A U.S. District Court judge in Texas on Monday tossed a Biden-era policy to increase staffing in long-term care facilities that participate in Medicaid or Medicare programs.
In May 2024, the Centers for Medicare & Medicaid Services, under then-President Joe Biden’s administration, issued a final rule requiring the facilities, including about 97% of nursing homes, to change their staffing requirements by providing 24-hour licensed nursing services at the facilities.
The mandate came after the Covid-19 pandemic heavily affected nursing homes and raised questions on whether enough was being done to care for residents at the facilities.
The Biden administration said it was establishing federal minimum nurse staffing standards to provide residents with safe and quality care, address insufficient staffing at facilities, and "create a consistent floor to reduce variability in the minimum floor for nurse-to-resident ratios."
In response to the policy, the American Health Care Association, Texas Health Care Association and other nursing home-affiliated organizations filed a lawsuit in June against the secretary of the U.S. Department of Health and Human Services and the administrator of the Centers for Medicare & Medicaid Services (CMS). In the Northern District of Texas filing, the plaintiffs argued that it "exceeds CMS's statutory authority, effects a baffling and unexplained departure from the agency’s longstanding position, and creates impossible-to-meet standards that will harm thousands of nursing homes and the vulnerable Americans they serve."
The lawsuit states that the mandate to use the services of a registered nurse for 24 hours a day, seven days a week, triples Congress' original directive of eight hours, seven days a week, and is a deviation from standing legislation that leaves it up to each facility to decide what their residents need.
"Over the years, Congress has considered alternative regulatory approaches, including proposals to replace the flexible sufficient-staffing requirement with a one-size-fits-all numerical minimum staffing requirement," the lawsuit stated. "But each time, Congress has declined to adopt such proposals, and instead concluded that the adequacy of nursing home staffing should be determined flexibly based on the particularized needs of each facility."
On Monday, U.S. District Judge Matthew Kacsmaryk threw out the Biden administration policy, citing that it is inconsistent with Congress' existing legislation. The filing listed current Health and Human Services Secretary Robert F. Kennedy Jr. and others as defendants.
"Though rooted in laudable goals, the Final Rule still must be consistent with Congress’s statutes," the court document states. "To allow otherwise permits agencies to amend statutes though they lack legislative power. Separation of powers demands more than praiseworthy intent."
The White House did not immediately respond to a request for comment.
The American Health Care Association (AHCA), which represents around 15,000 long-term care facilities and nursing homes across the U.S., called Monday's ruling "a victory for our nation’s seniors and their families."
"This unrealistic staffing mandate threatened to close nursing homes and displace vulnerable seniors," the AHCA said. "The court decision not only upholds the rule of law and balance of powers, but it protects access to care for our aging population."
The AHCA said it looks forward to working with Congress and President Donald Trump's administration "to pursue more common-sense workforce solutions."
The president of SEIU Local 2015, a California labor union that represents more than half a million long-term care workers, called the staffing requirement a "long-needed regulation."
"The Texas federal judge’s ruling to strike down the Biden Administration’s lifesaving safe staffing requirement is immoral — not just an offense to nursing home residents and their families, but also to the long-term care workers across the country," Arnulfo De La Cruz said in a Thursday statement.
