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Tag: CMS

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.

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.

Court Strikes Down Minimum Staffing Mandate, 24/7 Nurse Requirement

April 21, 2025

BY: Sarah Dobson

On April 7, a federal judge in Texas knocked down the Biden Administration’s April 2024 Centers for Medicare & Medicaid Services rule that mandated minimum staffing levels at skilled nursing facilities. In making his decision in favor of plaintiffs challenging the mandate, Judge Matthew J. Kacsmaryk ruled that CMS exceeded their authority and that their regulatory action was not consistent with Congress’s legislation governing nursing homes.

The rule would have mandated that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day. In addition, nursing homes would have had to have a registered nurse onsite at all times.

Lutheran Services in America has long advocated against these mandates, given the significant negative impact they would have had on access to care, especially in rural areas. We will continue to raise our unified, faith-based voice to ask Congress to permanently block the staffing mandate through legislation.

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

Disability Network Convenes in Minnesota

August 23, 2024

BY: Bill Kallestad

The Lutheran Services in America Disability Network (LSA-DN) met in Saint Paul, Minnesota, in late July, bringing together nearly 40 attendees representing 16 network organizations. The meeting was hosted in conjunction with Lutheran Social Service of Minnesota, ACCORD and AbleLight. An emphasis of the meeting was to inform implementation of the Centers for Medicare and Medicaid Services (CMS) recent rule changes in long-term services and supports (LTSS) with an emphasis on home- and community-based services (HCBS). As such, the group was joined by Curtis Cunningham, director of LTSS at CMS. Curtis shared current priorities from CMS as they work through state guidance to support recent rule changes. He also provided timing updates and took questions from members to share further insights.

Another key priority of LSA-DN is improving the use of data analytics to guide and inform changes in practice with the shift to value-based care. As such, staff from Lutheran Social Service of Minnesota shared insights and perspectives on their recent changes to improve their use of data. Survey results were also shared more broadly about LSA-DN data use and presented for discussion. Other topics included partnership development and continuing to build out the LSA-DN strategy across advocacy, culture and innovation.

Contact me for more information.

Bill Kallestad is the Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network.

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.

CMS Final Medicaid Access Rule — Action Moves to States

May 29, 2024

BY: Bill Kallestad

What: In April, the Centers for Medicare & Medicaid Services (CMS) released the final Medicaid Access Rule. As you know from our recent update, many of our shared concerns across the network were not addressed in the final rule, including new requirements related to payment of the direct care workforce. Specifically at least 80% of all Medicaid payments must be spent on compensation for direct care workers and/or states must report annually on percent of payments that go to the direct care workforce.  Other provisions also include changes in access to home- and community-based services (HCBS), health and safety protections, and quality measures.   Given the scope and impact on our work and services, our work continues and also moves to the state level.

What Happens Now? Because the Access Rule requires states to make significant changes to their Medicaid programs, CMS is allowing states several years to implement the provisions. This is a time to consider strengthening your discussions with state-level decisionmakers to inform the implementation of the provisions.

Under the rule, states are required to create home care and rate-setting advisory boards made up of Medicaid beneficiaries, home care workers and others to advise states on provider payment rates and worker compensation. Thus, its important to be in conversation with state-level officials to inform the make-up and considerations of these boards. We will continue conversations with CMS as we learn more about guidance, timing and other considerations.

How to prepare: Given the rationale for the rule change is to improve job quality and pay for direct care workers to attract more people to those jobs, it will be important to articulate the impact to your organization, including how this makes it harder to deliver quality services. The rule will also require states to be more transparent in how they pay for home- and community-based services, as well as how they set rates.

The following are the key components of the rule to be aware of:

  1. at least 80% of all Medicaid payments must be spent on compensation for direct care workers and/or states must report annually on percent of payments that go to the direct care workforce,
  2. states must report information on HCBS wait lists (specifically timely and full access to services),
  3. prioritization of person-centered planning,
  4. states must demonstrate an electronic incident management system,
  5. states must establish and manage a grievance process and
  6. states must report on a set of nationally standardize quality measures.

For more information, please contact Bill Kallestad.

Bill Kallestad is the Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network.

SNF Minimum Staffing Standard Published: Tell CMS How New Mandate will Impact your SNFs and Access to Care

September 11, 2023

BY: Sarah Dobson

On September 1, the Biden Administration officially published for public comment a proposed rule that would mandate minimum staffing levels at skilled nursing facilities. A 60-day comment period began September 6 and will end with all comments due on November 6.

Lutheran Services in America will be submitting comments sharing our concerns about the proposed new requirement and helping you do the same. We are currently analyzing the full rule and what it means for our network, but our initial concerns include the 24/7 RN requirement, only allowing time-limited hardship exemption waivers, and lack of funding for implementing mandated staffing increases.

Since early 2022 when the Administration originally announced their intent to mandate minimum staffing levels, we have heard from many of you that the uniform application of this new requirement, on top of the enduring workforce shortage in direct care, will result in reduced access to long-term care for older adults in rural and underserved communities as providers continue to struggle to fill staffing vacancies. We have worked diligently to ensure that the concerns of our network are heard and incorporated into the new rule, including meetings with key senators, the White House Domestic Policy Council, and CMS Administrator Chiquita Brooks-LaSure.

Our collective voice is powerful, and we look forward to continuing to bring its impact to bear on this rule.

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

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