Recent Policy Changes Impacting Long-Term Care and Medicare

In 2023, the Biden administration proposed a federal rule aimed at addressing chronic understaffing in nursing homes by mandating a minimum of 3.48 hours of care from nurses and aides per resident each day, along with requiring a registered nurse on-site 24/7. However, this regulation faced significant legal challenges, leading to its repeal in 2024 after Congress, through the One Big Beautiful Bill Act, prohibited its implementation until 2034. Advocates, including Patricia Hunter from the Nursing Home Reform Coalition, expressed disappointment, noting that the repeal could have saved approximately 13,000 lives annually.

These 3 Policy Moves Are Likely To Change Health Care for Older People

Industry representatives, such as Holly Harmon from the American Health Care Association, argued that the staffing mandate would have necessitated hiring an additional 100,000 caregivers, a workforce that is currently unavailable. They contended that compliance with the new requirements could lead to nursing homes limiting admissions or even closing. This perspective highlights the ongoing staffing challenges faced by long-term care facilities, which often experience high turnover rates.

These 3 Policy Moves Are Likely To Change Health Care for Older People

In July 2025, the Labor Department announced a return to the 1975 regulations that excluded home care workers from the Fair Labor Standards Act, effectively removing their entitlement to minimum wage and overtime pay. This decision was met with criticism from advocates like Kezia Scales of PHI, who described it as a significant regression in labor rights for a workforce primarily composed of women and minorities. The National Alliance for Care at Home supported the rescission, citing that many home care workers had not benefited from the previous regulations.

These 3 Policy Moves Are Likely To Change Health Care for Older PeopleThese 3 Policy Moves Are Likely To Change Health Care for Older People

Additionally, the Trump administration initiated a pilot program called WISeR (Wasteful and Inappropriate Service Reduction) to implement prior authorization in traditional Medicare. This program, which began in six states, utilizes artificial intelligence to review proposed treatments before approval. Critics, including David Lipschutz from the Center for Medicare Advocacy, raised concerns about potential conflicts of interest, as the vendors involved have financial stakes in the outcomes, which could incentivize denial of care.

These 3 Policy Moves Are Likely To Change Health Care for Older People

Advocates for nursing home reform expressed frustration over the repeal of staffing standards, emphasizing the need for federal regulations to ensure adequate care. Sam Brooks from the National Consumer Voice for Quality Long-Term Care stated, “It’s clear CMS has no interest in ensuring adequate staffing.” In contrast, industry representatives defended the changes, arguing that the previous regulations were impractical given the current labor market.

These 3 Policy Moves Are Likely To Change Health Care for Older People

Critics of the recent policy changes argue that they undermine the quality of care for older Americans. The rollback of staffing mandates and labor protections for home care workers has been described as a “shocking step backward” by advocates. Furthermore, the introduction of prior authorization in traditional Medicare has been met with skepticism, as it may complicate access to necessary medical services.

These 3 Policy Moves Are Likely To Change Health Care for Older People

As the political landscape evolves, further legislative efforts are anticipated to address these issues, particularly regarding the reinstatement of staffing standards and labor protections for home care workers. The ongoing evaluation of the WISeR program will also be closely monitored by stakeholders concerned about its impact on patient care.

These 3 Policy Moves Are Likely To Change Health Care for Older People