New federal nursing home staffing rule sparks lawsuit from Virginia and 19 other states, citing operational challenges
Richmond, Virginia – Virginia Attorney General Jason Miyares has teamed with 19 other state attorneys general in a lawsuit aiming at a new federal rule significantly raising staffing requirements for nursing homes. The lawsuit addresses reforms made earlier this year by the Centers for Medicaid and Medicare Services (CMS), which want to increase the necessary registered nurse coverage in nursing homes from eight 8 per day to almost-around-the-clock supervision.
Nursing homes have to make sure a registered nurse is on duty 24 hours a day under the new CMS rule, which will phase in May 2026 for urban-based facilities and May 2027 for rural locations. The rule also specifies improved reporting procedures for these establishments. The attorneys general contend that these new rules will place heavy financial and operational load on long-term care providers, potentially leading to partial closure of businesses.
“This new rule is yet another example of Washington bureaucrats imposing sweeping mandates without considering the devastating impact on our communities. Nursing homes in Virginia and across the country already face challenges, and this policy will force them out of business,” said Attorney General Jason Miyares. “Ultimately, the real cost will be felt by our most vulnerable citizens—those who rely on these facilities for care and support.”
The timing of this legal challenge aligns with continuous initiatives by a Virginia rural healthcare committee to solve these very manpower shortages. Comprising state delegates, the group has been traveling Virginia since April, learning from healthcare practitioners throughout the Eastern Shore to Southwest Virginia. Their results, which will be combined into an in-depth paper due by year-end, should affect legislative and budgetary decisions meant to solve staffing problems in the healthcare industry.
Though the new CMS rule is somewhat strict, there are clauses allowing some institutions to ease the changeover. A “hardship exemption” will be available, allowing nursing homes that cannot meet the new standards to continue operating while they work towards compliance. These facilities have to prominently display their exemption status on-site; details will also be available on Medicare’s website, thus guaranteeing openness for families and patients.
The Kaiser Family Foundation reports that up to 25% of nursing homes could be eligible for exemptions from some of the new criteria based on federal agency projections. Although the larger consequences of the rule—and the lawsuit against it—highlight the difficult balance between improving patient care and preserving the viability of vital healthcare services in communities around the nation, this exemption seeks to prevent service disruptions in facilities most affected by staffing shortages.
Attorney General Miyares is joined in the coalition by attorneys general from Alabama, Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Montana, Missouri, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Utah, and West Virginia.
Read the complaint here.
