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Senate Finance Committee Democrats are seeking feedback on proposals to increase nursing home ownership transparency, direct more funding to resident care and strengthen workforce policies. Nursing home representatives say they support several measures but oppose restoring the 2024 staffing mandate, arguing workforce and funding constraints must be addressed.
Senate Finance Committee Democrats, led by Ranking Member Ron Wyden, have issued a request for information on long-term care reform, seeking proposals on nursing home ownership, spending transparency and staffing. Nursing home representatives say they support parts of the effort but oppose bringing back the 2024 federal staffing rule, setting up a debate over how to improve care while addressing workforce shortages and costs.
The RFI asks how federal policy could require nursing homes to direct a minimum share of Medicare and Medicaid payments to direct resident care, rather than management fees, rent paid to related companies or corporate profits. It seeks input on what percentage threshold would work and how national rules might draw on state approaches. The report says Massachusetts, New York and New Jersey have adopted similar requirements.
The senators also propose restoring detailed ownership disclosures to the Centers for Medicare and Medicaid Services, extending beneficial-ownership reporting requirements to nursing homes, and having CMS examine an operator’s track record before approving ownership changes. The proposals would also strengthen oversight of private equity involvement in nursing home operations. These are proposals for feedback, not enacted requirements.
Workforce ideas include updating certified nursing assistant training, creating portable credentials, expanding apprenticeships and reviewing long-term care training standards every two to four years. The RFI also discusses changing the federal quality-rating system to give staffing measures more weight and tracking day-to-day staffing variation. Providers cited by Skilled Nursing News support several training and oversight measures, while objecting to reinstating the earlier staffing mandate.
Funding and Staffing at Stake
The RFI puts two connected questions before policymakers: where nursing home funding goes and whether staffing rules can translate into more care for residents. A spending floor could give regulators a way to track whether public payments support direct care, though the senators are still seeking views on how to set and apply such a threshold.
Staffing standards affect residents’ access to hands-on care, but providers argue that mandates cannot be met without enough workers and resources. The dispute matters to residents and families because the eventual policy choices could shape staffing expectations, oversight of owners and how public reimbursement is used. The RFI itself does not establish that these changes will improve outcomes; it gathers input as lawmakers consider possible legislation or other action.
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The Disputed 2024 Staffing Rule
The current federal staffing floor is described in the RFI as 18 minutes of direct care per resident per day, a standard the senators say has not changed in nearly 40 years. The Biden administration’s 2024 rule would have set a minimum of 3.48 hours per resident per day and required a registered nurse on site around the clock. Congress blocked the rule, and the Trump administration rescinded it in December 2025, according to the source report.
The RFI points to Illinois as an example of a different approach: staffing incentives tied to Medicaid payments. It says nursing home staffing there rose 11% from 2022 to 2026, four times faster than the national average over that period. That comparison is cited in the RFI and does not, by itself, establish that the incentive program caused the full increase.
The senators also frame the proposals as urgent in light of nearly $1 trillion in Medicaid cuts they say were enacted through the budget reconciliation law commonly called OBBBA. The source report does not provide further detail here on the cuts’ provisions or their specific effects on individual nursing homes.
““There is real common ground contained in this RFI.””
— Zach Shamberg, chief of government affairs at Saber Healthcare Group
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Details Still Under Review
The RFI is a request for input, and the source report does not state what final legislation, if any, will follow. No spending-floor percentage has been selected, and the proposed ownership disclosures, private equity limits and CMS review process have not been adopted as new federal requirements.
It is also unclear how lawmakers would respond to providers’ objections to a staffing mandate, what funding or workforce measures might accompany any future standard, or how proposed rules would account for differences among facilities and states. The report gives no deadline for a final policy decision or detailed account of the RFI’s response process.
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Responses Will Shape Reform
Lawmakers are seeking feedback through the RFI on the design of possible long-term care reforms. The next developments will depend on the responses from providers, states, residents’ representatives and other stakeholders, and on whether Senate Finance Committee Democrats turn any proposals into legislation or other policy recommendations.
Readers should watch for further details on the proposed care-spending threshold, ownership-reporting rules and staffing approaches. Until lawmakers take additional action, the measures remain proposals rather than requirements for nursing homes.
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Key Questions
What did Senate Finance Committee Democrats propose?
Their RFI seeks input on nursing home ownership transparency, limits on private equity influence, spending directed to resident care, stronger oversight and workforce policies.
Do nursing home providers support the proposals?
Some provider representatives support parts of the package, including CNA training updates and stronger accountability. They oppose restoring the 2024 staffing mandate, citing workforce and funding concerns.
That is under consideration, but no percentage has been chosen and no federal spending-floor requirement has been enacted. The RFI asks what threshold could be effective.
What happened to the 2024 federal staffing rule?
The rule proposed a 3.48-hour-per-resident daily staffing floor and a registered nurse on site 24 hours a day. According to the source report, Congress blocked it and the Trump administration rescinded it in December 2025.
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