HHS Repeals Federal Nursing Home Staffing Mandate, Citing Risks to Rural and Tribal Access to Care

The U.S. Department of Health and Human Services (HHS) has formally repealed key provisions of the Biden-era Minimum Staffing Standards for Long-Term Care Facilities and the Medicaid Institutional Payment Transparency Reporting Final Rule.

HHS leaders said the mandate “overreached,” limited access to care, and failed to reflect the realities of communities already struggling to recruit nurses and nursing assistants.

HHS has also determined that the 2024 federal staffing mandate placed disproportionate pressure on facilities in rural and Tribal regions. Those areas face some of the nation’s highest healthcare workforce shortages. According to CMS staffing data, rural nursing homes report significantly higher vacancy rates for registered nurses and certified nursing assistants compared with suburban and urban facilities.

HHS said its decision reflects evidence that facilities in these regions would be unable to meet the mandated staffing levels, which could have resulted in reductions in available beds or service capacity.

Tribal governments also told federal officials that the rule had been advanced without sufficient consultation and would have had significant operational impacts on long-term care programs in Indian Country.

HHS leaders said the mandate “overreached,” limited access to care, and failed to reflect the realities of communities already struggling to recruit nurses and nursing assistants.

What HHS Ended—and Why

The 2024 Centers for Medicare and Medicaid Services (CMS) rule would have required every Medicare- and Medicaid-certified nursing home to provide:

• 3.48 hours of nursing care per resident per day
• At least 0.55 hours from a registered nurse (RN)
• At least 2.45 hours from a nurse aide
• A registered nurse on-site 24/7

While the intent was to increase safety and quality, HHS said the rule had the opposite effect in many places.

Severe Workforce Gaps Made Compliance Impossible

Rural and Tribal regions are facing the largest healthcare staffing shortages in the nation. According to the most recent CMS Nursing Home Staffing Dashboard (2025 update), more than 60 percent of rural facilities reported “severe difficulty” hiring RNs, compared with 32 percent of suburban facilities. In several Tribal regions, vacancy rates for certified nursing assistants (CNAs) exceeded 40 percent.

HHS concluded that these shortages made a one-size-fits-all rule both unrealistic and harmful.

Tribal Communities Were Not Adequately Consulted

Tribal leaders argued the 2024 rule did not include meaningful consultation, despite its significant effect on Indian Health Service long-term care programs.

The Oneida Nation appreciates Secretary Kennedy for recognizing the unique staffing challenges in Tribal communities and rescinding a rule that would have severely limited our ability to care for our elders, —Tehassi Hill, Chairman, Oneida Nation.

HHS pledged that future regulatory changes affecting Tribal health services will undergo full government-to-government consultation.

Protecting Access to Quality Care

HHS Secretary Robert F. Kennedy Jr. said the rollback protects access to essential care.

“Safe, high-quality care is essential, but rigid, one-size-fits-all mandates fail patients,” Kennedy said.

This Administration will safeguard access to care by removing federal barriers—not by imposing requirements that limit patient choice. — HHS Secretary Robert F. Kennedy Jr.

CMS Administrator Dr. Mehmet Oz said the agency wants approaches that are achievable for all communities, not just those with robust labor pools.

“We cannot meet our mission by ignoring the realities facing rural and underserved populations,” Oz said.

The revocation of a nursing home rule which was overburdening rural areas across this country... with regulations that were going to destroy the nursing home industry in those communities. That is going to be $25 billion savings. This repeal moves us toward practical solutions that work for the American people.

The nation’s largest long-term care industry association also issued a statement supporting the repeal. Clif Porter, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), said the decision “rescinds an unrealistic regulation” and prevents potential nursing home closures that could have displaced residents.

Porter thanked Congress, the courts, and CMS leadership for “prioritizing protecting access to care for our aging population,” noting that providers had warned the original mandate would strain facilities already facing severe workforce shortages.

Trump Administration Deregulation Priorities

The repeal aligns with President Trump’s Executive Order, Unleashing Prosperity Through Deregulation. The order directs federal agencies to eliminate what it calls excessive or counterproductive regulations and restore decision-making authority to local communities and private providers.

HHS said the change gives states, Tribal nations, and local facility operators more flexibility to design staffing models that match their populations and available workforce.

What This Means for Older Adults, Families, and Care Access

Medicaid is the largest payer of nursing home care in the United States, funding more than half of all nursing home residents according to the CMS. Many facilities rely heavily on Medicaid reimbursement to operate, and a significant share of long-stay residents receive Medicaid benefits.

Staffing levels, however, vary widely across facilities. Private-pay–focused nursing homes sometimes have higher staffing levels than facilities serving primarily Medicaid residents, but this is not universal and depends on ownership, location, and available workforce.

Federal and state regulations set minimum requirements, and some facilities, both private pay and mixed-payer, exceed those standards, while others struggle due to workforce shortages or financial constraints.

Those individuals who have Long-Term Care Insurance generally have more options, including in-home caregivers and assisted living.

According to the federal government, the rollback of these regulations will provide several benefits.

Facilities May Avoid Closure or Reduced Beds

Many rural and Tribal facilities warned that the 2024 rule would lead to:

• Bed reductions
• Facility closures
• Longer waitlists
• Reduced Medicaid acceptance

Removing the mandate may allow these facilities to remain open and stabilize staffing.

Quality of Care Still Under Review

HHS stressed that repealing the rule does not end oversight. CMS will continue monitoring staffing, quality metrics, infection-control performance, and resident outcomes.

Facilities still must:

• Maintain adequate staffing to meet resident needs
• Comply with state-level staffing requirements
• Report staffing levels through the Payroll-Based Journal (PBJ) system

Your Loved One’s Care Still Depends on Local Staffing

Even with the repeal, workforce shortages remain a major barrier in many regions. If your parent lives in a rural or Tribal community, it’s essential to ask facilities directly:

• How they recruit and retain nurses
• Whether turnover is high
• How do they ensure a timely response to call lights
• What their current staffing ratios are

You can also use the LTC News Caregiver Directory to compare local home-care agencies and long-term care providers in your area.

What Happens Next?

HHS says it will engage with stakeholders over the coming year, including:

• Tribal governments
• Rural health coalitions
• Nursing home operators
• Consumer protection advocates
• Direct-care workforce groups

Possible next steps include:

• Revised, flexible staffing guidelines
• Incentives for rural and Tribal workforce development
• New quality-measurement proposals
• Updated payment models for Medicaid and Medicare-certified facilities

The agency emphasized that any future rulemaking will include full Tribal consultation and will account for the nation’s uneven healthcare workforce distribution.