The Trump administration delivered a surprisingly full-throated defense of the Biden administration’s disputed nursing home staffing rule in a brief filed Thursday with the US Court of Appeals for the Eighth Circuit.
The filing may be an indication that President
The staffing mandate requires most US nursing homes to meet a total mandatory staffing level made up of varying numbers of registered nurses, nursing aides, and licensed practical nurses. It also calls for maintaining an on-site registered nurse around the clock. The requirements apply to all facilities that accept Medicare and Medicaid patients and are to be phased in over several years.
In October, 20 Republican state attorneys general—along with two nursing homes and multiple state organizations representing nonprofit aging services providers—filed a lawsuit claiming the final rule is illegal, arbitrary and capricious, and causes irreparable financial harm. The plaintiffs also sought a preliminary injunction to block implementation of the rule.
The Justice Department, then under President
The new DOJ filing urges the appeals court to side with the district court judge and, once again, deny the requested preliminary injunction. In arguments similar to those offered by the Biden administration, the DOJ filing on Thursday asserts the plaintiff AGs’ lawsuit is “not likely to succeed on the merits” and that the staffing requirement “is not arbitrary and capricious.”
The Centers for Medicare & Medicare Services “reasonably determined that these requirements were warranted based on extensive consideration of a study that CMS had commissioned, public comments, academic literature, data collected from nursing homes, and listening sessions with residents, staff, and others,” the brief said.
The filing also argues the staffing requirements do “not conflict with any statutory provision.” The “requirements fall comfortably within the agency’s authority to establish “such other requirements relating to the health and safety of residents,” the filing asserts.
A facility with 100 residents would need “at least two or three RNs and at least ten or eleven nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the new minimum staffing standards,” the CMS has previously reported.
An estimated 12,000 registered nurses and more than 77,000 nursing aides are needed to meet the requirements, according to Biden administration officials.
Rachel Reeves, senior vice president of public affairs at the American Health Care Association, expressed disappointment with the DOJ’s response in the case.
“It’s unfortunate that career DOJ lawyers must continue to try to defend this flawed and overreaching policy when the law is clear that CMS is exceeding its statutory authority,” Reeves said in a statement. “This is all the more reason for Congress, the Administration, and the courts to put this issue to rest and protect access to care for our nation’s seniors.”
The AHCA, which represents more than 14,000 nursing homes, filed the first lawsuit challenging the staffing rule in US District Court for Northern District of Texas in May 2024.
“We and our co-plaintiffs remain confident in the strength of our case,” Reeves added.
The case is Kansas v. Kennedy, 8th Cir., No. 25-01097, brief filed 4/3/25.
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