KFF Health News: 3 Policy Changes That Could Transform Health Care for Seniors
January 23, 2026
KFF Health News: These 3 Policy Moves Are Likely To Change Health Care for Older People
Month after month, Patricia Hunter and other members of the Nursing Home Reform Coalition logged onto video calls with congressional representatives, seeking support for a proposed federal rule setting minimum staff levels for nursing homes.
Finally, after decades of advocacy, the Biden administration in 2023 tackled the problem of perennial understaffing of long-term care facilities. Officials backed a Medicare regulation that would mandate at least 3.48 hours of care from nurses and aides per resident, per day, and would require a registered nurse on-site 24 hours a day, seven days a week.
The mandated hours were lower than supporters hoped for, said Hunter, who directs Washington state’s long-term care ombudsman program. But “I’m a pragmatic person, so I thought, this is a good start,” she said. “It would be helpful, for enforcement, to have a federal law.”
In 2024, when the Centers for Medicare & Medicaid Services adopted the standards, advocates celebrated. However, industry lawsuits soon blocked most of the rule, with two federal district courts finding that Medicare had exceeded its regulatory authority.
After the 2024 elections, Hunter expressed concern about the changing political landscape, which proved to be well-founded. In July, as part of Republicans’ One Big Beautiful Bill Act, Congress prohibited Medicare from implementing the staffing standards before 2034. Last month, CMS repealed the standards altogether, meaning they never took effect.
“It was devastating,” Hunter remarked.
Similar to environmental law and consumer protections, the Trump administration’s enthusiasm for deregulation has undone long-sought rules to improve care for the aged. Additionally, it has introduced a Medicare experiment for prior authorizations, now underway in six states, alarming advocates, congressional Democrats, and many older Americans.
These policy shifts will significantly impact facilities and workers providing care, complicating health coverage in several states. “It’s clear CMS has no interest in ensuring adequate staffing,” said Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care.
“They’re repealing a regulation that could have saved 13,000 lives a year,” he added, citing an analysis by University of Pennsylvania researchers.
Industry groups argue that nursing homes, already struggling with high staff turnover, were unable to fill vacancies. The staffing mandate “was requiring nursing homes to hire an additional 100,000 caregivers that simply don’t exist,” said Holly Harmon, a senior vice president at the American Health Care Association. “Facilities would have been forced to limit admissions or downsize to comply with the requirements, or close altogether,” she added.
For supporters, the focus is likely to shift to updating requirements in 35 states and the District of Columbia, which have already established some nursing home staff standards, and developing them in those that haven’t.
Rules for Home Help
A second rescinded regulation, more unexpected, caused upheaval in July when the Labor Department announced a return to a policy excluding home care workers from the federal Fair Labor Standards Act.
Historically, the FLSA mandated that workers receive the federal minimum wage (currently $7.25 an hour) and overtime pay. It exempted most “domestic service workers” until 1975, when a new Labor Department regulation included them—except for home care workers.
“There was a misinterpretation of home care work as being casual, nonprofessional, non-skilled,” said Kezia Scales, a vice president at PHI, a national research and advocacy organization. For almost 40 years, workers and their supporters lobbied to change the rule, viewing it as a contributor to low wages and meager benefits for a rapidly growing workforce, primarily composed of women, minority groups, and many immigrants.
In 2013, the Labor Department responded with a rule that brought home care workers under the labor act, entitling them to minimum wage, time and a half for overtime work, and payment for travel time between clients. After industry lawsuits failed to overturn it, “everything settled down,” Scales noted.
However, in July, the Labor Department abruptly announced it would revert to the 1975 regulations and stop enforcing the 2013 rule, claiming it had “negative effects on the ground” and hindered consumer access to care.
Agencies employing most home care workers, primarily funded through Medicaid, supported this change. “Many workers never got any benefit from this,” said Damon Terzaghi, a vice president at the National Alliance for Care at Home. A 2020 federal report found that 16 states had capped Medicaid-covered home care hours at 40, thus avoiding overtime payment.
The alliance estimates that the number of impacted agencies and businesses has declined by 30% since 2013, supporting the rescission. Scales, however, called it “a shocking step backward.”
Where they agree is that the U.S. has never truly committed to adequately funding long-term care at home. With the July legislation setting the stage for a $914 billion cut to Medicaid over the coming decade, this situation seems unlikely to change anytime soon.
