A big ugly federal impact upon nursing home care
July 16, 2025 | Uncategorized
McKnight’s Long-Term Care News (July 16, 2025).
That passage of House Resolution 1 – formerly known as the “Big Beautiful Bill” – was not a bigger disaster for nursing home care is a credit to the American Health Care Association. The extreme hostility of ideologues toward provider taxes as state Medicaid funding mechanisms is not confined to their use by hospitals, yet no reductions will occur under the new law for existing nursing home provider taxes.
That is about the end of the good news. Those states that had not yet enacted a nursing home provider tax, with Texas the most prominent example, will now never be able to, nor will states like mine, under the 6% taxable threshold of net patient income, ever be able to raise theirs if state budgetary necessity demands it.
Damage to hospitals under the new law will inescapably impact nursing homes. State healthcare systems are interdependent. Hospitals will lose massive revenue due to paring back Medicaid expansion under the Affordable Care Act. Under the guise of requiring beneficiaries to work, millions of adults will effectively be harassed out of Medicaid enrollment. That will be coupled with future hospital provider tax reductions that will total an estimated $232 billion. The consequences can only be imagined. My state of New Hampshire is one of seven the New York Times found to be worst-impacted in its federal funding loss proportion.
Supersized vetting of the Medicaid expansion population adds a massive unfunded burden upon states. Many state agencies tasked with new responsibilities are underfunded and have antiquated information technology systems not up to the new demands.
While the U.S. House would have reduced from three months to one the period in which providers can bill for care provided prior to an application for “traditional” — as opposed to expansion — Medicaid, a small win in the U.S. Senate was making that reduction one month. But a month of unreimbursed care is still a hit.
The most certain calamity will be 4% cuts in Medicare payments due to massive deficit spending, triggering the Statutory Pay-As-You-Go Act of 2010. Let’s not kid ourselves into thinking that Freedom Caucus types will allow a vote to prevent those cuts. Indeed, the architects of H.R. 1 could have expressly exempted H.R. 1 from the application of those cuts, but chose not to.
I know we are to be grateful H.R. 1 suspended the nursing home staffing mandate for a decade, but I’m not. Suspending it did legislators as much of a favor as it did providers, who had that rule beat fair and square in court. The $23.1 billion in forecast savings from suspending this rule will help pay for very important things, such as the $1 billion reported cost of “[p]referential treatment for meals provided to crew members on a commercial vessel, certain fishing vessels or certain fish processing facilities.”
On the staffing mandate, we found ourselves as supplicants in our familiar gruel-seeking Oliver Twist role: “Please, sir, I want some more.” In his confirmation hearing, Health and Human Services Secretary Kennedy had declared the mandate a “disaster,” but his agency continued to appeal court setbacks. This incongruity now seems designed to preserve the rule for its cost savings to be used in H.R. 1, which makes one feel ill-used.
Finally, in addition to triggering Medicare cuts, the stupendous red ink of H.R. 1 dries up any realistic chance of federal investment in our healthcare workforce, while its policies robbing states of Medicaid resources will thwart their own workforce investments. That will be on top of the fact that many in our existing workforce, including an estimated 5,000 nursing home workers in Massachusetts alone, face deportation due to the end of Temporary Protected Status for those from countries like Haiti.
I had hoped that the COVID-19 pandemic would bring a new appreciation of the vital role and needs of long-term care in our aging society, and yet, five years after it began, we still find ourselves undervalued and in existential struggles.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association.