Federal 24/7 RN Staffing Mandate for Nursing Homes Eliminated by Trump Administration

In a major regulatory shift, the U.S. Department of Health and Human Services (HHS) has moved to roll back most of the federal nursing home minimum staffing requirements that were finalized in 2024, significantly reshaping the oversight landscape for long‑term care facilities and the nurses who work in them. The change affects nursing homes participating in Medicare and Medicaid and raises new questions about how “adequate staffing” will be defined and enforced going forward.​

What the original rule required

The 2024 federal staffing rule, issued under the Biden administration, set the first national minimum nurse staffing standards for long‑term care facilities. It required,

•  At least 3.48 hours of nursing care per resident per day, including a minimum of 0.55 hours from registered nurses and 2.45 hours from nurse aides/Certified Nursing Assistants.
• Along with a requirement that a registered nurse be on‑site 24 hours a day, 7 days a week.
• These standards applied to Medicare and Medicaid‑certified nursing homes nationwide.​

Why HHS is repealing most provisions

In late 2025, HHS and the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule rescinding most of those staffing mandates, including the HPRD minimums and the 24/7 RN requirement, while leaving certain assessment and planning expectations in place.

• Federal officials cited concerns that the 2024 rule would disproportionately strain nursing homes in rural and Tribal communities with severe workforce shortages, increasing the risk of facility closures and reduced access to care in areas already facing limited options.
• Analyses used by HHS estimated that full implementation would have required nursing homes collectively to hire on the order of 100,000 additional caregivers, a target many providers argued was unattainable under current labor market conditions.​

The rule was highly controversial and faced significant opposition from multiple states, with several judges rescinding it over the years.

• In June 2025, a federal judge in Iowa vacated the Biden administration’s nursing home staffing mandate that required a registered nurse (RN) be on-site 24/7 and set a minimum number of nursing hours per resident per day. The court found that the Centers for Medicare & Medicaid Services (CMS) exceeded its legal authority with these requirements, stating that only Congress—not CMS—can impose such rigid staffing floors.
• A federal judge in Texas struck down the Biden administration’s controversial nursing home staffing mandate on April 8, 2025, dealing a blow to efforts aimed at establishing nationwide minimum nurse-to-patient ratios in long-term care facilities. 

Provider and advocate reactions

Provider organizations in the skilled nursing sector have largely welcomed the rollback, framing it as a necessary course correction that prevents financially fragile facilities—especially in rural markets—from being pushed toward closure by mandates they could not meet. Some industry representatives describe the repeal as a “win” for facilities that were worried about complying amid persistent staffing shortages, while also acknowledging ongoing pressure to demonstrate quality and safety to regulators and families.​

Nursing and consumer advocates, however, have expressed deep concern that rescinding federal minimum staffing standards could weaken protections for residents and increase workloads for nursing staff. Advocacy groups warn that without a clear national floor, some facilities may prioritize cost savings over staffing adequacy, potentially worsening burnout, turnover, and resident outcomes unless states and individual operators adopt strong standards of their own.​

The American Health Care Association (AHCA) and National Center For Assisted Living (NCAL),  criticized the rule as unrealistic and potentially damaging to an already strained industry. On September 06, 2023, they released a joint press release condemning the proposed rule. 

"This unfunded mandate doesn't magically solve the nursing crisis," Mark Parkinson, AHCA President, told NPR.

The American Healthcare Association (AHCA), released the following statement in 2023 while the proposal was still being considered, “We are concerned that in proposing a one-size-fits-all numerical staffing threshold, CMS would remove the role of clinical judgment in staffing facilities, and inadvertently create patient access challenges across the health care system. Implementing a numerical staffing threshold could drive nursing homes to further reduce capacity or close in order to meet the requirements. Fewer nursing home beds could adversely impact hospital patients who are denied the specialized care they are prescribed when they must stay, sometimes months, in hospital beds awaiting discharge to post-acute care settings. This could become especially dire in rural and underserved communities.” 

What it means for nurses in long‑term care

For nurses and nurse aides, the repeal removes the immediate federal push for a rapid, nationwide staffing build‑up but also eliminates a uniform benchmark that was intended to support safe, consistent care. Employment and wage effects are likely to be mixed: the large hiring surge anticipated under the 2024 rule will probably not occur at the originally projected scale, but facilities still face intense scrutiny around quality, which may sustain demand for experienced long‑term care nurses in many markets.​

State regulators and individual facilities now bear more responsibility for defining and enforcing what constitutes “adequate” staffing, making nurses’ voices and data particularly important in shaping policies that protect both residents and the workforce.

🤔Nurses, share your thoughts below.