The Trump administration has rolled back a series of health care regulations affecting nursing homes, home care workers and Medicare beneficiaries — scrapping minimum staffing standards and launching a new experiment that expands prior authorization in traditional Medicare.
The changes reverse years of advocacy efforts by consumer groups and labor organizations. They are expected to affect care delivery for millions of older Americans while reshaping oversight of providers, according a recent report by The New York Times.
The Biden administration finalized a Medicare rule in 2024 that requires nursing homes to provide at least 3.48 hours of nursing and aide care per resident per day. It also mandates a registered nurse to be on site 24 hours a day, seven days a week.
Supporters viewed the rule as a baseline enforcement tool.
“I’m a pragmatic person, so I thought, this is a good start,” Patricia Hunter, director of Washington state’s long-term care ombudsman program, told the Times. “It would be helpful, for enforcement, to have a federal law.”
A ‘devastating’ move
Industry lawsuits quickly blocked most of the regulation, with two federal courts ruling that Medicare exceeded its authority.
Following the 2024 elections, Конгресс barred implementation of the standards before 2034. Last month, the Centers for Medicare and Medicaid Services (CMS) repealed the rule entirely.
Hunter called the move devastating — with advocates saying it signals a retreat from oversight.
“It’s clear (CMS) has no interest in ensuring adequate staffing,” said Sam Brooks of the National Consumer Voice for Quality Long-Term Care. “They’re repealing a regulation that could have saved 13,000 lives a year.”
Industry groups countered that facilities could not meet the requirements.
The rule “was requiring nursing homes to hire an additional 100,000 лица, осуществляющие уход that simply don’t exist,” Holly Harmon of the American Health Care Association told the Times in an email.
Wage protections, Medicare pilot
In July, the U.S. Department of Labor also rescinded a 2013 rule extending minimum wage and overtime protections to home care workers, reverting to a 1975 interpretation of federal labor law, the Times noted.
Since 2013, agencies have paid about $158 million in back wages, according to research organization ФИ. Industry groups supported the rollback, citing Medicaid funding limits.
CMS has also launched WISeR — standing for Wasteful and Inappropriate Service Reduction — a six-year pilot that introduces искусственный интеллект-powered prior authorization into traditional Medicare programs in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
“It injects some of the worst of Medicare Advantage into traditional Medicare,” said David Lipschutz of the Center for Medicare Advocacy, adding that vendors approving or rejecting treatments “have an incentive to deny care.”
Democrats have introduced legislation to halt the program.
“We should be reducing red tape in Medicare, not creating new hurdles that second-guess health care providers,” said Rep. Suzan DelBene (D-Wash.)
For now, WISeR is operating, with CMS promising annual public evaluations, according to the Times.
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