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Lawmakers Face Government Shutdown as CMS Launches Workforce and Rural Health Initiatives

September 25, 2025

BY: Sarah Dobson

As of today, with just days left before fiscal year 2025 funding expires, Congress is racing to avoid a government shutdown. Late last week, the House passed a continuing resolution, mostly along party lines, to fund the government through November 21. However, the Senate has not yet acted on it and seems unlikely to do so, making a government shutdown more likely when current funding expires on October 1.

While Republicans indicate general support for a short-term funding patch without any additional provisions to allow more time for broader negotiations, this is at odds as Democrats advocate that any temporary funding bill must include a permanent extension of expiring health insurance premium tax credits. The President canceled a planned meeting (that was set to take place today, Sept. 25) with Democratic leaders and signaled he would use a shutdown to shrink federal agencies by designating fewer workers as “essential.” His administration also directed agencies to consider firing employees working on unfunded programs that don’t align with his priorities to support additional downsizing once funding resumes.

Meanwhile, lawmakers have yet to reach consensus on a second budget reconciliation package, which could bring damaging cuts to Medicaid and other critical human services. Lutheran Services in America urges advocates to contact their lawmakers now to protect these essential programs.

Amid these debates, the Centers for Medicare & Medicaid Services has announced two major initiatives. First, a $75 million investment in workforce training for skilled nursing facilities, aimed at addressing shortages of nurses and certified nursing assistants. The program will support tuition reimbursement, stipends, and training programs in collaboration with states. Second, CMS has launched the $50 billion Rural Health Transformation Fund, giving states the opportunity to address pressing rural health challenges over the next five years.

Congress is also taking steps to address workforce shortages through new legislation. The bipartisan Healthcare Workforce Resilience Act and the Dignity Act of 2025 seek to expand the pool of authorized healthcare workers through immigration reforms. In addition, new research highlights the role of telehealth and artificial intelligence in expanding healthcare capacity—though neither alone can solve the workforce crisis.

Stay engaged with these fast-moving developments: Join our next Capitol Conversations webinar on Thursday, October 16 at 1 p.m. ET.

Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

Congress Watch: Midterm Elections that Could Sway the Balance of Power in the House

September 24, 2025

BY: Sue Polis

With so much change happening in Washington, D.C. with Republicans in control of the executive, legislative and judicial branches, many are starting to look to the 2026 midterm elections to see what the future might hold. We will continue to see Republican control of all branches? Will Democrats win control of the House of Representatives and change the balance of power in Congress?

The races to watch are starting to emerge and we are tracking toss-ups elections in 2026 in both the House and the Senate. The best way to make your voices heard is to engage early and often in cultivating relationships with current and future elected officials.

What can you do now? Congress will recess the week of November 10 for the Veterans Day holiday. This is a good time to request in-district and in-state meetings with your elected officials and/or invite them for a site visit to tour and see the work of your organization up close.

For more information, please contact Lutheran Services in America advocacy staff: Sarah Dobson at SDobson@lutheranservices.org, Bill Kallestad at BKallestad@lutheranservices.org, and Kylie Bowlds at KBowlds@lutheranservices.org.

Sue Polis is Vice President of Public Relations and Government Affairs at Lutheran Services in America.

Policy Shifts at CMS & HHS and What it Means for Social Service Providers 

September 24, 2025

BY: Sue Polis

The U.S. Department of Health and Human Services (HHS) and agencies under it, including the Centers for Medicare and Medicaid Services (CMS), have recently offered insights into policy priorities that further signal significant policy shifts. Below is a synopsis of key changes, including potential opportunities and challenges for social service providers.

In May, CMS, through their Innovation Center (CMMI), recently released their new strategic direction, which focuses on evidence-based prevention, data access, and choice and competition. Given CMS’s recent withdrawal of federal Medicaid guidance that impacts the ability of states to use waivers and other funds to address health-related social needs, CMMI’s new strategic direction points to the following areas of interest: 

  • Evidence-Based Prevention: Includes great focus and emphasis on meeting nutrition needs, including food access, healthy food access and food as medicine; accountable care and accountable care organizations (ACOs) that assume global risk/downside risk; caregiver support; chronic disease management and disease prevention
  •  Data Access: Priorities include global risk/total cost of care models and waivers for predictable cost sharing for certain services.  
  •  Drive Choice and Competition: With a focus on rural providers, ACOs, community health centers; site neutral payments across settings; changing certificate of need requirements; and prioritizing high value care and services and incentivize unnecessary utilization

