White House Order Aims to Tie Nursing Home Medicare Payments to Worker Retention

The White House today announced that President Biden will enact “the most sweeping set of executive actions to improve care in history,” which will include directives related to nursing home staffing and Medicare payments.

Specifically, Biden’s executive order will direct the Department of Health and Human Services (HHS) to “build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers,” according to a White House fact sheet.

Overall, Biden’s executive order includes more than 50 directives across cabinet agencies related to expanding care access, with a particular focus on long-term care and child care. Long-term care costs are up 40% in the past decade, threatening access, the White House emphasized in its announcement.


“At the same time, many workers providing this critical care find themselves in low-paying jobs with few benefits,” the fact sheet stated. “Care workers, who are disproportionately women of color, struggle to make ends meet, and turnover rates are high.”

This set of actions from the White House comes a little more than a year after Biden put forward a sweeping set of proposed nursing home reforms, including a federal minimum staffing standard. The Centers for Medicare & Medicaid Services (CMS) is still in the process of formulating a proposed staffing mandate, to be released later this year.

Nursing home providers and industry associations have pushed back on a federal mandate that would be unfunded and that they fear would be impossible to meet, given the current workforce shortage.


Among other actions put forward on Tuesday, the White House touted that, “The Administration is also promoting the use of apprenticeship programs and partnering with employers, unions, and others to recruit, train, and keep long-term care workers on the job while also helping them advance their careers as registered and licensed nurses.”

This is a developing story and will be updated.

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