Nursing home leaders are anticipating big changes to the sector with President Donald Trump’s inauguration drawing closer. The federal staffing mandate is likely to be on the chopping block, as Republicans eye $22 billion in savings if it is delayed or stopped.

However, operators must balance this win, among potential others, with the incoming administration’s declarations surrounding federal spending.

Michaela Sims, founder of Sims Strategies and member of ADVION Policy Council, said operators can win big with expansive provider payment reform among other operator-friendly changes, due to the “Republican trifecta” given a Republican president and Republican-controlled chambers of Congress.

“The chances are higher that the Republicans would want to do a ‘clear the decks’ strategy, and what we mean by that is, basically [they will] negotiate whatever they need to get the funding of the government off of their plates for next October,” said Sims.

“Sweeteners” could be added by the new administration, such as reform to the Physician Fee Schedule (PFS) and a permanent extension for telehealth along with a delay or stop to the staffing mandate, said Cynthia Morton, CEO of ADVION.

While the sector felt financially supported under the first Trump term, and the new administration may very well abandon Biden’s staffing mandate, there’s concern surrounding the administration’s talk of reducing federal spending, said Stu Almer, president and CEO of Gurwin Healthcare System in New York.

“We can’t speculate as to what will happen with the upcoming transition of power, but it is generally difficult for providers to budget and execute all strategic plans in an unpredictable environment,” Almer told Skilled Nursing News.

Almer said that removing the federal staffing mandate may be helpful for New York operators, who are already having to contend with a state mandate. As it stands, the vast majority of nursing homes aren’t able to meet the state mandate and New York remains in a health care workforce crisis, much like the rest of the country.

“This has been evidenced by declarations by the Commissioner of Health, acknowledging an acute labor supply shortage in health care,” said Almer. “This brings us back to the need to expand the pipeline of health care professionals and ensure that Medicaid and Medicare funding are protected from any potential federal spending cuts.”

Aside from the federal staffing mandate being derailed, experts expect a loosening of the regulatory noose.

Fred Bentley, managing director for post-acute and long-term care and senior living practice at ATI Advisory, anticipates that in 2026 and beyond, a lot of the Biden Administration’s regulation initiatives will be ditched or scaled back.”

Added authority and discretion given to surveyors, for one, may be one of the items likely to reverse course, he said.

Potential wins within Republican budget negotiations

Bipartisan opportunities may get some attention as Republicans negotiate for the budget they need, but nothing is set in stone.

The telehealth extension, for one, is set to expire unless Congress acts to extend it permanently in an upcoming “lame duck” session.

“We really do not know which direction that could take, but it is kind of a hot potato out there. We do know we’re going into an administration that is not going to favor greater regulation of health care providers,” said Morton.

As for changes to PFS, It’s important to note too that it was during the last year of the first Trump administration when Congress decided to move a significant portion of value in the PFS over to primary care codes, and the rest of the codes had to offset that by sustaining reductions, Morton said.

The move set off a number of payment cuts every year in an effort to remain budget neutral, and that has affected nursing home care over time by way of cuts to therapy providers, she said. Congress could make a move to add an inflationary factor to offset cuts, but it likely won’t be until the new Congress meets.

“ADVION signed with more than 120 organizations asking Congress to add the inflationary update to the Physician Fee Schedule, but really, we will take any major reform that brings us more relief, and we’ll be looking for and fighting for a possible patch in December,” she said.

Republicans may stop mandate, but plan for shifting political pendulum

If the rule were delayed or stopped, it would provide a lot of dollars in savings that could be used to offset other spending for those in control a year from now, Morton said.

“If that gets delayed, there’s $22 billion associated with that,” added Sims.

At the same time, operators and associations would do well to plan accordingly for another flip in four years.

Historically, one party would be in power for multiple election cycles, but in the past decade or so, the pendulum has shifted between the two political parties, added Sims, who along with Morton, led a webinar recently on how the latest election could shape health care and long-term care.

“The party in charge, it’s flipping every two to four years,” said Sims, introducing more uncertainty on policies.

The newly formed Department of Government Efficiency, headed by Elon Musk and Vivek Ramaswamy, will introduce a “whole swath” of initiatives that could affect nursing home operators, with their goal of fewer government officials and fewer regulations, Sims said.

On top of a new department promising to cut bureaucracy, Trump – while on the campaign trail – talked about a resistance to cutting Medicare.

These are promises that experts say will get the administration into hot water, particularly around Medicare. Trump vowed “no cuts” to Medicare while hinting at program reductions aimed at “bad management,” according to a recent report from Forbes.

Meanwhile, provisions in surveys around the safety of Covid vaccinations and infection control made under the Biden Administration may be on shaky ground if Robert F. Kennedy, Jr. and Mehmet Oz are confirmed, according to Bentley.

“We’re still in the very early stages. Trying to discern RFK Jr. and Dr. Oz’s priorities is tricky … they are far from traditional Republican appointees,” said Bentley. However, “it is interesting to think about these secretaries in terms of their shelf life, given that they seem to be even more at the beck and call of Trump. It’s not unreasonable to think that we may have major ideological shifts and changes within the administration, depending on who’s heading it up.”