HHS also recently released their Make America Healthy Again key strategies report with a broad prevention-based agenda across several areas, including some more specifics important for social service providers including: executive actions, process reform and deregulation, public awareness and education, and private sector collaboration. Some more specific areas that Lutheran Services in America will continue to monitor include:

  • USDA Nutrition Programs: USDA will use its authorities to prioritize utilization and promotion of whole, healthy foods across its 16 nutrition programs.
  • Supplemental Nutrition Assistance Program (SNAP): USDA will provide states with technical assistance in SNAP waiver development and implementation to restrict the purchase of junk food and reorient the program towards better nutrition. 
  • MAHA Boxes: USDA will develop options to get whole, healthy food to SNAP participants. 
  • Head Start Nutrition: ACF and USDA will implement the new Dietary Guidelines for Americans (DGAs) through supporting access to USDA’s Child and Adult Care Food Program (CACFP) and the National School Breakfast and Lunch programs in Head Start providers, and will provide supplemental funding opportunities to support the provision of whole, healthy foods in Head Start programs. 
  • Medicaid Quality: CMS will collaborate with states to establish quality metrics for Medicaid managed care organizations that promote measurable health improvements through nutrition coaching and other fitness indicators (e.g., predicted VO₂ Max). 
  • Quality Measurement: HHS and CMS will develop quality measures that promote children’s health outcomes rather than just healthcare utilization. 
  • Pediatric Mental Health: HHS will ensure the Pediatric Mental Health Care Access Program at Health Resources and Services Administration (HRSA) is effective at providing access to pediatric mental health professionals, especially as youth anxiety and depression are increasing and are linked to factors such as screen time, vaping, poor nutrition and lack of physical fitness.  

For more information, please contact Sue Polis.

Sue Polis is Vice President of Public Relations and Government Affairs at Lutheran Services in America.

What the Budget Bill Means for Medicaid and our Network

July 17, 2025

BY: Sarah Dobson

On July 4, President Trump signed into law a sweeping budget reconciliation package that was passed in the Senate on July 1 and House on July 3 on party-line votes of 51–50 and 218–214, respectively. The law contains a number of provisions that will impact our network in several areas.

  • Healthcare:
    • Medicaid: The law imposes more stringent work reporting requirements for “able-bodied” adults between 19 and 64; lowers the allowable rate for state provider taxes for some provider types, with specific carve-outs for nursing homes and intermediate care facilities; grants states new authority to offer HCBS through standalone waivers that don’t require individuals to meet institutional-level of need.
    • SNF minimum staffing: Prohibits implementation of the SNF minimum staffing regulation for 10 years.
    • Rural hospitals: Includes a $50 billion rural hospital stabilization fund designed to support states with approved rural health transformation plans, allocating $10 billion annually from 2026 to 2030.
    • Medicare: The CBO projects that the law will trigger future cuts to Medicare totaling nearly $500 billion due to the Statutory Pay‑As‑You‑Go Act of 2010 (S-PAYGO). This law kicks in when legislation increases the deficit and would trigger an estimated $45 billion in Medicare cuts for fiscal year 2026.
  • Housing: Creates a permanent 12% allocation increase in low-income housing tax credits (LIHTC) starting in 2026, while also permanently reducing the 50% bond financing threshold test to 25% beginning in 2026, lowering a barrier to affordable housing production.
  • Refugees: It institutes a permanent ban on refugees and other humanitarian-status immigrants from getting Medicaid.
  • Nonprofit tax provisions:
    • Charitable deduction: It establishes a non-itemizer deduction for charitable contributions at $1000 for individuals and $2000 for joint filers;
    • Excludes two provisions we opposed: one putting nonprofit status in jeopardy if an organization was deemed to have ties to a “terrorist” group and a second levying UBIT on transportation and fringe-benefit related costs.

The focus now turns to implementation of the law, with much of the impact depending on which state is being discussed. For example, the Kaiser Family Foundation has prepared a state-by-state analysis of the impact of Medicaid spending reductions.

Looking ahead, we anticipate another budget reconciliation bill in the fall. In a recent interview, House Budget Committee Chair Jodey Arrington (R-TX) said that majority Republicans seek deeper cuts to Medicaid and spending reductions in Medicare that weren’t included in the first bill. They also plan to cut funding for states that fail to enforce existing laws against Medicaid benefits for undocumented immigrants and reimbursement rates for “healthy, able-bodied adults” added to Medicaid under President Barack Obama’s Affordable Care Act.

We will be tracking both implementation of the current law and further legislative efforts carefully and will update you as needed.

Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

Here We Stand: Advocating for People, for Care, for Medicaid

July 17, 2025

BY: Sarah Dobson

Our members continue to be at the forefront of advocacy in defending Medicaid, grounded in our unified, faith-based message: Here We Stand. For People. For Care. For Medicaid.

Across our network, members have demonstrated commitment through advocacy, outreach, and a willingness to share their stories.

  • Our members came to Washington to join in three Capitol Hill fly-ins to make their voices heard, resulting in over 80 meetings (cumulatively) with key members of Congress.
  • Our calls to action engaged more than 700 individuals, including 128 from the Lutheran Services in America network, expanding our reach to new partners and advocates.
  • In partnership with 4media Group, 34 advocates were trained in media engagement and eight earned media pieces, such as op-eds and letters to the editor, were written, collectively reaching an audience of more than 3 million.
  • Our Here We Stand video and paid ad campaign ran in more than a dozen reputable websites, including USA Today, Forbes and broadcast television news sites. The campaign yielded more than 381,000 impressions, exceeding our goal of 250,000, and garnered nearly 233,000 completed views—an above-industry benchmark video completion rate of 70 percent.
  • Coverage included TV, statewide radio and earned media, including KenCrest, Genacross Lutheran Services, and enCircle.

The breadth of our engagement reflects the power of faith-rooted advocacy and the impact of our collective voice in protecting care for millions.

Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

Capitol Conversations Policy Webinar Series Kicks Off with “Building a Workforce for the Future”

September 17, 2024

BY: Sarah Dobson

On September 11, the Lutheran Services in America public policy department launched a new “Capitol Conversations” webinar series aimed at informing and engaging the network in advocacy, with a session titled “Building a Workforce for the Future: Trends and Practice Shaping Policy.”  Following an overview presented by Sue Polis, vice president of public relations and government affairs, of the focus areas of Lutheran Services in America’s strategy to address the workforce shortage (recruitment and retention, strengthening the pipeline, and readiness to fill roles), a cross-section of network members heard from four speakers: Stephanie Badger, The Nickles Group; Ryan Kenyon, the office of Sen. Kevin Kramer (R-ND); Wanda Harris, The Evangelical Lutheran Good Samaritan Society; and Kelli Dobner, Samaritas.

Stephanie introduced members to the Healthcare Workforce Coalition, which she helps lead. The coalition advocates in three areas to address the shortage: education, recruitment and retention, and international workers. Their work supports classifying nurses as STEM workers for greater federal funding availability and advocating for better protection for healthcare workers from workplace violence and mental health challenges.

Ryan highlighted Sen. Kramer’s sponsorship of the Healthcare Workforce Resilience Act (HWRA), which would allow previously unused green cards to be distributed to up to 40,000 healthcare workers, while identifying the challenges ahead for passage. He also discussed the hardship imposed on nursing home providers by the Centers for Medicare & Medicaid Services (CMS) minimum staffing rule, urging continued efforts to advocate directly with the agency.

Network members Wanda and Kelli shared their experiences dealing with workforce shortages in the field, including the ways in which the crisis has reshaped their business, and the importance of addressing workplace culture and professional development in recruiting and retaining employees.

Next steps include urging your lawmakers to support the HWRA, joining Lutheran Services in America in asking CMS and Congress to better address staffing and reimbursement issues, and watching the recording of this event. If you would like more information about our policy engagement on workforce or other issues, or if you have requests for future topics for this series, please contact me.

Sarah Dobson is Senior Director of Public Policy and Advocacy at Lutheran Services in America.

The Fight Continues on CMS’s Skilled Nursing Facilities Minimum Staffing Rule

June 26, 2024

BY: Alesia Frerichs

In April, the Centers for Medicare and Medicaid Services (CMS) issued the minimum staffing mandate for skilled nursing facilities. Our press release in response to the final rule outlined our concerns and recommended solutions. As your national advocacy presence in Washington, D.C., we continue to work with and for you in response to this rule.

Our strategy is clear:

  • Our faith-based, community-centered, trusted, non-profit providers consistently deliver high quality care as measured by star ratings and clinical outcomes.
  • The final rule ignores our high-quality standards amidst the dual challenges of chronic Medicaid underfunding and rising labor costs.
  • The rule impedes access to quality care and choice for older adults and other Medicaid recipients as facilities are forced to close.
  • It is imperative to advance solutions to expand access to care and strengthen the workforce.

Read What Has Been Done to Date

So, what’s next? Our commitment is to strenuously pursue all financial and programmatic remedies to alleviate the burdens associated with the implementation of this final rule.

