Federal Ruling Overturns Key Biden Mandate

A federal judge has struck down Biden’s controversial nursing home staffing mandate that would have required 24/7 registered nurse coverage, dealing a significant blow to the former administration’s healthcare reforms.

Quick Takes

US District Judge Matthew Kacsmaryk ruled the Biden administration overstepped its authority by replacing Congressional staffing requirements
The mandate would have required nursing homes to have registered nurses present 24/7 and maintain 3.48 nursing hours per resident daily
Nursing home associations successfully argued that the rule threatened facility closures and resident displacement
The ruling represents a significant setback to the former administration’s healthcare changes, which focused on improving elder care standards

Federal Judge Overturns CMS Nursing Home Staffing Rule

US District Judge Matthew Kacsmaryk has struck down a Biden administration rule that would have imposed strict staffing requirements on nursing homes nationwide. The rule, implemented by the Centers for Medicare & Medicaid Services (CMS), mandated that nursing homes provide 24/7 registered nurse coverage and maintain at least 3.48 nurse staffing hours per resident daily. Judge Kacsmaryk determined that CMS exceeded its authority by establishing requirements that replaced Congressional directives on nursing home staffing standards.

Federal judge blocks Biden nursing home staffing mandate https://t.co/WTFndbKnrc

— Fox News (@FoxNews) April 9, 2025

The judge’s ruling came in response to lawsuits filed by several nursing home industry groups, including the American Health Care Association (AHCA). These organizations argued that the mandate would place impossible burdens on facilities already struggling with staffing shortages, particularly in rural areas. The court agreed, issuing a summary judgment in favor of the plaintiffs that effectively nullifies the former administration’s staffing initiative.

Industry Concerns Over Mandate Implementation

Nursing home operators consistently warned that the staffing requirements would be impossible to implement amid nationwide healthcare worker shortages. Facilities in rural and underserved communities would have been particularly vulnerable to closure if forced to meet the mandated staffing ratios. Industry representatives claimed the rule failed to account for regional workforce variations and would have required thousands of additional nurses at a time when qualified workers are already scarce.

Katie Smith Sloan of LeadingAge, another industry group, criticized the mandate’s approach, stating that addressing fundamental funding and workforce challenges would be more effective than imposing strict staffing requirements. The organization had repeatedly called for comprehensive solutions to nursing shortages rather than mandates that failed to address underlying workforce issues.

Legal Basis for the Ruling

Judge Kacsmaryk’s decision centered on statutory interpretation and agency authority. He ruled that CMS “lacks authority to issue a regulation that replaces Congress’s preferred minimum hours with its own” staffing standards. The court found that Congress intended nursing home staffing decisions to be based on individual resident needs rather than one-size-fits-all requirements imposed by federal agencies.

The judge specifically noted that the CMS rule did not properly consider the individualized nursing needs of residents as required by existing legislation. By setting a universal baseline staffing requirement, the agency had created a standard that conflicted with Congressional intent. This ruling reinforces limits on executive agency authority to impose regulations not explicitly authorized by legislation.

Mixed Reactions to the Court Decision

While nursing home industry representatives celebrated the ruling as a protection for resident care access, patient advocates expressed disappointment. Sam Brooks from the National Consumer Voice for Quality Long-Term Care argued that the staffing standards would have improved care quality for vulnerable residents. The Biden administration had cited research suggesting higher staffing levels correlate with better health outcomes for nursing home residents.