Tag Archives for Senator Jack Reed

Medicare and Medicaid at 60: Historic Milestones, Looming Changes

Published in RINewstoday on August 4, 2025

As 68 million Medicare beneficiaries recognize the 60th anniversary of Medicare, changes are coming to these landmark programs. Presented as efforts to slash costs and combat fraud, the thought of change to Medicare in almost any way leaves many older Americans feeling threatened that their health and financial security will be impacted in a negative way.

A Legacy Under Threat – or Repair?

On July 30, 1965, President Lyndon B. Johnson signed H.R. 6675 into law during a ceremony at the Truman Library in Independence, Missouri. Lasting between 45 and 60 minutes, the event marked the official creation of Medicare and extended guaranteed health coverage to 16 million Americans aged 65 and older—coverage that had not previously existed.

Former President Harry Truman, who had fought for national health insurance two decades earlier, was present for the ceremony. He was enrolled as Medicare’s first beneficiary and received the first Medicare card at the event.

Speaking at the bill signing, President Johnson declared, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime… No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents.” Johnson concluded, “When the final chapter of this generation is written, it will be said that we met the needs of the old, and that we did not abandon them to the despair and loneliness and hardship that comes when illness strikes the aged.”

Today, Medicare provides universal health coverage to Americans age 65 and older—though, as the National Committee to Preserve Social Security and Medicare (NCPSSM) humorously noted in its blog, “Ironically, the program is not yet old enough to qualify for itself.”

 The law created Part A to provide hospital insurance funded through payroll taxes and Part B to cover doctor visits and outpatient services on a voluntary basis. Part C, known as Medicare Advantage, offers a privatized, for-profit alternative to traditional Medicare. Part D (coverage through private, for-profit insurers rather than through the traditional Medicare program), added in 2003, provides coverage for prescription drugs. Over the years, Medicare has evolved to offer a wider range of services, yet it still falls short in some areas. Efforts to expand coverage to include essential benefits like dental, hearing, and vision have repeatedly failed to pass Congress.

Medicaid is a federal-state program that offers health coverage to low-income individuals, including children, pregnant people, and those with disabilities — in addition to covering long-term care for eligible seniors. It is a key funding source for U.S. safety net healthcare providers.

NCPSSM’s President and CEO, Max Richtman said that, “We should take a moment to marvel at the fact that — like Social Security — Medicare was created by national leaders who had a vision of a more just society, where, instead of leaving older people to get sick and die in poor houses or becoming a burden to their children, America would commit itself to providing basic health (and financial) security to our most vulnerable citizens.  Through the foresight of Franklin D. Roosevelt and Lyndon Johnson, these benefits (Medicare Part A and Social Security) would be earned through workers’ payroll contributions, giving Americans a true stake in insuring themselves against the hardships of aging.”

What’s at Stake

Despite Medicare’s broad support, it has frequently come under political attack, often rationalized by concerns over its long-term financial viability. The most recent Medicare Trustees report projects that the program’s Part A trust fund could be depleted by 2033 if Congress does not act. At this point the fund’s reserves would only be able to pay 90% of the total scheduled benefits in what there is to spend on Part A.

In 2025, following weeks of political discourse, the “Big Beautiful Bill” was signed into law on July 4, 2025. Known formally as H.R. 1, the sweeping 900-page legislation passed the House on May 22 by the razor-thin margin of 215–214–1. Every House Democrat opposed the measure. Two Republicans joined them. Freedom Caucus Chair Andy Harris of Maryland voted “present.” Two Republican members abstained.

Richtman, sharply criticized the law, saying it “rips health coverage away from as many as 16 million Americans and food assistance from millions more.” Its Richtman’s opinion to warn that 7.2 million seniors who are dually enrolled in Medicare and Medicaid, and another 6.5 million who rely on SNAP (Supplemental Nutrition Assistance Program), stand to lose vital support for health care and nutrition.

