The U.S. Department of Health and Human Services helps oversee nursing home care in the United States. (Main photo by Getty Images; seal courtesy of U.S. DHHS)
Congressional leaders are moving to overturn the federal government’s new nursing home staffing mandates as part of a larger effort to cut Medicaid and other forms of government spending.
Earlier this week, Sens. Deb Fischer, a Nebraska Republican, and James Lankford, an Oklahoma Republican, reintroduced a bill to overturn the mandates through legislation they call the Protecting Rural Seniors’ Access to Care Act.
Companion legislation was introduced in the House last week by Rep. Michelle Fischbach, a Minnesota Republican. Rep. Randy Feenstra of Iowa is a co-sponsor of the House bill.
Senate leaders have already indicated they intend to include the legislation in budget reconciliation efforts, citing estimates that the new staffing requirements would cost Medicaid and Medicare, which pays for much of the care delivered by nursing homes, as much as $22 billion over 10 years.
A budget resolution passed by the House on Feb. 25 calls for $880 billion in cuts to Medicaid over the next 10 years, in part to pay for border security. A senior-advocacy group called the Center for Medicare Advocacy argues such cuts would be “devastating for nursing facility residents” and would decimate the entire Medicaid program.
The center notes that the average annual cost of a nursing home bed ranges from $104,025 for a semi-private room to $116,800 to a private room. Because people over the age of 65 earn, on average, $39,000 per year, Medicaid picks up most of the cost for nursing home care.
Nationally, Medicaid was the primary payor for 63% of all nursing home residents in 2024. According to federal data compiled by the Kaiser Family Foundation, or KFF, Medicaid paid for the care of 50% of all of Iowa’s nursing home residents last year, with Medicare paying for 7% of residents’ care. The remaining 43% were private-pay residents.
Study: Mandates would save 13,000 lives per year
The staffing mandates, which were approved by the Biden administration, are being phased in over a period of years and include exemptions for care facilities in rural areas as well as facilities that have shown they’ve made a good faith effort to increase staffing without meeting the new standards.
The mandates include a requirement for 24/7 coverage by a registered nurse, as well as 3.48 hours of total nursing care per resident, per day.
Fischer has said such requirements will harm the residents of nursing homes, are impossible for rural facilities to meet, and will force some homes to simply close. She noted that even without the new mandates in place, Nebraska saw 44 nursing homes close during the past 10 years.
“My bill advocates for these seniors, their care, and their families. It fights for our rural communities and for nursing homes in Nebraska,” Fischer told her Senate colleagues earlier this week. “I’ll keep pushing for this legislation until the president signs it into law — to protect seniors from a rule that would only harm them, their families, and their caretakers.”
The mandates are backed by consumer groups and organizations such as the National Association of Local Long-Term Care Ombudsmen, but are opposed by the industry and GOP state attorneys general.
A University of Pennsylvania study recently concluded that the staffing mandates, if left in place, would save roughly 13,000 lives per year. In Iowa alone, the researchers said, the mandates would save 101 to 250 lives per year.
DHHS backs mandates in court, at least for now
In addition to congressional challenges, the staffing mandates are being challenged in two separate federal court cases filed in Iowa and Texas by industry officials and GOP state attorneys general.
In the Iowa case, the Trump administration’s then-acting secretary of the U.S. Department of Health and Human Services, Dorothy Fink, filed an answer to the lawsuit earlier in February, denying claims that the staffing mandates are arbitrary, capricious or illegal.
In the department’s answer, Fink also argues the federal government has not underfunded Medicaid and Medicare reimbursements to nursing homes as the industry has claimed.
On its face, the filing suggests the Trump administration is backing the staffing mandates, but industry observers expect the administration will reverse course in the near future.
On Feb. 14, 2025, Fink was replaced when Robert F. Kennedy, Jr. was sworn is secretary of health and human services. Kennedy has been outspoken with regard to his opposition to the mandates, which he has described as a “disaster” that could lead to rural nursing homes closing.
In December, a coalition of seven elder-advocacy groups, including the National Association of Local Long-Term Care Ombudsmen, intervened in the case and argued that nonprofit and publicly operated nursing homes, on average, already exceed the newly mandated staffing ratios.
The new regulations, they argued, are only burden to for-profit operators who might otherwise divert Medicare and Medicaid dollars to “excessive profits” for facility owners.
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