A caregiver is told on a Tuesday afternoon that discharge is set for Wednesday morning. The wound is still draining, the medication list has changed, the stairs at home are the same stairs they always were, and nobody has explained who will help. Most families assume the date is final. It is not. If the person you care for has Medicare, you can challenge a discharge you believe is unsafe, the challenge costs nothing, and it can be started with a telephone call.
The Notice That Starts the Clock
Every Medicare patient admitted as an inpatient must receive a form called An Important Message from Medicare about Your Rights. The hospital has to deliver it at or near admission and no later than two calendar days afterward, and it must present a second copy before the discharge itself. Printed on that form is the name and toll-free number of the organization that reviews discharge appeals in your area.
That form is easy to lose in a folder of paperwork nobody reads during a frightening week. Find it and keep it where you can reach it. If the hospital never gave it to you, ask for it, and raise the omission with the patient advocate. A discharge appeal depends on that notice, so its absence is worth pursuing rather than shrugging off.
Who Reviews the Appeal
The reviewers are not hospital employees. Medicare contracts with independent organizations, staffed by physicians, to decide these disputes. In New York the reviewer is Commence Health, which covers the state along with New Jersey, Puerto Rico, and the Virgin Islands, and it can be reached at 1-866-815-5440. Its materials and staff may also identify the organization as Livanta, the contractor that operates it, so either name is the right place.
How to Ask, and By When
Telephone that number no later than the day the discharge is scheduled. Nothing needs to be filed in writing, no attorney is involved, and there is no fee at any point. You may make the call yourself as the person’s representative rather than putting a sick patient on the phone.
Once you ask, the hospital must give you a second document, the Detailed Notice of Discharge, setting out the specific medical reasons it believes the stay should end. Read it, because it tells you exactly what the reviewers will be weighing. You may also submit a letter from the treating doctor supporting your position, which carries real weight.
A decision usually arrives within a day of the reviewers receiving the records.
What It Costs While You Wait
The hospital cannot send the patient home while the review is open, and Medicare keeps paying for the stay. You remain responsible only for the ordinary amounts you would have owed anyway. In 2026 that means the Part A deductible of $1,736 for a benefit period, and $434 a day only if the stay passes sixty days.
If the reviewrs side with the patient, coverage continues for as long as the care is medically necessary. If they side with the hospital, Medicare pays through noon of the day after the decision is delivered, which gives a family a short window to arrange something safer. Missing the deadline is the costly mistake: a late request follows different rules, and the patient can be billed for the days after the original discharge date.
This right belongs to people in Original Medicare and to people enrolled in Medicare Advantage plans equally.
Ask One Question Every Day: Admitted, or Observation?
Here is the trap that catches the most families, and it has nothing to do with how sick anyone is. A patient can spend three nights in a hospital bed, receive tests and treatment, and never be admitted at all. That is called observation status, and Medicare treats it as outpatient care.
It matters because Medicare will only pay for rehabilitation in a nursing facility after three consecutive days as an admitted inpatient. Observation days do not count. Neither do hours in the emergency room, nor the day of discharge. Families routinely discover this at the nursing home’s billing desk, long after the decisions were made.
So, ask directly, on the first day and again on each day afterward, whether the person is admitted as an inpatient or under observation, because the answer can change without anyone telling you. When observation runs past twenty-four hours, the hospital must give you a written notice confirming outpatient status. Tell the doctor plainly if rehabilitation is likely to be needed afterward, since that affects how the stay is classified.
If someone was admitted and the hospital later switched the status to observation, you can appeal that change while still in the hospital, using a separate form called the Medicare Change of Status Notice. One caution: the older process for appealing past stays after the fact closed on January 2, 2026, and late requests are now refused unless there is good cause. Acting during the stay is what protects you.
Say Plainly What Cannot Be Managed at Home
Hospitals are required to plan the discharge with the patient and the family rather than around them, and to help arrange the care that follows. Ask for the plan in writing. Then be specific about what will not work, because a vague worry is easy to dismiss and a concrete fact is not. The medications cannot be managed alone. The wound needs daily dressing, and no one has been trained. There are twelve steps to the front door and no railing. Nobody is home between eight and six.
Where to Get Help in New York
Free, unbiased Medicare counseling is available through the city’s HIICAP program. Call Aging Connect at 212-244-6469 and ask for HIICAP. Elsewhere in the state, the counseling line is 1-800-701-0501. General Medicare questions go to 1-800-MEDICARE, and Medicare explains the appeal itself on its page for fast appeals.
If you are caring for someone who is chronically ill, frail, or living with memory loss, PSS Circle of Care can be reached by call or text at (866) 665-1713.
Sources: Centers for Medicare & Medicaid Services, Beneficiary Notices Initiative and 2026 Medicare Parts A & B Premiums and Deductibles fact sheet; Medicare.gov; Commence Health; New York City Department for the Aging.