The Center for Medicare Advocacy (CMA) also raised serious concerns. CMA is a national, non-profit law organization, working to advance access to Medicare and quality health care through advocacy on behalf of older and disabled people. They warn that Medicare is being steadily privatized. More than half of all beneficiaries now receive their care through Medicare Advantage plans, which costs taxpayers approximately 20 percent more than traditional Medicare. These plans often restrict access to care through networks and pre-authorization requirements. CMA estimates that the $84 billion in overpayments to Medicare Advantage plans this year alone could instead have funded comprehensive dental, vision, and hearing coverage for every Medicare recipient.

CMA further maintains that H.R. 1 strips Medicare coverage from certain lawfully present immigrants who had earned eligibility through their work histories. Undocumented immigrants are not eligible for Medicare. It also blocks implementation of enhancements to the Medicare Savings Program that would have helped low-income beneficiaries afford care, stops new federal nursing home staffing standards estimated to have the potential to save 13,000 lives per year, and limits Medicare’s ability to negotiate lower drug prices for some of the most expensive medications.

Medicaid, enacted alongside Medicare in 1965 to serve low-income individuals and families, faces even steeper reductions under H.R. 1. The law’s new eligibility restrictions are projected to cause from 10-16 million people to lose coverage.

Medicaid Fraud, Waste, and Abuse

Medicaid fraud, like other forms of healthcare fraud, involves intentionally submitting false information to receive payment for services not rendered, unnecessary services, or inflated claims. This fraudulent activity has serious consequences, harming patients, honest providers, and taxpayers. In 2024, the national Medicaid improper payment rate was estimated at 5.09%, translating to $31.1 billion in federal Medicaid improper payments. Medicaid Fraud Control Units (MFCUs) recovered $1.4 billion in FY 2024, representing a return of $3.46 for every $1 spent. Criminal recoveries in FY 2024 were the highest in 10 years, reaching $961 million, more than double the five-year average.

In 2024, 8% of Medicaid claims were deemed improper payments due to fraudulent practices. Fraudulent billing for services not rendered or exaggerated in complexity (upcoding or ghost billing) was a common theme in 2024 fraud cases. Misuse of telehealth and the involvement of third-party billing firms were also notable trends in Medicaid fraud cases in 2024. Prescription drug scams, especially involving opioids and controlled substances, remain among the most significant Medicaid fraud cases. Medicaid fraud in managed care settings increased by 30% in the past five years.

Examples of recipient fraud include lending or sharing a Medicaid Identification card; forging or altering a prescription or fiscal order, using multiple Medicaid ID cards, re-selling items provided by the Medicaid program, and selling or trading the card or number for money, gifts or non-Medicaid services.

Examples of provider Fraud, Waste, and Abuse include billing for Medicaid services that were not provided or for unnecessary services, selling prescriptions, intentionally billing for a more expensive treatment than was provided, giving money or gifts to patients in return for agreeing to get medical care, and accepting kickbacks for patient referrals.

Rhode Island Senators React 

In response to the changes in H.R. 1, Rhode Island’s U.S. Senators Jack Reed and Sheldon Whitehouse joined the entire Senate Democratic caucus to introduce S. 2556 on July 30, the 60th anniversary of Medicare and Medicaid. This three-page bill seeks to repeal the health care cuts included in H.R. 1 and permanently extend the Affordable Care Act’s enhanced tax credits, which are set to expire at the end of 2025. Full Democratic caucus sponsorship of legislation—led in this case by Senate Minority Leader Chuck Schumer—is exceptionally rare and underscores their urgent need to call out the Big Beautiful Bill for its healthcare changes.

S 2556 has been referred to the Senate Finance Committee and at press time no House companion measure has been introduced.

Senator Reed emphasized the wide-reaching impact of H.R. 1, saying that millions of people are expected to lose health coverage under the combined effects of the bill’s Medicaid and ACA cuts. The repercussions, he said, will be felt by health clinics, hospitals, seniors, nursing homes, and patients across the country.

According to an analysis by KFF (formerly the Kaiser Family Foundation) 43,000 Rhode Islanders could lose health coverage due to the bill. Of those, 38,000 would lose insurance as a result of Medicaid cuts, and another 5,500 due to changes in the Affordable Care Act. The same analysis projected that Rhode Island would lose $3 to 5 billion in federal Medicaid funding over the next decade due to the law’s provisions.

