A nursing home need not accept every applicant, but you should not treat a blanket refusal because your mother is a Green Card holder as automatically legal—get the exact reason in writing and challenge any discriminatory rule.
“My mom arrived in the US as a new Green Card holder in 2025. She had a stroke and needs a nursing home for therapy, but our social worker is getting rejections from facilities in our state because she isn't a US citizen. Is it common or legal for nursing homes to deny access to Green Card holders?”
Summary
Several refusals do not by themselves prove illegal discrimination because CMS expressly says nursing homes need not accept every applicant. But an admissions office should not blur your mother’s lawful permanent residence with a separate payment problem, and a written “citizens only” rule deserves immediate civil-rights review.
The next route depends on whether the homes are applying a true citizenship rule or are actually saying that no payer has been approved.
If a facility confirms that it rejects lawful permanent residents because they are not citizens, preserve that statement. CMS says homes need not accept every applicant, but covered facilities may not discriminate on protected grounds such as national origin, disability, or age; 42 U.S.C. § 1981 also protects every person’s right to make and enforce contracts against nongovernmental impairment. Citizenship is not expressly named in Section 1557, so a citizenship-only claim may also require state-law or court-specific analysis. [CMS Resident Rights; 45 CFR 92.101; 42 U.S.C. § 1981]
This route is viable now only if she satisfies all state financial and rules and has an exception to the federal or qualifies for coverage funded under your state’s own law. Once eligible, state Medicaid programs may not put covered nursing-facility services on a waiting list, although an individual facility may still decline admission. [8 U.S.C. § 1613; CMS Nursing Facilities]
On the facts given, arrival in 2025 means she has not accumulated the five continuous years of U.S. residence CMS requires a permanent resident to have before applying for Medicare. Even an otherwise qualifying stroke-therapy stay cannot create Medicare eligibility by itself. [CMS Original Medicare Eligibility]
Medicaid’s duty to provide covered nursing-facility services without a waiting list does not force every particular nursing home to accept every applicant. [CMS Nursing Facilities; CMS Resident Rights]
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Watch out for
Next steps
These steps preserve her placement options while identifying whether the obstacle is discrimination, payment, or an incomplete clinical referral.
Do this now
Get each rejection in writing
Email each admissions director: “Please confirm the specific reason for denying this referral and identify any written admission policy involved. Is the reason lawful permanent-resident status, payer eligibility, network participation, bed availability, inability to meet clinical needs, or missing documents?” Save replies, voicemails, names, and dates.
Requirements
Before accepting “not eligible”
Separate Medicare from Medicaid
On the facts given, she does not yet meet Medicare’s five-continuous-years requirement. Have the hospital’s Medicaid eligibility unit submit the state long-term-care Medicaid case and screen the facts against the § 1613 exceptions, especially prior refugee/asylee status and qualifying veteran, active-duty, spouse, or dependent status. The state-specific application cannot be identified without knowing the state.
Requirements
At the same time
Complete the clinical admission packet
Have the hospital discharge team send the complete packet to Medicaid-certified nursing facilities that provide stroke rehabilitation. PASRR Level I is required for all applicants to Medicaid-certified nursing facilities; a positive screen triggers Level II review. [CMS PASRR Guidance]
Requirements
Within 180 days
Challenge a discriminatory refusal
If the facts indicate national-origin, disability, age, race, color, or sex discrimination, file with the HHS Office for Civil Rights at https://ocrportal.hhs.gov/. A complaint may also be emailed to OCRComplaint@hhs.gov or mailed to Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F HHH Building, Washington, DC 20201. File within 180 days; OCR may extend that period for good cause. [HHS OCR Complaint Process]
Requirements
Before admission
Do not sign personal liability
Cross out or reject language making you personally responsible for the bill. A facility may require a representative with lawful access to your mother’s funds to arrange payment from her funds, but it cannot condition admission on your personal guarantee. [42 CFR 483.15(a)(3)]
Requirements
Legal sources
This answer is based on the U.S. Code, current federal regulations, and guidance from CMS, Medicare, Medicaid, and the HHS Office for Civil Rights.
CMS, Your Rights and Protections as a Nursing Home Resident
A home need not admit everyone, but its decisions remain subject to civil-rights law.
Nursing homes don’t have to accept all applicants, but they must comply with Civil Rights laws that say they can’t discriminate based on race, color, national origin, disability, age, or religion.
