Refusing to readmit a resident counts as a discharge unless the resident was away over 90 days.

New Hampshire

New Hampshire Medicaid does not pay to hold a bed during a hospital stay. State law requires a home to hold the bed for 10 calendar days when a return within 10 days is reasonably expected and the home is paid for those days; for a Medicaid resident the home may not charge more than the Medicaid rate. Medicaid pays for up to 30 therapeutic-leave days per resident in a state fiscal year when the days are written into the plan of care. A resident whose bed was not held can return to the next available bed.

New York

Under New York's Medicaid state plan, for residents 21 and older, Medicaid pays to hold a bed only after the resident has been in the home 30 days and only if the home's vacancy rate on the first day of the absence is no more than 5%. It pays for therapeutic leave for up to 10 days in 12 months, and for leave by a resident on hospice for up to 14 days in 12 months. It does not otherwise pay to hold a bed during a hospital stay, except at the five New York State Veterans' Homes. Each home must readmit, immediately upon the first available semi-private bed, a Medicaid-eligible resident who still needs nursing home care and whose hospital stay or therapeutic leave went beyond the bed-hold period.

North Carolina

North Carolina Medicaid does not pay to hold a bed during a hospital stay; any bed hold is a private agreement between the resident and the home, and the admission contract must state the charge. Medicaid does keep paying the home's full daily rate for therapeutic leave ordered by the resident's physician: up to 60 days a calendar year for a resident of a skilled nursing facility, with no more than 15 consecutive days without approval. State law also says that if a resident is in a hospital (other than a State mental hospital) for no more than 15 days, counted from hospital admission until the home receives written notice of the discharge date, the home must give the resident the first bed available after it gets that notice and priority over new applicants, unless the home can no longer provide the needed treatment.

Ohio

Ohio Medicaid pays to hold a bed for up to 30 days a calendar year during a hospital stay, therapeutic leave or visits with family or friends, while the resident intends to return. The payment counts as payment in full, and the home may not charge the resident extra for those days. Bed-hold days are not available in some situations, including for a resident enrolled in a Medicare or Medicaid hospice program. Leave for therapy or visits must be approved in advance by the resident's physician. Before leave, or within 24 hours of an emergency hospitalization, the home must give written bed-hold information. A Medicaid resident who has used all 30 days must be admitted to the first available Medicaid-certified bed in a semiprivate room.

Pennsylvania

Medical Assistance pays to reserve a bed during a hospital stay for up to 15 days in a row, but only if the home's occupancy that quarter was at least 85%. For a Medical Assistance resident whose hospital stay is 15 days or fewer, the home must readmit the resident to the same bed, paid or not, if the resident still needs nursing home care, and may not bill the resident for those days. After a longer stay, the home must readmit the resident to the first available bed if they still need nursing home care. These rules also apply to Community HealthChoices managed care plans. Medical Assistance also pays for up to 30 days per calendar year of therapeutic leave that is in the care plan and ordered by the attending physician.

Rhode Island

Rhode Island Medicaid does not pay to hold a bed during a hospital stay or any other absence. A family may pay privately; for a Medicaid resident the home may not charge more than its Medicaid daily rate for at least the first 5 days of a hospital stay or therapeutic leave. A resident who still needs the home's care must be readmitted to the first available semi-private bed at the right level of care.

Tennessee

TennCare (Tennessee Medicaid) does not pay nursing homes to hold a bed. A TennCare rule states that effective July 1, 2018, Medicaid bed hold days are no longer reimbursed.

Texas

Texas Medicaid pays to hold a bed only during a therapeutic home visit of up to 3 days, if a physician authorized such visits in the plan of care and the home documents the visit; a visit longer than 3 days is treated as a discharge from the first day. The state plan does not pay to hold a bed during a hospital stay. Before a hospital transfer or therapeutic leave, the home must give written information about its bed-hold policy, and it may charge to hold a bed only under a written agreement, no more than the daily Medicaid rate, and not for days the state is paying. A resident whose absence lasts longer than the bed-hold period returns to their previous room if available, or to the first available bed in a semi-private room, if they still need the home's services and are eligible for Medicaid or Medicare nursing home coverage.

Vermont

Vermont Medicaid pays to hold a bed for up to 6 days in a row during a hospital stay, but only when the home would otherwise be full and the resident's doctor expects a return within 10 days. It also pays for up to 24 home-visit days (overnight stays) in a calendar year when visits are part of the plan of care. Separately, state law gives residents the right to keep their bed during a hospital stay of up to 10 days in a row, as long as the bed is paid for at the resident's usual rate (for Medicaid residents, the Medicaid daily rate). A resident whose bed was not kept has the right to return to the first available bed if the home can meet their medical needs.

Virginia

Under Virginia's Medicaid regulation, Medicaid pays to reserve a nursing home bed during a resident's temporary absence for leaves of absence of up to 18 days per year for any reason other than an inpatient hospital admission. The regulation does not provide payment to hold a bed during a hospital stay.

Wisconsin

Wisconsin Medicaid pays a nursing home to hold a Medicaid resident's bed during a hospital stay of up to 15 consecutive days per stay (no limit on the number of stays) and during therapeutic leave, if the home's occupancy was 94% or more in the prior calendar month (homes closing or reducing beds may get an approved exemption). Bed hold is not paid for residents receiving Medicare Part A nursing facility services or in approved traumatic brain injury stays. Therapeutic leave must be approved in the prescribing provider's plan of care. A resident cannot be administratively discharged unless the hospital stay is longer than 15 days. Covered bed-hold days the state does not pay for may not be billed to the resident or family. State licensing rules require a home to hold the bed of a resident on leave or in the hospital who has said they intend to return under the home's admission terms for bed hold, until the resident returns or waives the hold, for up to 15 days. Charges for holding the bed are set out in the admission terms.

Checked against state sources in Oct 2026. State rules are added here as each state's rules are checked against its own sources.