Reed also noted that the bill includes cuts to the SNAP (food stamps) program—reducing federal funding by 20 percent through 2034. States would have the option to pick up the difference using their own funds.  In Rhode Island, where 1/3 of the population is on social welfare assistance of some kind, including Medicaid and SNAP, an estimated 144,000 Rhode Islanders are expected to lose SNAP benefits entirely. To maintain SNAP provisions in Rhode Island, the estimated cost could be as high as $51 million.

Reed explained that without ACA premium tax credits, younger workers will also face rising health insurance premiums beginning in 2026, putting additional financial strain on working families. When people lose access to health insurance, they are more likely to delay or skip care, leading to poorer health outcomes and higher overall costs. Federal law would still require hospitals to provide emergency care, meaning hospitals will absorb the financial burden when patients cannot pay. There are also new limits on how medical costs can be held against individuals, especially in Rhode Island, with provisions against destroyed credit ratings, liens, and bankruptcy moves.

BBB Supporters Say It’s a Pill We May Need

According to supporters of H.R. 1, recent changes to Medicare, Medicaid, and SNAP may be seen as fearful, but positive, because they improve affordability, access, and long-term health outcomes.  They says that H.R. 1. Medicare’s new $2,000 cap on drug costs protects seniors from crushing out‑of‑pocket expenses. Medicaid’s pilot coverage for obesity treatments like GLP‑1 drugs supports preventative care and could reduce chronic illness. Meanwhile, efforts to modernize SNAP enrollment and target benefits more effectively aim to reduce administrative waste and better serve low‑income families. However, the introduction of new SNAP work requirements, while controversial, is intended to encourage workforce or volunteer participation among beneficiaries. These reforms reflect a broader commitment to updating essential safety net programs, making them more efficient, equitable, and responsive to today’s health and economic realities—without sacrificing core benefits, supporters add.

A New Reality

As aging advocates and policymakers mark the 60th anniversaries of Medicare and Medicaid, they are forced to address a new reality in both programs. Rather than continually expanding to meet growing needs of older adults, these programs now face reductions that could lead to challenges in access, lower quality care, increased paperwork, disruption in treatment, higher premiums, and fewer covered services. Provider reimbursements are also expected to be cut, which may further limit access to care.

Instead of being a milestone for celebration, the 60th anniversary of Medicare and Medicaid has become a turning point for aging advocate groups—marking not progress, but threat for millions of older Americans who depend on these essential programs to live with dignity, independence, and health.

Historic Social Security Legislation Awaits President’s Signature

Published in RINewsToday on Dec. 30, 2024

After 40 years, a polarized Congress actually worked together on behalf of millions of Americans with public pensions to push through bipartisan legislation repealing two Social Security provisions that would benefit these individuals. Just past midnight in the early hours of Saturday, on Dec. 21, 2024, the U.S. Senate took up S. 597, a companion measure to H.R. 82, the Social Security Fairness Act, repealing unpopular WEP (Windfall Elimination Provision) & GPO (Government Pension Offset) provisions titles in the Social Security program.   

The House had overwhelmingly passed H.R. 82, introduced last month introduced by Reps. Garret Graves (R-Louisiana) and Abigail Spanberger (D-VA).

The Senate companion measure, authored by U.S. Senators Susan Collins (R-Maine) and Sherrod Brown (D-OH), overwhelmingly passed without amendment, by a Yea-Nay vote, 76-20 (with Sens. Marco Rubio (R-FL), JD Vance (R-Ohio), Joe Manchin (I-WV) and Adam Schiff (D-CA) not voting) and now goes to President Biden to be signed into law. At press time, H.R. 82 has not been signed and the President has until Dec. 31 to sign or veto the bill.

Before the historic Senate vote, at a Dec. 16 meeting with Patrick Yoes, National President of the Fraternal Order of Police (FOP), and Executive Director Jim Pasco met with President-elect Donald J. Trump at his home in Mar-a-Lago, President elect Donald Trump announced his support for the upper chambers’ passage of the “Social Security Fairness Act”— the “FOP’s top priority.”