45 CFR 92.101
Section 1557 names the protected grounds governing covered health programs; citizenship is not expressly included in this list.
§ 92.101(a)(1)
Except as provided in title I of the ACA, an individual must not, on the basis of race, color, national origin, sex, age, disability, or any combination thereof, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any health program or activity operated by a covered entity.
42 U.S.C. § 1981
Federal law protects every person’s contract rights against nongovernmental impairment, which can be relevant to an express noncitizen contracting rule.
(a)–(c)
All persons within the jurisdiction of the United States shall have the same right in every State and Territory to make and enforce contracts, to sue, be parties, give evidence, and to the full and equal benefit of all laws and proceedings for the security of persons and property as is enjoyed by white citizens, and shall be subject to like punishment, pains, penalties, taxes, licenses, and exactions of every kind, and to no other. The rights protected by this section are protected against impairment by nongovernmental discrimination and impairment under color of State law.
42 CFR 483.15
A facility cannot require a relative to become personally liable for the resident’s bill.
§ 483.15(a)(3)
The facility must not request or require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may request and require a resident representative who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.
CMS Original Medicare Part A and B Eligibility
A permanent resident generally needs five continuous years of U.S. residence before applying for Medicare.
Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.
Medicare Skilled Nursing Facility Coverage
Medicare SNF coverage has separate hospital, timing, clinical, facility, and benefit-period requirements.
Coverage requirements
You have Part A and have days left in your benefit period. You have a qualifying inpatient hospital stay. You enter the SNF within a short time (generally 30 days) of leaving the hospital. Your doctor or other health care provider has decided that you need daily skilled care (like intravenous fluids/medications or physical therapy). You must get the care from, or under the supervision of, skilled nursing or therapy staff. You get these skilled services in a Medicare-certified SNF.
8 U.S.C. § 1613
The federal five-year waiting period begins when the person enters with qualified-alien status, subject to statutory exceptions.
§ 1613(a)
Notwithstanding any other provision of law and except as provided in subsections (b), (c), and (d), an alien who is a qualified alien (as defined in section 1641 of this title ) and who enters the United States on or after August 22, 1996, is not eligible for any Federal means-tested public benefit for a period of 5 years beginning on the date of the alien's entry into the United States with a status within the meaning of the term ‘qualified alien’.
CMS SHO #26-001
The October 2026 Medicaid change continues to recognize LPRs while preserving their existing five-year waiting rule and exceptions.
SHO #26-001
Beginning October 1, 2026, sections 1903(v)(5) and 2107(e)(1)(R) of the Social Security Act (the Act), as added and amended, respectively, by section 71109 of the WFTC legislation, generally limit federal financial participation (FFP) for medical assistance (Medicaid) and child or pregnancy-related health assistance (CHIP), with limited exceptions, to U.S. citizens and U.S. nationals, lawful permanent residents (LPRs), Cuban/Haitian entrants, and Compact of Free Association (COFA) migrants. States must continue to apply the five-year waiting period to LPRs in accordance with 8 U.S.C. § 1613(a), unless an exception provided in 8 U.S.C. §§ 1613(b) or (d)(1) applies (e.g., LPRs who are veterans or active-duty armed forces service members or certain family members of such an individual).
CMS Medicaid Nursing Facilities
Eligible adults cannot be put on a Medicaid nursing-facility-services waiting list, but state level-of-care standards still apply.
States may not limit access to the service, or make it subject to waiting lists, as they may for home and community based services. Need for nursing facility services is defined by states, all of whom have established NF level of care criteria.
CMS PASRR Guidance
Every applicant to a Medicaid-certified facility receives the federal PASRR preliminary screen, regardless of payer or citizenship.
In brief, the PASRR process requires that all applicants to Medicaid-certified nursing facilities be given a preliminary assessment to determine whether they might have SMI or ID. This is called a "Level I screen." Those individuals who test positive at Level I are then evaluated in depth, called "Level II" PASRR.
HHS OCR Complaint Process
HHS explains exactly where and when to submit a health-care civil-rights complaint.
Be filed in writing by mail, fax, e-mail, or via the OCR Complaint Portal. Be filed within 180 days of when you knew that the act or omission complained of occurred. OCR may extend the 180-day period if you can show "good cause."
These are the official federal rules as published on the cited dates; federal and state rules can change.
This is general information about official processes, not legal advice, and SettleKit is not a law firm.
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