In the litigation against the federal nursing home staffing mandate, in which state attorneys general from 20 states are seeking a temporary halt, a federal judge heard oral arguments from both the government and the states on Thursday.
The U.S. Department of Justice (DOJ) urged the federal judge to deny the injunctive relief requested by the state attorneys general and several providers, arguing that Congress has allowed federal authorities to implement rules pertaining to staffing, citing past restrictions for social workers and infection prevention and control.
Meanwhile, the lawyer representing the states, Kansas Deputy Attorney General Abhishek Kambli, argued that federal officials cannot oversee limits on staffing and that the staffing rule would impose three types of irreparable harm on all plaintiffs.
‘Irreparable harm’
In seeking injunctive relief, the states argued that nursing homes will be able to pause activities that are currently leading to higher costs and other burdens as a result of the staffing mandate looming.
“It at least gives the plaintiffs breathing room to make those decisions, which they don’t have without injunctive relief,” Kambli said.
Enhanced facility assessments required by the staffing rule – and implemented in August – have led to increased costs, Kambli said. Also, to comply with the final rule when it takes effect in 2026, plaintiffs must start hiring additional nursing staff now, which imposes significant operational burdens, he argued. Moreover, states are facing harm due to the need to update their Medicaid websites to reflect changes required by the rule.
After hearing the state’s arguments, Judge Leonard T. Strand of the U.S. District Court for Northern Iowa expressed uncertainty about granting a preliminary injunction, questioning whether delaying the rule might complicate recruitment efforts for providers if the rule is ultimately upheld.
Specifically, the judge questioned whether evidence exists showing that an injunction would relieve providers of “the stress” of having to make hires in advance of the mandate.
To this the lawyers representing the states and providers responded that putting the rule on pause would give some relief, however temporary, including for elements of the mandate such as hiring registered nurses to be available around the clock, every day.
The plaintiffs’ lawyers also said that they are seeking “a reprieve” and are confident that the staffing mandate will ultimately be defeated.
“In this case, there’s obviously a substantial likelihood of success. On the merits, there’s irreparable harm,” Kambli said, adding during rebuttal that the plaintiffs’ goal wasn’t just to win now and then lose at final judgment.
HHS authority on staffing limits questioned
After the government’s arguments, Judge Strand questioned whether federal officials had the authority to increase the number of hours to 24/7 by registered nurses (RNs), stating it meant overstepping congressional authority.
Noting that Congress established a distinct rule earlier on the matter, he wondered whether the Secretary of Health and Human Services (HHS), Xavier Becerra, had any power to go beyond the limit set earlier by the legislative branch.
The government’s lawyers responded that Congress had set certain broad requirements while HHS controlled the details related to staffing. Examples they used to support their argument included HHS mandating infection control programs and overseeing specifics of staffing of social workers. Certain long-term care facilities are required to employ a social worker with at least a bachelor’s degree in social work or a similar professional qualification, a stipulation put in place by HHS.
Although no timeline was shared for a decision on the preliminary injunction, Judge Strand stated that he was planning to issue his ruling as soon as possible.
“There are reasons to expedite the situation, so I will work as quickly as I can,” he said at the conclusion of the hearing.