Earlier this year, Collins and Brown had called on Senate leadership to immediately bring their legislation, which had 62 Senate co-sponsors—above the margin needed for passage—to the Senate floor for a vote. Collins held the first Senate hearing on this policy in 2003 as Chair of the Senate Government Affairs Committee. She, along with the late Senator Dianne Feinstein, first introduced the Social Security Fairness Act in 2005. 

Their bipartisan efforts pushed the legislative Social Security fix across the goal line, at the end of the second session of the 118th Congress.  For Brown, who lost his bid for re-election in November, passage of S. 597 was a bitter sweet moment for him as he leaves the U.S. Senate after serving as a U.S. senator from Ohio since 2007. 

In a Nutshell… 

According to Graves, WEP reduces the earned Social Security benefits of an individual who also receives a public pension from a job not covered by Social Security.  This financially impacts educators who do not earn Social Security in public schools but who work part-time or during the summer in jobs covered by Social Security, who have reduced benefits, even though they pay into the system just like others, Graves says.

Likewise, the GPO affects the spousal benefits of people who work as federal, state, or local government employees — including police officers, firefighters, and educators — if the job is not covered by Social Security. The GPO reduces by two-thirds the benefit received by surviving spouses who also collect a government pension, added Graves. 

According to the National Education Association (NEA), more than 2.8 million public sector employees in 26 states were impacted by GPO and WEP. Educators were affected in 15 of those states, because they pay into their state pension system, but not into Social Security, says NEA. 

The WEP currently impacts approximately 2 million Social Security beneficiaries, and the GPO impacts nearly 800,000 retirees.

Rally calls for passage of H.R. 82, gets Majority Senate Leader’s attention

Before Congress left Capitol Hill for recess, Graves and Spanberger, the primary sponsors of H.R. 82, had filed a discharge petition for their Social Security Fairness Act — which secured the required 218 signatures needed  to force a floor vote in the U.S. House. On Nov. 12, 2024,  a bipartisan majority voted 327 to 74, under suspension of rules to pass the legislation, sending it to the upper legislative chamber for consideration.

A week before the Senate vote on Dec. 21th, the National Active and Retired Federal Employees Association along with unions representing fire fighters, teachers, police officers and other public service workers rallied at 11:30 a.m., at the Upper Senate Park at the U.S. Capitol, in pouring rain outside the Capitol, calling for passage of H.R. 82. Joining the rally, Majority Senate leader Chuck Schumer.  “I’m here to tell you all today – we are going to call a vote on repealing WEP and GPO,” he said, calling the two Social Security titles “unfair and un-American.”  

 After the rally, Graves quickly issued this statement:  “The Senate Majority Leader has called for a vote on our bill H.R. 82 – provided he gets the necessary 60 votes to get it to the floor. More than 60 Senators support our Social Security Fairness Act. In the House we have led the effort for years to build the winning coalition, resulting in the most cosponsored bill – the most popular bill – in the Congress. We defied the odds and fought back sneak attacks to successfully complete a discharge petition that resulted in the first vote in history to repeal the WEP and GPO. The heavy lifting is done. The path to victory could not be clearer. A WEP-GPO repeal could be in the stockings of millions of public service retirees this Christmas. Pass H.R. 82 now,” he said.   

GOP lawmakers express concerns over financial impact

In response to a request from Chuck Grassley, the Congressional Budget Office (CBO) had provided the Ranking Member of the Senate Budget Committee with its legislative analysis. The findings showed that the elimination of the WEP and GPO, as specified in H.R. 82, would permanently increase outlays for scheduled Social Security benefits—that is, the amounts that the program would pay if it continued to pay benefits as scheduled under current law, regardless of whether the program’s two trust funds had sufficient balances to cover those payments. That increase in Social Security benefits would drive the program’s spending even further above its revenues than it is already projected to be under current law. CBO estimates that the changes will cost nearly $ 200 billion over a 10-year period.

Senators Mike Crapo (R-ID), Grassley (R-IA), Ted Cruz (R-TX), Rand Paul (R-KY) and Thom Tillis (R-NC) and 16 other Republican Senators opposed passage, expressing strong concerns about the bill’s cost. This apprehension reinforced by the recently released CBO analysis.

