Nursing home staffing mandate ‘dead’ as Trump wins, but staffing wage challenges remain

A day after newly elected President Donald Trump scored a surprisingly decisive victory, many long-term care stakeholders were looking forward to sweeping policy changes. But some experts also warned Wednesday that Trump’s victory will go both ways.

Providers hope to capitalize on Trump’s anti-regulatory prospects, reverse the Biden administration’s onerous new staffing requirements set to take effect in 2026 and undo current opposition to nursing home profiteering.

“Certainly, as with other Republican administrations, this will be more beneficial if you own or operate a skilled nursing facility or a chain,” said Fred Bentley, director of Medicare Innovation at ATI Advisory. “The personnel mandate is dead on arrival. They will scale back or reduce regulatory oversight and surveys. You can go a little further, and it will be a more favorable environment.

Still years of work to come immigration reform needed to boost the long-term care workforce won’t even be up for debate under the next president, Bentley said McKnight’s long-term care news. Stricter rules for Medicare Advantage plans are also likely gone, increasingly denying access to post-acute care.

Trump’s victory and Republicans’ takeover of the Senate could give the party a clear path to make important changes. The only major questions left unanswered late Wednesday afternoon were how big the party’s majority would be in the Senate, and whether Republicans would also be able to retain control of the House of Representatives.

LTC advocacy groups are participating

Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living, said in a statement released Tuesday that he welcomed the opportunity to work with Trump.

“It is critical that our nation’s leaders prioritize, support and invest in America’s seniors and their caregivers,” Porter said, inviting collaboration with Trump and the 119th Congress to address quality care and the growing shortage of caregivers and to advocate for the aging of nations. population.

“While we are eager to get started, there is still much that can be accomplished before the end of the year,” Porter added. “We urge lawmakers to pass legislation during the lame-duck session that rationalizes regulations, expands workforce development, and increases access to care for seniors and individuals with disabilities.”

Providers see the lame-duck session — the post-election period that runs from now until Inauguration Day on Jan. 20 — as an opportune time to tap outgoing members of Congress for support on issues they may have previously avoided. It could also be an opportunity for those leaving to implement reforms that were not voted on earlier in the session.

For example, Senator Jon Tester (D-MT) supported legislation blocking the Center for Medicare & Medicaid Services’ nursing home staffing rule. He was voted out of office on Tuesday, but LTC advocates believe Tester and others could still have major influence on the rule and other bills in the final days of the 118th Congress.

“We are optimistic that a Trump administration would repeal the unrealistic staffing mandate, but there are still multiple avenues for Congress and the courts to address this issue,” Porter told us. McKnight’s. “We will continue to pursue all angles to protect access to care and push for more meaningful workforce solutions.”

Linda Couch, LeadingAge’s senior vice president of policy, said that if no activity overrides the staffing mandate, the Trump administration could decide to suspend implementation and issue a final rule to repeal it.

“We do see that action as a possibility; however, we will continue our legal advocacy unless or until an agency revocation is issued,” she shared McKnights in an email.

Efforts are also already underway to understand what the new administration might focus on first — and to get some skilled nursing and other LTC initiatives high on that priority list.

“In the near term, we will focus on working with Trump’s transition teams to share LeadingAge’s agenda and gain a clear understanding of the new administration’s goals on housing, aging, health care and long-term care” , said Katie Smith Sloan, president and CEO of LeadingAge. said Wednesday. “As we learn more, we will better understand its potential impact on our members and those they serve – wherever they live. That is our top priority in the short term.”

Previous record

During his first day of the presidency in 2017, Trump used the joint CEO maneuver and ordered a freeze on all ongoing regulatory actions. That could also be a go-to in his second term.

As of Wednesday afternoon, several rules that could affect post-acute care providers were still under review by the White House Office of Management and Budget. This included five CMS rules, including a proposal that would govern policy and technical changes to the Medicare Advantage and PACE programs in 2026. There are six pending Department of Labor rules, including proposed updates to the Fair Labor Standards Act and finalization of a rule to limit COVID exposure among health care workers.

