The tax and budget bill passed on May 22 by the House of Representatives through the budget reconciliation process is worse for nursing home residents than earlier drafts. The devastating cuts to the Medicaid program, however they are worded, will inevitably lead to cuts in services and program eligibility and coverage for residents, nearly two-thirds of whom rely on Medicaid to pay for their nursing home care each day.
But some provisions in the bill will be particularly devastating to residents.
Many of the 800,000 low-income residents who are eligible for both Medicare and Medicaid and who currently rely on Medicaid to pay Medicare’s premiums and cost-sharing obligations will lose Medicaid coverage.
The reduction of the look-back period for Medicaid coverage, from 90 days to 30 days, means that residents who are found by their state to be eligible for Medicaid could, nevertheless, lose coverage for 60 days. Many residents rely on the longstanding provision guaranteeing retroactive coverage because they apply for Medicaid for the first time after they move into a nursing home. Many residents had never needed or sought Medicaid until their nursing home stay, but the limited Medicare benefit, virtual absence of private insurance, and high private-pay out-of-pocket charges make them turn to Medicaid to help pay for their care.
So-called “work requirements” that will remove Medicaid-eligible workers because of additional paperwork requirements will reduce staffing levels in nursing homes, including nursing staff, housekeeping staff, food workers, and more. These workers are so poorly paid that many qualify for Medicaid coverage. Loss of Medicaid coverage for themselves and their families means many workers may no longer be able to work as they and their children suffer more illness.
Delay for 10 years of the staffing rule’s requirements that nursing facilities have nursing staff on site will lead to unnecessary deaths of residents. An analysis by University of Pennsylvania experts calculated that an additional 13,000 residents would die each year if the staffing rule did not go into effect.
The Senate must stop the reconciliation bill.
See:
- H.R. 1, “One Big Beautiful Bill Act.”
- “Nursing Home Residents Will Suffer if Proposed Tax Bill Becomes Law” (CMA Alert, May 22, 2025).
- “Medicaid Cuts Will Devastate Nursing Home Residents” (CMA Issue Brief, Feb. 27, 2025).
- “Nursing Home Industry is Heavily Taxpayer-Subsidized” (CMA Special Report, Jul. 2021).
- Letter (Jul. 8, 2024) from Rachel M. Werner, Professor, Health Care Management and Economics, Professor, Medicine, University of Pennsylvania, Norma B. Code, Director of Research, LDI, Professor, Medical Ethics and Health Policy, University of Pennsylvania, to Senator Elizabeth Warren
- Centers for Medicare & Medicaid Services, “Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting,” 89 Fed. Reg. 40876 (May 10, 2024).
June 5, 2025 – T. Edelman