Citing a CBO analysis of S. 82, the Republican Senators were concerned that the legislative proposal would reduce the Social Security trust fund by an additional $200 billion during the next decade, moving up the insolvency date by six months.

On the Senate floor, North Carolina Republican Sen. Thom Tillis said the bill’s title made it sound like “motherhood and apple pie,” quipping “who could be against Social Security fairness?” But he argued it wasn’t the right approach to address the problem.

However, 29 Republican Senators, including Sen. John Kennedy (R-LA), were not concerned about the CBO analysis, voting for passage of the legislative proposal. 

Following the Senate vote, in a video on X, Kennedy stated: “Social Security is not free. People pay into it. The money we “spent” today in this bill – all we did is give it back to the people who earned it. Today was a good day. It was a good day for fairness, it was a good day for the Social Security system, and a good day for the people of Louisiana – even if you aren’t affected by these two unfair provisions of the Social Security Act, all Louisianians I know believe in fairness. Right is right and wrong is wrong, and I think we did the right thing here, and I’m pleased.” 

With the dust settling after the Senate vote, after 40 years of trying to fix a Social Security benefits issue impacting public sector workers, Democratic and Republican lawmakers put aside political differences and finally fixed the pressing policy issue.

Celebrating the historic passage 

Following the Senate vote for passage of H.R. 82, the National Fraternal Order of Police, International Association of Fire Fighters, National Active and Retired Federal Employees Association, American Federation of Government Employees, American Federation of State, County & Municipal Employees, National Rural Letter Carriers’ Association, National Education Association, and Peace Officers Research Association of California applauded this legislation being sent to the president’s desk to enhance the fairness of Social Security to public workers. 

U.S. Senator Sheldon Whitehouse (D-RI) commended the passage of the Social Security Fairness Act, legislation he cosponsored to eliminate two policies. “Thousands of Rhode Islanders who receive government pensions but also contributed to Social Security through private-sector employment stand to benefit from the legislation,” he says.

“I’ve worked with my colleague Sherrod Brown for years to pass this legislation in order to ensure that millions of teachers, postal workers, firefighters, law enforcement officers, and other dedicated civil servants get the benefits they have earned, says U.S. Senator Jack Reed. “I’m glad we were able to finally deliver this correction for millions of hardworking Americans and I’m committed to protecting and strengthening Social Security to ensure all Americans are able to retire with the dignity and financial security they have earned,” he said.

Max Richman, President and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM) called for passage of this bill because it because it removes an unfairness in the retirement system by allowing teachers, firefighters, and police officers (among others) and their families to collect Social Security benefits. 

Before the Senate vote, NCPSSM announced its opposition of any amendment that diluted this legislation or cut Social Security benefits in any way — including raising the retirement age.  The Washington, DC-based Social Security advocacy group circulated a letter to all 100 U.S. Senators before the vote on Dec. 21, opposing any efforts to raise the retirement age. 

According to Richtman, nearly 3 million public sector employees are on the verge of being able to receive the Social Security benefits they’ve earned — thanks to the United States Senate. 

“We supported this bill because it removes an unfairness in the system by finally allowing teachers, firefighters, and police officers (among others) and their families to collect full Social Security benefits. Many of our own members and supporters made it clear that they want the WEP & GPO repealed,” says Richtman.

“The Senate vote delivers us to the doorstep of a long-sought goal — to restore fairness to a system that has worked incredibly well for nearly 90 years to provide American workers with basic financial security,” says Richtman. 

According to a statement issued by National Education Association, Martha Karlovetz estimated that these discriminatory laws have cost her more than a hundred thousand dollars since 1995, when she retired from teaching at the Parkway School District outside St. Louis, Missouri. And if her husband had passed away before her, the laws would have meant that Karlovetz would have received only $14 per month in survivor benefits, even though her husband paid Social Security taxes throughout his 40-year career at McDonnell-Douglas/Boeing.