Any rule still on that list in mid-January could be permanently frozen, and any rule finalized before then could be subject to congressional review.

“If the new administration is serious about reducing regulations and burdens, there is plenty of that in healthcare,” Dan Mendelson, CEO of Morgan Health and founder of Avalere Health, wrote on LinkedIn on Wednesday.

It’s unclear whether Trump would go so far as to scrap Biden-era rules that aimed to increase transparency over nursing home ownership and give state licensing boards and others more quality information that could be used in considering of future transactions.

However, provider advocates fully expect Trump to dial back the rhetoric and promote a much more hospitable environment for healthcare mergers and acquisitions.

“There was a ferocity with which President Biden vilified the nursing home industry,” Brendan Williams, CEO of the New Hampshire Health Care Association, told me. McKnight’s Wednesday. “President-elect Trump harbors no such animosity toward the industry, and I expect his administration to push back on Biden’s bizarre regulatory vendetta.”

Mendelson said he expects “a more permissive deal environment and more deal activity in healthcare.”

A big determining factor in the extent to which Trump could unravel on the mergers and acquisitions front is who he taps as his secretary for the Department of Health and Human Services. The president-elect has said that former independent candidate and vaccine conspirator Robert F. Kennedy Jr. will play a “major role” in his government’s health care, influencing food and drug regulation. Trump has not indicated whether that could be as an adviser or in a more official capacity.

Williams said he is “very uncertain” about how Kennedy’s promised role would interact with the post-acute sector, where both the workforce and residents have largely rejected COVID vaccines this fall.

Medicare and MA Expectations

Because Trump campaigned on protecting Medicare and the nation is rapidly aging, Bentley predicted that Trump could break the issue with typical Republican expectations.

“I don’t feel like the budget hawks are after Medicare. Maybe they will try to come after Medicaid and tighten the sails on Medicaid spending, and that could have adverse consequences,” he said. “But it looks like the tap will be wide open.”

That would include more favorable compensation for Medicare Advantage insurers, Bentley predicts, which plans might (or might not) pass on any gains in the rates they pay to skilled nurses. But Bentley warned that this “cuts a lot of different ways.”

“The extent to which the Biden administration focused on improving access to skilled nursing care and home health care and requiring MA plans to provide the same level of access and coverage as service-based Medicare beneficiaries has disappeared or significantly toned down. Bentley commented.

Big budget questions

Bigger questions about how Trump approaches federal budget negotiations could also hang heavily over the industry. Congress must still pass a new short-term funding law in December to avoid a shutdown.

“There is motivation from both sides of the aisle to prevent a government shutdown. Budget concerns are legitimate for healthcare providers, as well as for all sectors,” said Melissa Schakowsky, director of government affairs at the Ambassadors Group, an advocacy group for long-term care providers. “It is also unknown how bold conservatives will be in cutting government spending, especially on entitlement programs.”

Couch said the big question is what happens to the House of Representatives’ balance of power.

“The response could have a direct impact on Congress’s willingness to finalize the FY 25 bills, and we want them to do so as quickly as possible,” she explained. “Continuing resolutions are not helpful to the programs or the agencies, especially the longer-term CRs. If all the work from FY25 is pushed to the next session, these bills could get caught up in decisions about raising the debt ceiling and other very tricky wickets.”

And what happens in the future, year-round budget processes could also spell bad news for patients and healthcare providers.

Some Republicans have pushed for across-the-board cuts that would reduce health care spending. While some facilities may rely on insurance companies and private pay to improve their bottom lines, skilled nurses rely almost exclusively on Medicare and Medicaid payments.

Trump has suggested that his confidant Elon Musk joins his cabinet as “secretary of cost savings;” Musk has said he wants that Eliminate $2 trillion from the federal budget.

Williams said Wednesday that he hopes there are no proposals from Musk “that would harm Medicaid and Medicare.”