The federal government is challenging an April ruling that struck down key provisions of the Biden-era nursing home staffing mandate.

On Monday, the Department of Health and Human Services (HHS) notified the U.S. District Court for the Northern District of Texas that it is appealing the decision to the Fifth Circuit Court of Appeals.

The appeal follows an April 7 decision by District Judge Matthew J. Kacsmaryk, who invalidated the mandate’s minimum hourly staffing requirements. The Centers for Medicare & Medicaid Services (CMS) had aimed to establish minimum staffing requirements to improve quality and safety. However, the court sided with the nursing home industry, which had argued that CMS had overstepped its legal authority and failed to fully consider the policy’s practical implications, including severe workforce shortages.

By appealing the decision, HHS is seemingly seeking to reinstate the proposed staffing rule, perhaps undermining nursing home industry confidence that the Trump administration would dismiss the rule.

However, legal experts said that is simply not the case.

Mark Reagan, managing shareholder at Hooper, Lundy & Bookman, doubted that the appeal signaled any real change, and he expects the original ruling to be upheld if the case proceeds. The appeal is likely just a “placeholder,” he said, to preserve potential savings for reconciliation as the Republican-backed budget reconciliation bill – popularly called the “One Big Beautiful Bill” – heads to the Senate. It is estimated that the bill will trigger cuts of $500 billion from Medicare and $700 billion in Medicaid funding to states over a 10-year period.

“I highly doubt that this development means anything consequential at the moment,” Reagan told Skilled Nursing News. “There is a strong desire to bank the savings associated with the staffing mandate as part of the Reconciliation process. It was therefore essential for the judgment to be appealed in order to preserve that opportunity. As such, I see the notice as nothing more than a placeholder at present.”

HHS appeal needless

That said, advocates for nursing homes were disappointed with the HHS appeal.

“It is unfortunate that more time and taxpayer dollars must be wasted debating this unrealistic regulation when ultimately, our legal arguments will prevail,” Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services, said in an emailed statement. “From the start, the rule has been an unnecessary distraction from the real task at hand: strengthening the long-term care workforce.”

Nursing home advocates do support the Congressional plan to put a 9-year moratorium on the staffing rule, and using the savings to offset parts of the reconciliation bill with proposed Medicaid cuts.

Moreover, Smith Sloan stressed the need for increased Medicaid funding to support workforce recruitment and retention, urging a complete dismissal of the rule.

Sights set on legislative defeat

Meanwhile, Clif Porter, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), echoed Smith Sloan’s views on the waste of funds caused by HHS’ legal appeals, and also urged quick legislative action.

“This is all the more reason that Congress must act swiftly and responsibly with budget reconciliation. Rescinding the staffing mandate would not only generate significant federal savings, but safeguard access to care for our nation’s seniors,” Porter said in an emailed statement. “There are better ways to strengthen the long-term care workforce, and we implore Congress to advance more productive solutions.”

CMS’ final staffing rule stipulates a minimum 3.48 clinical staff hours per resident per day (HPRD), in addition to the 24/7 requirements for registered nurses (RNs) to be on-site.

Following the appeal, the case now moves to the Fifth Circuit, where experts foresee an eventual court defeat.

“In any event, I am highly confident that the [earlier decision] will be affirmed if the appeal would be prosecuted through its end before the 5^th Circuit and otherwise,” Reagan said.

Craig Conley, shareholder at law firm Baker Donelson, agrees with Reagan’s view, saying that the HHS appeal was a standard step in the legal process – although it was still something that caught him slightly off guard.

“I expected HHS would appeal the April decision as it is part of the process, and I suspect that the Fifth Circuit will uphold the lower court decision,” Conley told SNN, adding, “Even though I expected an appeal, it is somewhat surprising given the overall stance of the current administration in relation to regulations – but that was the same stance taken in the lower court by HHS.” 

In the end, nothing has changed since the last legal ruling on the staffing mandate.

“I don’t foresee the rule being implemented any time soon, if at all,” Conley said.