Medicare’s AI Referee
Beyond rolling back policies for the care of the aged, the Trump administration has established a pilot program to introduce prior authorization into traditional Medicare, utilizing artificial intelligence and machine learning technologies. Touted as a boon to taxpayers, Medicare calls it WISeR—Wasteful and Inappropriate Service Reduction.
Prior authorization, which allows private insurers to review proposed treatments before agreeing to pay for them, is widely used in Medicare Advantage plans, despite its unpopularity with patients, doctors, and healthcare organizations. It has rarely been used in traditional Medicare.
This month, however, WISeR debuts in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, Washington) in a six-year trial to determine whether tech company reviews can reduce costs and improve efficiency while maintaining or enhancing care quality.
Initially, WISeR targets 17 items and services that CMS identified as having a higher risk of waste, fraud, and abuse. The list includes knee arthroscopy for arthritis, electrical nerve stimulation devices for various conditions, and treatment for impotence.
The pilot program excludes emergency services and inpatient hospital care, where delays pose “a substantial risk.” Algorithmic denials will trigger review by “an appropriately licensed human clinician.” The tech companies involved will receive “a share of averted expenditures.”
“It injects some of the worst of Medicare Advantage into traditional Medicare,” said David Lipschutz, co-director of the Center for Medicare Advocacy. The six vendors that approve or reject treatments “have a financial stake in the outcomes,” he noted, creating an incentive to deny care.
Moreover, the CMS Innovation Center overseeing the pilot could theoretically bypass Congress and expand prior authorization to include more medical services in more states.
The agency did not respond to questions about the qualifications of the human clinicians reviewing denials, only stating they would have “relevant experience” and that tech companies would be “financially penalized for inappropriate denials, high appeal rates, or poor performance.” An “independent, federally funded evaluation” is planned, with public reports to be released annually.
Democrats in Congress have introduced bills in both houses to repeal WISeR. “We should be reducing red tape in Medicare, not creating new hurdles that second-guess healthcare providers,” said Rep. Suzan DelBene of Washington, one of the bill’s sponsors.
For now, however, WISeR has opened for business, receiving prior authorization requests through its electronic portals.
By Paula Span
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
January 23, 2026
KFF Health News: These 3 Policy Moves Are Likely To Change Health Care for Older People
Month after month, Patricia Hunter and other members of the Nursing Home Reform Coalition logged onto video calls with congressional representatives, seeking support for a proposed federal rule setting minimum staff levels for nursing homes.
Finally, after decades of advocacy, the Biden administration in 2023 tackled the problem of perennial understaffing of long-term care facilities. Officials backed a Medicare regulation that would mandate at least 3.48 hours of care from nurses and aides per resident, per day, and would require a registered nurse on-site 24 hours a day, seven days a week.
The mandated hours were lower than supporters hoped for, said Hunter, who directs Washington state’s long-term care ombudsman program. But “I’m a pragmatic person, so I thought, this is a good start,” she said. “It would be helpful, for enforcement, to have a federal law.”
In 2024, when the Centers for Medicare & Medicaid Services adopted the standards, advocates celebrated. However, industry lawsuits soon blocked most of the rule, with two federal district courts finding that Medicare had exceeded its regulatory authority.
After the 2024 elections, Hunter expressed concern about the changing political landscape, which proved to be well-founded. In July, as part of Republicans’ One Big Beautiful Bill Act, Congress prohibited Medicare from implementing the staffing standards before 2034. Last month, CMS repealed the standards altogether, meaning they never took effect.
“It was devastating,” Hunter remarked.
Similar to environmental law and consumer protections, the Trump administration’s enthusiasm for deregulation has undone long-sought rules to improve care for the aged. Additionally, it has introduced a Medicare experiment for prior authorizations, now underway in six states, alarming advocates, congressional Democrats, and many older Americans.
These policy shifts will significantly impact facilities and workers providing care, complicating health coverage in several states. “It’s clear CMS has no interest in ensuring adequate staffing,” said Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care.
“They’re repealing a regulation that could have saved 13,000 lives a year,” he added, citing an analysis by University of Pennsylvania researchers.
