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Groups representing Oklahoma nursing homes say staffing mandate faces uncertain future under Trump

Matthias Zomer
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As President Donald Trump comes into office, a federal staffing mandate for nursing homes faces an uncertain fate, with some speculating he might stall or completely shelve its provisions. Groups representing Oklahoma’s nursing homes provided updates on where it stands and what they think could come this year.

Judge denies request to halt staffing mandate temporarily

The Center for Medicare and Medicaid Services (CMS) staffing rules would require nursing homes to have a registered nurse (RN) on site 24/7 and employees to spend a minimum amount of time with each resident.

Facilities say it asks them to find staff they can’t afford and who don't exist. Oklahoma is one of about 20 states that joined a lawsuit against the federal government over it last year. LeadingAge Oklahoma, which represents 58 nonprofit nursing homes in the state, signed on.

The suit argues this rule will cost facilities significantly to implement, and workforce shortages in long-term care complicate their ability to meet it.

“The main concern and [LeadingAge’s] stance … is that the workforce simply does not exist. … And when you look at the aging demographic, and how the country's population — especially the state of Oklahoma's population — is getting older, that problem is exacerbated,” Claire Dowers-Nichols, the CEO of LeadingAge Oklahoma, told StateImpact in November.

Last week, U.S. District Judge Leonard T. Strand denied the plaintiffs’ motion to halt the rule’s implementation temporarily.

“With regard to nearly every aspect of the Final Rule, the plaintiffs have failed to demonstrate that a preliminary injunction is necessary in order to preserve the status quo and prevent irreparable harm during the pendency of these proceedings,” Strand wrote in his ruling.

Strand specifically notes that because the RN and hours per resident per day requirements don’t begin to take effect until May 2026, challenges to financial and compliance burdens “are too speculative to constitute irreparable harm for purpose of a preliminary injunction.”

Dowers-Nichols said she understands it might seem early, but the concern she’s hearing from her members is that there won’t be enough workforce.

“When you look at the nursing students now, there are not enough of them, and there will not be enough of them when this requirement is actually required in [2026],” Dowers-Nichols said.

An analysis found the rule would require Oklahoma to hire over 1,200 full-time employees, including 538 nurse aides and 715 RNs, over the five years the rule is phased in. It will cost Oklahoma nursing homes an estimated $76 million per year.

Any appeals for summary motion or to dismiss the case must be filed by March 3.

Dowers-Nichols said there’s an acknowledgment the Trump administration could overturn the mandate altogether. But she doesn’t know what the next step will be at this time.

“We're kind of in a holding pattern until we see what the administration does and what happens next in the case,” Dowers-Nichols said.

Staffing incentive has merit

CMS also recently announced an incentive program to recruit registered nurses, with up to $40,000 in tuition reimbursements and/or a $10,000 stipend, to work for nursing homes or state survey agencies. This is not an element of CMS’ final rule, but serves as a “complementary push to aid providers and regulators struggling with nursing shortages.”

Individual nursing homes, nursing home chains and nursing home associations can't apply. CEO Steve Buck of Care Providers Oklahoma, which represents a portion of the state’s nearly 300 nursing homes, said he hopes eligible groups, like colleges offering nursing degree programs, will compete on Oklahoma’s behalf.

“If you look at a state like Oklahoma, which recently was reported to be 46th in the number of RNs per capita, anything that we could do to add skilled health care professionals into the workforce has merit,” Buck said. “So we appreciate the fact that this project is being launched.”

“There are still a lot of questions about how many nurses will actually be allocated to long-term care,” Buck added. “It's too early to write the ending to that story. But that's one of the things that we will monitor closely in the months ahead."

Buck said recruiting, training, educating and licensing nurses takes time. He said Oklahoma nursing homes are still underfunded by Medicaid, despite the recent approval of a nursing home rate increase by the state Health Care Authority Board.

“It's important for us to remember today that you have to have a viable availability of long-term care providers to be able to be in business when that surge of seniors presents itself,” Buck said.

Buck said continuing to highlight this gap will be Care Providers Oklahoma’s focus during the 2025 legislative session. He said the group is working on a bill with recently elected Sen. Kelly Hines (R-Edmond) to include a supplemental item in the Oklahoma Health Care Authority’s annual budget request reflecting the gap between cost and reimbursements.

“The Health Care Authority has been very cooperative in doing that voluntarily,” Buck said. “We would like to make sure in the future that continues, and it becomes part of statute.”

StateImpact Oklahoma is a partnership of Oklahoma’s public radio stations which relies on contributions from readers and listeners to fulfill its mission of public service to Oklahoma and beyond. Donate online.

Jillian Taylor reports on health and related topics for StateImpact Oklahoma.
StateImpact Oklahoma reports on education, health, environment, and the intersection of government and everyday Oklahomans. It's a reporting project and collaboration of KGOU, KOSU, KWGS and KCCU, with broadcasts heard on NPR Member stations.
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