A federal court has blocked a federal rule requiring minimum staffing levels in nursing homes, handing a legal victory to long-term care providers and advocacy groups who argued the mandate was unworkable.
What happened
On April 7, 2025, U.S. District Judge Matthew J. Kacsmaryk of the Northern District of Texas struck down a Centers for Medicare & Medicaid Services (CMS) rule that mandated 24/7 registered nurse (RN) coverage in all nursing homes receiving Medicare and Medicaid funding. The rule also required facilities to meet specific minimum daily hours of direct care by RNs and nurse aides. Judge Kacsmaryk ruled that the policy, while intended to improve care, failed to consider the unique circumstances and staffing needs of individual facilities, rendering it unlawful.
The backstory
CMS originally introduced the staffing mandate as part of a broader push to enhance the quality of care in long-term care facilities. However, the American Health Care Association (AHCA), a major industry trade group, filed a lawsuit claiming the rule violated the Administrative Procedure Act. The AHCA argued that the rule was “arbitrary and capricious,” especially given the current nationwide shortage of nursing staff. A 2023 CMS research study even acknowledged the lack of “clear evidence” supporting universal minimum staffing levels, a finding that critics used to push forward their legal challenge.
Going deeper
In his opinion, Judge Kacsmaryk emphasized that Congress requires any staffing regulations to be tailored to each facility’s specific care needs. He stated that the CMS rule constituted a “blanket mandate” that did not meet this requirement. By ignoring the practical and structural differences among nursing homes, particularly those in rural or underserved areas, the rule, according to the court, violated both legislative intent and the principle of separation of powers.
What was said
Judge Kacsmaryk wrote, “Congress mandated consideration of a facility’s individual nursing needs,” and that CMS’s approach disregarded this statutory requirement. Industry advocates have long echoed this view, stating that while quality care is a shared goal, a one-size-fits-all policy ignores the operational realities of many nursing homes. Supporters of the rule, however, argued that the minimum staffing thresholds were necessary to ensure resident safety and care consistency across the board.
In the know
While this court ruling halts the CMS staffing mandate, the legal battle may not be over. The Trump administration has not indicated whether it will appeal the decision, but the possibility remains. Regardless, providers must still comply with federal and state requirements to ensure adequate staffing based on resident needs. In some states, licensure standards may be stricter than those set by CMS, meaning that nursing homes could still be subject to intensive staffing demands even without a federal minimum.
Why it matters
This ruling directly impacts nursing homes nationwide that rely on Medicare and Medicaid funding. By invalidating the CMS staffing mandate, the court has relieved many facilities—especially those in rural and underserved areas—of a regulation they argued was financially and operationally unsustainable. The decision shows the legal importance of tailoring federal healthcare regulations to reflect the diverse capacities and needs of providers. It also signals to federal agencies that sweeping mandates lacking a clear evidentiary basis may not survive judicial scrutiny. For residents and their families, the ruling raises new questions about how nursing homes will maintain quality care without federally enforced minimum staffing levels. The outcome could influence future rulemaking efforts across the healthcare sector, particularly those involving workforce shortages and compliance burdens.
The bottom line
Although nursing homes can temporarily breathe easier without the looming threat of a federal staffing mandate, they must remain vigilant. The law could still change, and state requirements may demand equally high staffing levels. Providers should focus on maintaining flexible, resident-centered staffing practices that align with both current regulations and evolving policy trends.
FAQs
Will this ruling affect staffing mandates in hospitals or other healthcare settings?
No, this ruling applies only to nursing homes regulated under Medicare and Medicaid, not hospitals or other healthcare providers.
Can individual states still impose their own staffing requirements?
Yes, states can and often do enforce their own staffing standards that may be stricter than federal regulations.
How might this decision impact nursing home residents' quality of care?
Some experts worry that removing federal minimums could lead to inconsistent staffing and lower care quality in under-resourced facilities.
Does the court ruling apply nationwide or only in Texas?
While issued by a Texas court, the ruling has national implications because it halts enforcement of a federal rule.
Are nursing homes still required to provide 24/7 care?
Yes, all facilities must still meet resident care needs around the clock, even without a registered nurse on-site 24/7.