“The repeal of GPO and WEP is truly a historic win for all public employees and their families,” said Karlovetz. “These unfair provisions have taken a great toll. I have lost well over $110,000 in benefits earned in the 15 years I worked and paid into Social Security before becoming a teacher in Missouri, a GPO-WEP state. Now that we have helped achieve this victory, educators like me can breathe easier. For some, this is truly life-changing,” she says.

With the 119th Congress fast approaching, Congressional lawmakers must work together to fix a financially ailing Social Security Program.  Just like they did to pass bipartisan legislation to right a wrong affecting millions of retirees and public sector workers.  

To see Nov. 8 CBO correspondence to Sen. Grassley as to impact of S. 82 on the Social Security program, go to https://www.cbo.gov/system/files/2024-11/60876-HR82.pdf

 To download a CRS report that details Social Security beneficiaries affected by both the Windfall Elimination Provision (WEP) and the Government Pension Offset (GPO), to https://crsreports.congress.gov/product/pdf/R/R45845

Nursing home workforce crisis deepens with minimum staffing standards

Published in RINewsToday on February 13, 2023

“The long-term care industry is enduring the worst workforce crisis in its history, in Rhode Island, and across the country. Although providers are committed to recruiting and retaining staff to provide quality care for residents, despite our best efforts, many nursing homes have fallen short of the staffing ratio set by the RI Department of Health,” notes James Nyberg, Executive Director of the East Providence-based Leading Age Rhode Island (LARI), representing nonprofit providers of aging services.

“We are extremely  concerned about the impending fines that will be imposed on nursing homes here in Rhode Island as a result of our state’s existing nursing home minimum staffing ratio statute,” said Nyberg. Because of staffing ratio mandates, “the industry would have faced fines of over $11 million, in just one sample quarter (April – June 2022), since over 70% of nursing homes are not in compliance,” he said.  

“While April-June was a sample, the fines go into effect for July-September and we will receive a similar notice in just a few weeks, with only 10 days to pay the fine,” says Nyberg, stressing that these fines will only increase going forward if nursing homes are unable to meet the minimum staffing ratio.

Nyberg calls on the Rhode Island General Assembly to rescue Rhode Island’s nursing homes and provide relief from these penalties by delaying them and exploring an alternative approach to support the efforts of nursing homes to meet the ratio.  He warns that the current fine-based approach is excessive and counterproductive and will lead to reduced access to care and threaten the survival of the state’s nursing homes.

Nyberg points out that the current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (five nursing homes have already closed since the COVID pandemic began).  These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes.  

“We are working with numerous stakeholders on various initiatives to develop a pipeline of workers, but the simple fact is that it will take time.  In addition, as you know, the industry has faced years of underfunding from Medicaid, which pays for the majority of nursing home care.  This has made recruiting and retaining workers more difficult than ever,” says Nyberg. 

John Gage, President of the Rhode Island Health Care Association (RIHCA) agrees with Nyberg’s assessment of the nursing home workforce.  “Nursing homes across the nation are facing an historic labor shortage as the direct result of chronic Medicaid underfunding and the devastating impact of the Covid-19 pandemic on the workforce, he says, noting that the state’s nursing home workforce is down 20% since the start of the pandemic, with 2,000 workers lost from Jan. 2020 to June 2022.  Nationwide, the nursing home workforce is down 210,000 workers.

According to Gage, Rhode Island’s staffing mandate, while well-intentioned, will siphon tens of millions of dollars from resident care. In the first year of full implementation of the state’s minimum staffing mandate, RIHCA estimates that facilities will be fined upwards of $60 million. “These fines will imperil care, not bolster it,” he warns.  

Without legislative action, Rhode Island nursing homes will be fined an estimated $11 million on or about February 28, 2023, because of their inability to attract workers to meet the mandate from July 1, 2022, through September 30, 2022, Gage charges. “There are simply not enough available workers to fill the open staff positions, and resources are scarce.  Nursing homes will be devastated by these fines.  Facilities will reduce admissions, backing up hospital referrals and clogging hospital beds.  More nursing facilities will close – five have already closed since the beginning of the pandemic,” he predicts.  

Gage asks, “Who will care for Rhode Island’s frailest elders?” To recreate a minimum staffing mandate in nursing homes on the federal level would be a huge mistake, especially given the historic workforce crisis here in Rhode Island and nationwide,” he says.  

