The U.S. Department of Health and Human Services (HHS) has withdrawn legal appeals in the Fifth Circuit and the Eighth Circuit defending federal minimum staffing requirements in nursing homes. 

The U.S. Court of Appeals for the Fifth Circuit granted the HHS motion to dismiss on Friday, Sept. 19. HHS on Sept. 18 filed a motion to dismiss the case in the Eighth Circuit. The court had not issued an order on that motion as of the afternoon of Sept. 24.

HHS’ submissions for dismissal mark the last stages of a 16-month legal battle between HHS and nursing home industry stakeholders, including the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and LeadingAge, the two largest nursing home provider associations.

Leaders of those nursing home groups praised HHS for withdrawing its appeals and cited other recent developments, such as the 10-year moratorium on the mandate that was in the One Big Beautiful Bill Act (OBBBA) and the Centers for Medicare & Medicaid Services(CMS) proposal to rescind the mandate, currently under review by the White House budget office.

“Coupled with Congress’ recent moratorium, this development brings finality to a misguided mandate that only threatened access to nursing home care for millions of seniors,” said Clif Porter, president and CEO of AHCA/NCAL. “We appreciate that the administration is issuing an interim final rule to rescind the vacated regulation, and more importantly, we look forward to working with policymakers on more meaningful ways to improve quality and strengthen the long term care workforce.”

Porter highlighted AHCA/NCAL’s Caregivers for Tomorrow campaign, stating that attracting and retaining a stronger workforce demands “a supportive, multi-pronged approach,” and calling on lawmakers to take action.

LeadingAge also reaffirmed its opposition to the staffing mandate while putting the focus on the work needed to build a sustainable workforce.

“Rigid, one-size-fits-all staffing requirements do not serve the diverse needs of older adults or the providers who care for them,” said LeadingAge SVP, Policy, Linda Couch. “ … We now look forward to learning details about the potential repeal of the rule waiting at the Office of Management and Budget, and to working collaboratively with CMS on the core issues: ensuring older adults’ ability to access care by supporting staff and providers who deliver needed services through effective policies.”

Mandate saga draws to a close

The staffing requirements began under the Biden administration; the Centers for Medicare & Medicaid Services (CMS) in April 2024 issued a final rule establishing minimum staffing levels. Skilled nursing leaders fought the move, citing numerous concerns and impediments, including that there are not enough registered nurses to meet the requirements in many markets.

In April 2025, Judge Matthew Kacsmaryk of the U.S. District Court for Northern Texas ruled the mandate wasn’t consistent with Congressional legislation governing nursing homes.

“Though the final rule attempts to remedy chronic nursing home deficiencies, it does so deficiently,” said Kacsmaryk. “The final rule still must be consistent with Congress’s statutes. To allow otherwise permits agencies to amend statutes though they lack legislative power. Separation of powers demands more than praiseworthy intent.”

The One Big Beautiful Bill Act, passed in July 2025, included a 10-year moratorium on the staffing requirements. Earlier this month, CMS filed an interim final rule with the White House Office of Management and Budget, which would rescind the staffing mandate.

With HHS withdrawing its legal appeals, the legal saga is poised to end, with all signs pointing to the mandate being dead.