Texas has filed a lawsuit against the Biden administration, challenging a new federal mandate that requires minimum staffing levels in nursing homes. The state argues the rule exceeds federal authority and could devastate rural care facilities.
Texas Attorney General Ken Paxton filed the lawsuit on Wednesday in the Northern District of Texas, asserting that the federal Centers for Medicare and Medicaid Services overstepped its authority with this mandate, The Hill reported.
The controversial rule requires all nursing homes receiving federal funds through Medicare and Medicaid to have a registered nurse on staff 24/7 and provide at least 3.48 hours of nursing care per resident daily. These requirements are set to roll out in phases, with nonrural facilities required to comply by May 2027 and rural facilities by May 2029. The Department of Health and Human Services estimates the cost of compliance to be $43 billion over the next decade.
Paxton argued that the new rule could lead to the closure of many nursing homes in rural areas, exacerbating care shortages where they are already severe. “This power grab by [President] Biden’s health bureaucrats could put much-needed care facilities out of business in some of the most underserved areas of our state,” Paxton said in a statement. He further emphasized that the state would fight the federal government’s attempt to impose hiring quotas that he claims are unattainable.
The lawsuit contends that Congress has repeatedly declined to impose such staffing requirements, and that the CMS does not have the authority to override legislative intent.
The complaint highlights that the new regulations eliminate the flexibility historically granted to nursing homes in determining adequate staffing levels. It argues that the one-size-fits-all approach contradicts the flexible standards previously endorsed by Congress.
Under the new rule, certain exemptions and longer compliance timelines are available for rural communities and facilities experiencing workforce shortages, provided they demonstrate a good faith effort to meet the staffing requirements. However, Texas asserts that the rule would force nursing homes in the state to hire more than 10,000 qualified personnel — an amount that Paxton argued is not currently available in the local labor market.
The lawsuit was filed in Amarillo, Texas, in the court of Judge Matthew Kacsmaryk, a former President Donald Trump appointee. Kacsmaryk has previously ruled against the Biden administration on several high-profile issues, including cases involving immigration and LGBTQ protections.
The American Health Care Association, an industry group, filed a similar lawsuit in the same district earlier this year, challenging the exact nursing home staffing requirements.
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