Gage’s comments echo concerns expressed by another group of US Senators in Jan. 20 correspondence (https://www.tester.senate.gov/wp-content/uploads/1-20-23-Nursing-Home-Staffing-Mandate-Letter-FINAL.pdf) sent to CMS by Senators John Bourasso, Jon Tester, and eleven other US Senators.  They caution the agency that a one-size fits all mandate would undermine access to care for patients, and they encouraged CMS to work with Congress on tailored solutions that address the workforce challenges facing nursing facilities.

At the federal level

Just days ago, U.S. Senators Bob Casey (D-PA), Chairman of the Senate Committee on Aging, and Ron Wyden (D-OR), Chairman of the Senate Finance Committee, called on the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to encourage the federal agency to establish minimum staffing standards in nursing homes to ensure high-quality care for nursing home residents. In Feb. 10 correspondence, Casey and Wyden, along with Senators Sherrod Brown (D-OH), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Cory Booker (D-NJ), and Elizabeth Warren (D-MA) urged CMS to advance the agency’s ongoing study to determine adequate staffing requirements in nursing homes.

“We appreciate the work that CMS has undertaken to promote safety and quality in nursing homes and applaud the Biden-Harris Administration’s commitment to protecting our nation’s seniors,” said the senators in Feb. 10 correspondence, urging CMS to “bring this work to completion.” 

“In our view, that means continuing the agency’s ongoing study to determine the level of staffing that is necessary to ensure safe and high-quality care for nursing home residents, developing an evidence-based and actionable proposal for mandatory minimum staffing levels, and a robust and transparent process—including direct stakeholder engagement— that will allow for further discussion and fine-tuning of requirements before the proposal is finalized,” wrote the senators.

The senators noted that studies have shown a correlation between inadequate staffing levels and lower quality of care. More recent studies have demonstrated that higher nurse staffing ratios mitigated the effect of COVID-19 outbreaks in nursing homes and resulted in fewer deaths. A recent Department of Health and Human Services Office of Inspector General report examining the high level of COVID-19 infections in nursing homes also pointed to the need for the establishment of minimum staffing requirements.  

In the correspondence, the senators cite the Social Security Act, which requires skilled nursing facilities to “provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents,” including the services of a registered nurse at least 8 consecutive hours per day, 7 days a week. The letter commends CMS for working to update this vague standard that has led to substantial variation in staffing levels and quality of patient care across facilities.

“Achieving the shared goal of ensuring quality care in nursing homes nationwide is a complex undertaking, says LeadingAge’s Ruth Katz, senior vice president, policy. LeadingAge is an association of nonprofit providers of aging services, including nursing homes.

“As our Get Real on Ratios proposal highlights, a number of conditions must be met in advance of any mandate implementation,” suggests Katz. “The senators correspondence to CMS is a promising development; it covers many of the same points as our Get Real on Ratios proposal – a recognition of the critical need for adequate reimbursement; that one size does not fit all, and that workforce shortages will need to be addressed with additional support. Without addressing these, staffing mandates are impossible. We look forward to continuing our discussions with Congressional leaders on this critical issue so that older adults and families can access much-needed care and services,” she says.

“The Senior Agenda Coalition of RI fully supports the need to develop national staffing standards to ensure quality care is provided to nursing home residents across our nation. It is important to note that Rhode Island has been a leader in this area. For many years our state has required 24/7 RN coverage in nursing homes and in 2021 the legislature passed the Nursing Home Staffing and Quality Care Act that includes staffing standards,” says Maureen Maigret, Policy Advisor to Senior Agenda Coalition of RI. “Now we must work to address workforce shortage issues and ensure that adequate government resources are provided especially through Medicaid payments so the standards can be met, and our critical direct care workers receive competitive living wages in order to keep them working in long term care,” she adds.

As the House Leadership hammers out the FY 2024 budget, it is crucial that adequate Medicaid funding is allocated to allow nursing homes to attract the necessary staff to meet the state’s minimum nursing standards that it codified into law. We must address this policy problem now rather than just kick the can down the road.