We will continue to work with staff at CMS to monitor and inform guidance to states as this rule is implemented to ensure our network providers can inform and understand the process for exemptions and delays that are part of the final rule.

We are monitoring continuing congressional action aimed at stopping the implementation of the rule using the Congressional Review Act (CRA).  This process allows Congress to pass legislation disapproving of federal agency rules and immediately prohibiting their implementation.  Lawmakers from the House and Senate including Sen. Jon Tester (D-MT), Sen. Joe Manchin (I-WV), Sen. Angus King (I-ME), Sen. Jeanne Shaheen (D-NH), Sen. Maggie Hassan (D-NH), Sen. Kyrsten Sinema (I-AZ), Sen. James Lankford (R-OK), and Rep. Cathy McMorris Rodgers (R-WA) are currently working to secure passage of CRA legislation to halt the minimum staffing rule.  While only a simple majority is needed to initially pass the legislation, a two-thirds majority of each chamber would be required to override an expected Presidential veto.

We are continuing our active engagement with the Administration to hold them accountable for their expressed commitment to provide additional support for providers related to workforce recruitment, retention, and training: the final rule set aside $75 million for these purposes. For example, we in order to connect our members to these resources.

We are also exploring how best to support the lawsuit that the American Health Care Association (AHCA) recently filed against CMS. The lawsuit asks the court to set aside the new staffing rule, which may delay or even stop implementation.

To ensure adequate reimbursement for critical staff, we are building an approach with CMS to develop a national Medicaid reimbursement strategy that would include specific recommendations/guidance to states in setting their Medicaid rates to ensure providers can pay livable wages. Our overarching aim is to pursue increases in Medicaid reimbursement sufficient to cover the actual cost of providing skilled nursing care and paying a livable wage.

We are also working to strengthen a broader workforce advocacy strategy, including active legislation, to pursue Congressional support across the workforce continuum, with a focus on recruitment, retention, strengthening the workforce pipeline, and training.

  • Related to older adults, we will advocate for greater flexibility for SNFs to provide onsite training for new hires and existing employees, especially CNAs, including addressing CNA training capabilities for SNFs who have received survey penalties
  • Loan forgiveness, tax credits, and other incentives, building on existing channels to address these issues beyond doctors and registered nurses
  • Updates to immigration and refugee policies that would increase availability of workforce with a focus on supporting a waiver process to ensure people trained abroad can practice to the full scope of their licenses.
    • Easing the pathway for people entering the country to secure work visas.
    • Allowing the granting of special visas to fill CNA vacancies.
    • Ensuring previously authorized green cards can be used the strengthen the pipeline of healthcare workers.

We are committed to continuing to work in partnership with organizations like the American Health Care Association (AHCA,) LeadingAge, and others, to elevate the very real impacts the minimum staffing rule has on providers and communities across the country.

What can you do now?

If you haven’t already, please reach out to your state Medicaid leaders to share your concerns as this rule is being implemented. This is a good time to raise your voice as CMS is drafting guidance to states to implement the rule.

Please share your own stories of the impact of the workforce shortage on access to care in your communities, as well as coverage from your local news outlets so we can stay up to date on the way the story is being told across the country, with us by contacting Sarah Dobson.

Alesia Frerichs is the President & CEO of Lutheran Services in America.

Opposing the CMS Minimum Staffing Rule: What Has Been Done to Date?

June 24, 2024

BY: Sarah Dobson

In April, the Centers for Medicare and Medicaid Services (CMS) issued the minimum staffing mandate for skilled nursing facilities. From the start, we engaged our members from across the country to raise our voice and the visibility of the impact of this ruling with the administration and other key policy makers including:

  • Conducting targeted stakeholder meetings, secured based on the breadth and impact of our network in the senior services space and existing advocacy relationships, including with:
    • CMS Administrator Chiquita Brooks-LaSure and her staff, to ensure our members concerns were heard specific to the proposed rule.
    • Key senators and their staff who lead or serve on committees with oversight of Medicaid issues to share our on-going concerns including Senate Committee on Health, Education, Labor and Pensions (HELP); and Senate Finance Committee, House Energy and Commerce, House Ways and Means, among others.
    • The White House Domestic Policy Council, which advises the President on domestic policy issues. And
    • the Office of Management and Budget during final rulemaking to share our concerns.
  • Activating our network in a letter-writing campaigns to Congress and CMS with over 200 messages sent to key policymakers from across the country.
  • Submitting comments on the proposed rule to ensure the challenges associated with implementation were clearly articulated.

