Trump Administration Repeals Minimum Staffing Standards for Long-Term Care Facilities

This article was exclusively distributed to subscribers on December 8, 2025. Click to receive additional information about how to subscribe and to activate a complimentary trial subscription.

On December 3, CMS issued an (the 2025 IFR) repealing the long-term care (LTC) facility minimum staffing requirements established under the Biden Administration in April 2024 (the ). The 2024 Final Rule was set to be phased in over three years and included the following components:

• Minimum Staffing Standards: Required specific nurse staffing hours per resident day.
• RN Presence Requirements: Mandated the presence of a registered nurse (RN) onsite 24 hours a day, seven days a week.
• Facility Assessment Enhancements: Revised how facilities assess their resource needs to care for residents.
• Payment Transparency Rules: Required public reporting on the portion of Medicaid payments spent on direct care and support staff.

The 2025 IFR repealed the 2024 Final Rule’s Minimum Staffing Standards and RN Presence Requirements but left the Facility Assessment Enhancements and Payment Transparency Rules in effect.

In justifying the repeal, CMS noted that H.R. 1 () already imposes a ten-year moratorium prohibiting the enforcement of the Minimum Staffing Standards and RN Presence Requirements until October 2034. As a result, CMS stated that there are currently no active regulations implementing minimum statutory nursing service requirements for LTC facilities. To address this regulatory gap, CMS restored the pre-2024 Final Rule requirements. In addition, CMS stated that the U.S. District Courts for the Northern District of Texas and the Northern District of Iowa had already vacated the Minimum Staffing Standards and RN Presence Requirements, ruling that they were unlawful overreaches of CMS’s statutory authority. Finally, CMS expressed concerns with the appropriateness of the Minimum Staffing Standards because they “impose one-size-fits-all minimum requirements on all facilities across the country without accounting for differences in local labor supply, overall acuity of the facility’s resident population, or available resources.” CMS posited that the standards could heighten the risk of facility closures, resulting in a disparate reduction in access to care in certain communities—especially in rural and Tribal areas.

The 2025 IFR is scheduled to go into effect on February 2, 2026. Stakeholders are invited to submit feedback before this date. Given the ten-year congressional moratorium, similar staffing mandates are unlikely to be reinstated before 2034, meaning that the 2025 IFR effectively “closed the book” on these provisions in the near-term. LTC facilities—particularly those in areas most affected by health care workforce shortages—may benefit from avoiding the 2024 Final Rule’s stringent staffing requirements. However, the absence of enforceable national staffing minimums reignites previous concerns about the impact of chronic understaffing on resident safety and care quality. The long-term effects of these changes to the minimum staffing standards will likely depend on how CMS, states, and providers respond to ongoing workforce shortages, as well as whether future attempts to reform LTC staffing effectively balance provider flexibility with accountability.

For more details on the 2024 Final Rule, Manatt on Health subscribers can see this Manatt on Health .

There are no active regulations implementing the statutory minimum statutory nursing service requirements for LTC facilities in Sections 1819(b)(4)(C)(i) and 1919(b)(4)(C)(i) of the Social Security Act. 

American Health Care Association v. Kennedy, Case Nos. 24-144 and 24-171, 777 F. Supp.3d 691 (N.D. Tex. 2025); Kansas v. Kennedy, Case No. C24-110-LTS-KEM, F. Supp. 3d (N.D. Iowa, June 18, 2025).

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