The Department of Health and Human Services (HHS) funding cuts – only temporarily restored by a federal court – would be detrimental to nursing homes in many states if made permanent.

Pennsylvania, New York, California, Wisconsin and Minnesota are among the states named in a multi-state lawsuit, which aims to block the Trump administration from cutting these Covid-era public health grants that total $11 billion.

Officials and nursing home advocacy groups in these states are highlighting the impact of the funding loss on state health departments, including for initiatives in nursing homes.

For nursing homes, services and initiatives that would suffer will include workforce initiatives, infection prevention training, HVAC upgrades as well as smoother care transitions, to name a few.

In Pennsylvania, for example, the $495 million in federal funding received was allocated to help build the long-term care workforce by creating training programs and professional development resources for staff, nursing home advocacy groups told Skilled Nursing News.

Grants in the state were also going toward identifying and implementing innovative care models, and a focus on quality initiatives and value-based care, President and CEO Zach Shamberg of the Pennsylvania Health Care Association (PHCA) told SNN.

Pennsylvania was planning to alleviate a staffing shortage of nearly 2,600 care providers to meet state staffing ratios, according to a workforce survey published by the PHCA. The state is expected to incur an additional shortage of 20,000-plus staff per year through 2032, the survey found.

Millions of the public health grants go toward nursing homes in each state. They fund such care initiatives as Pennsylvania’s Long-Term Care RISE program, which improves quality care for residents in nursing homes, personal care homes, and assisted living.

For Pennsylvania, if the HHS cuts are reinstated, this program would be terminated, according to a statement from PA Gov. Josh Shapiro. Pennsylvania joined the lawsuit, citing the loss of the RISE program among other crucial uses of the funding.

RISE operates through funding to local county and municipal health departments to enhance workforce capacity, surveillance methods and infection prevention. The potential HHS cuts would exacerbate workforce shortages and increased demand in the state.

Cuts need consultation

Given how crucial the funding can be, any further cuts should be discussed with providers to weigh potential impact, Shamberg said.

“Just as we requested throughout the pandemic: before cuts like these are implemented, or critical funding is clawed back, the Trump administration should bring long-term care providers to the table to identify any potential harmful effects,” said Shamberg. “Providers across Pennsylvania should be involved in decisions impacting their promise to the residents they serve.”

In the lawsuit, DOJ claimed the funding cut was appropriate since the public health emergency (PHE) expired almost two years ago. States countered that the funding wasn’t set to expire until June 2027.

“To be clear: these funds are not ‘waste, fraud, or abuse,’” added Shamberg. “And while some may declare the COVID-19 pandemic to be ‘over’, nursing homes, personal care homes, and assisted living communities are still feeling the devastating impact every single day. And there is still much more to be done.”

Infection prevention, HVAC upgrades at stake

In New York, almost $400 million may be lost if the cuts are allowed to go forth, according to Stephen Hanse, president and CEO of the NYS Health Facilities Association (NYSHFA).

Funding would impact Covid vaccination programs for vulnerable populations, which includes nursing homes, Hanse told SNN.

“New York’s nursing homes can’t afford to lose a single dollar given the state’s severe underfunding of Medicaid for nursing home care,” he said, referring to the state’s failure to update Medicaid rates for today’s nursing home costs.

Similarly, California’s temporarily reinstated $972 million in public health funding would allow state and local public health authorities to continue to monitor and respond to communicable and infectious disease outbreaks in skilled nursing facilities, along with other health care settings, leading to the state’s involvement in the lawsuit.

Funding is also used to move patients more smoothly along the health care continuum, assisting hospitals in directing residents to the next appropriate care setting, which could very well be a nursing home.

“Congress explicitly authorized funding for the grants at issue to help keep our country healthy and protect us from future pandemics,” California Attorney General Rob Bonta said in a statement. “HHS and its Secretary, Robert F. Kennedy Jr., cannot unilaterally do away with that critical federal funding.”

The stakes are high, Bonta said, with thousands of jobs and key public health programs and initiatives due to be eliminated.

For Wisconsin, the impact on nursing homes will likely come indirectly, said Rick Abrams, CEO for the Wisconsin Health Care Association and Wisconsin Center for Assisted Living (WHCA/WiCAL). The state is looking at $225 million in cut federal funds.

“Grant funding on important things like mental health and other similar issues, the impact is always indirect,” said Abrams. “Especially if a contractor or subcontractor that one of our nursing homes or assisted living centers are working with either has to scale back, or worse yet, stop providing the services.”

Layoffs in MInnesota, California

In Minnesota, Toby Pearson, president and CEO of Care Providers of Minnesota, told SNN that the $220 million in cuts for the state would impact support for nursing homes, notably funding for HVAC upgrades and staffing training around disease prevention, just one of many reasons why the state joined others in the lawsuit against HHS.

Infection prevention training and capacity building for staff ends immediately with cut HHS funds; the funding serves more than 10,000 nursing home residents across Minnesota, the Minnesota Department of Health (MDH) told SNN. Three nursing homes serving 429 residents collectively were supposed to get HHS funding to replace their HVAC systems, the agency added.

Further, a study aimed at helping nursing homes improve compliance with infection control requirements is abruptly ending, MDH said.

The Minnesota agency already sent layoff and separation notices to 170 employees whose jobs were funded by the grants, and nearly 20 employees due to start at the department – an estimated 300 notices were going out to agency staff as of April 1.

Minnesota Commissioner of Health Dr. Brooke Cunningham said a temporary restraining order doesn’t guarantee immediate access to federal funds, and that the state needs to continue monitoring and assessing the situation before decisions on layoffs are made.

“The future is not yet certain. We will once again have to take some time to figure out what this fully means for the critical services we provide, our community partners, and most importantly, the staff that have received layoff notices,” Cunningham said in a statement.

And Bonta hinted that similar layoffs could happen in California, depending on the court’s decision.

Abrams said that if the TRO is vacated, states like California and Minnesota run into a situation where they start giving money out, only to have to claw it back.

“Generally, we are in a holding pattern on these funds as it works its way through the judiciary,” said Abrams.

The lawsuit involving 23-states and the District of Columbia filed against the Trump administration argues that the HHS cuts violate the Administrative Procedure Act (APA) and would cause undue harm to state health program beneficiaries.

And even though a federal judge on Friday temporarily blocked HHS from cutting the $11 billion in Covid-era funding, citing disruption of critical services, the matter will be up for further discussion on April 16.