Our collective advocacy had an impact in shaping the final rule—with longer phase-in periods in rural and underserved communities, and hardship exemptions.  At the same time, these small wins are wholly insufficient given the inadequacy of Medicaid reimbursement rates and the ongoing crisis in the direct care workforce. This rule will accelerate nursing home closures in underserved and rural communities and make it harder to provide quality access to care for older adults across the country.

Read Our Strategy to Build on our Work Opposing This Rule

United, we will continue to take action together as one of the largest faith-based provider networks; we have the reach, we have the expertise and we have the responsibility.

Sarah Dobson is Senior Director of Public Policy and Advocacy at Lutheran Services in America.

Taking Action to Advance Housing Solutions

April 30, 2024

BY: Sarah Dobson

To build on the work of our network to advance housing solutions in communities across the country, Lutheran Services in America is supporting the federal expansion of the Low-Income Housing Tax Credit (LIHTC). Provisions in pending legislation represent what would be the largest single investment in affordable housing in decades.

Earlier this year, the House passed with strong bipartisan support the Tax Relief for American Families and Workers Act of 2024 (H.R. 7024), which includes key provisions to expand LIHTC. Action has moved to the Senate, and we are asking you to contact your senators and urge them to pass this legislation to better address our nation’s housing crisis by meeting critical, urgent needs that have been under-resourced.

If passed, this bipartisan legislation will expand and strengthen LIHTC by financing the construction or preservation of an estimated 200,000 additional affordable housing units nationwide, generating more than $34 billion in wages and business income, supporting over 304,000 jobs, and generating almost $12 billion in federal, state, and local tax revenue.

We hope you will join us in raising our collective voice on this urgent issue. If you have any questions, please contact Sarah Dobson.

Sarah Dobson is Senior Director of Public Policy and Advocacy at Lutheran Services in America.

President and Congress Agree to Deal Suspending the Debt Limit, Making Other Federal Spending Changes

June 6, 2023

BY: Sarah Dobson

On May 28, House Speaker Kevin McCarthy (R-CA) and President Joe Biden released the Fiscal Responsibility Act of 2023, legislation to suspend the debt limit until January 1, 2025. The bill marked the culmination of weeks of negotiation between the two sides to agree on a way to suspend the debt limit and include other legislative provisions as well. Not included in the deal was a provision that had been discussed to increase administrative barriers to Medicaid participation via increased work requirements and reporting, which Lutheran Services in America had opposed.

The package passed the House of Representatives on May 31 by a bipartisan vote of 314 to 117 and the Senate on June 1 by a vote of 63 to 36. The President signed the bill into law on June 3, narrowly avoiding the June 5 deadline when the Treasury Department had indicated the United States would no longer be able to pay all of its bills.

Key elements of the legislation of interest to our network include:

  • Cap in spending: The bill will cap federal defense and non-defense spending for fiscal years 2024 and 2025, with non-defense spending receiving the greater share of the reduction. The deal will reduce those caps by another percentage in the event Congress does not pass appropriations bills to fund the government by January 1, 2024 and January 1, 2025, respectively.
  • New time limits and work requirements for SNAP and TANF:
    • The bill includes new, additional time limits for able-bodied adults without children (ABAWDs) receiving benefits from the Supplemental Nutrition Assistance Program (SNAP,) formerly known as food stamps. Current law subjects ABAWDs 18–49 years old to a three-month limit every three years for getting food assistance unless they can prove they are working 20 hours a week or 80 hours a month. The new law expands this requirement up to the age of 54. The bill does provide full work requirement exemptions for veterans, people experiencing homelessness, and those aging out of foster care.
    • The bill expands work requirements under the Temporary Assistance for Needy Families (TANF) program. First, the legislation creates a new pilot program in up to five states for six years to measure “work outcomes” (as opposed to existing work participation rates) and requires the states and the Department of Health and Human Services (HHS) to negotiate metrics and targets. The legislation further requires that all states measure “work outcomes,” including employment and earnings. It is unclear how the states would administer this change. The bill also makes changes to the caseload reduction credit (which states can receive by decreasing the number of individuals receiving TANF relative to a fixed metric) in a way that could result in families being removed from the program entirely.
  • Rescission of unspent COVID-19 funds: The bill will take back approximately $30 billion of COVID-19 aid that federal agencies received through multiple COVID-19 relief bills but had not yet spent.
  • End of student loan repayment pause: The bill will end the student loan payment pause, requiring borrowers to begin repayment 60 days after June 30. This section also prohibits the Secretary of Education from taking any action to extend the current student loan pause absent express Congressional authorization.

Sarah Dobson is the Senior Director of Public Policy and Advocacy at Lutheran Services in America.

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