Industry groups argue that nursing homes, already struggling with high staff turnover, were unable to fill vacancies. The staffing mandate “was requiring nursing homes to hire an additional 100,000 caregivers that simply don’t exist,” said Holly Harmon, a senior vice president at the American Health Care Association. “Facilities would have been forced to limit admissions or downsize to comply with the requirements, or close altogether,” she added.
For supporters, the focus is likely to shift to updating requirements in 35 states and the District of Columbia, which have already established some nursing home staff standards, and developing them in those that haven’t.
Rules for Home Help
A second rescinded regulation, more unexpected, caused upheaval in July when the Labor Department announced a return to a policy excluding home care workers from the federal Fair Labor Standards Act.
Historically, the FLSA mandated that workers receive the federal minimum wage (currently $7.25 an hour) and overtime pay. It exempted most “domestic service workers” until 1975, when a new Labor Department regulation included them—except for home care workers.
“There was a misinterpretation of home care work as being casual, nonprofessional, non-skilled,” said Kezia Scales, a vice president at PHI, a national research and advocacy organization. For almost 40 years, workers and their supporters lobbied to change the rule, viewing it as a contributor to low wages and meager benefits for a rapidly growing workforce, primarily composed of women, minority groups, and many immigrants.
In 2013, the Labor Department responded with a rule that brought home care workers under the labor act, entitling them to minimum wage, time and a half for overtime work, and payment for travel time between clients. After industry lawsuits failed to overturn it, “everything settled down,” Scales noted.
However, in July, the Labor Department abruptly announced it would revert to the 1975 regulations and stop enforcing the 2013 rule, claiming it had “negative effects on the ground” and hindered consumer access to care.
Agencies employing most home care workers, primarily funded through Medicaid, supported this change. “Many workers never got any benefit from this,” said Damon Terzaghi, a vice president at the National Alliance for Care at Home. A 2020 federal report found that 16 states had capped Medicaid-covered home care hours at 40, thus avoiding overtime payment.
The alliance estimates that the number of impacted agencies and businesses has declined by 30% since 2013, supporting the rescission. Scales, however, called it “a shocking step backward.”
Where they agree is that the U.S. has never truly committed to adequately funding long-term care at home. With the July legislation setting the stage for a $914 billion cut to Medicaid over the coming decade, this situation seems unlikely to change anytime soon.
Medicare’s AI Referee
Beyond rolling back policies for the care of the aged, the Trump administration has established a pilot program to introduce prior authorization into traditional Medicare, utilizing artificial intelligence and machine learning technologies. Touted as a boon to taxpayers, Medicare calls it WISeR—Wasteful and Inappropriate Service Reduction.
Prior authorization, which allows private insurers to review proposed treatments before agreeing to pay for them, is widely used in Medicare Advantage plans, despite its unpopularity with patients, doctors, and healthcare organizations. It has rarely been used in traditional Medicare.
This month, however, WISeR debuts in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, Washington) in a six-year trial to determine whether tech company reviews can reduce costs and improve efficiency while maintaining or enhancing care quality.
Initially, WISeR targets 17 items and services that CMS identified as having a higher risk of waste, fraud, and abuse. The list includes knee arthroscopy for arthritis, electrical nerve stimulation devices for various conditions, and treatment for impotence.
The pilot program excludes emergency services and inpatient hospital care, where delays pose “a substantial risk.” Algorithmic denials will trigger review by “an appropriately licensed human clinician.” The tech companies involved will receive “a share of averted expenditures.”
“It injects some of the worst of Medicare Advantage into traditional Medicare,” said David Lipschutz, co-director of the Center for Medicare Advocacy. The six vendors that approve or reject treatments “have a financial stake in the outcomes,” he noted, creating an incentive to deny care.
Moreover, the CMS Innovation Center overseeing the pilot could theoretically bypass Congress and expand prior authorization to include more medical services in more states.
The agency did not respond to questions about the qualifications of the human clinicians reviewing denials, only stating they would have “relevant experience” and that tech companies would be “financially penalized for inappropriate denials, high appeal rates, or poor performance.” An “independent, federally funded evaluation” is planned, with public reports to be released annually.
Democrats in Congress have introduced bills in both houses to repeal WISeR. “We should be reducing red tape in Medicare, not creating new hurdles that second-guess healthcare providers,” said Rep. Suzan DelBene of Washington, one of the bill’s sponsors.
For now, however, WISeR has opened for business, receiving prior authorization requests through its electronic portals.
By Paula Span
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
