Medicare 2026

Nursing Home Staffing After the Federal Minimums Ended: What Facilities Must Still Do

If you or someone you love may need nursing home care, you've probably seen headlines about federal staffing rules being rolled back. The picture is less dramatic than it may sound. The specific hour-by-hour minimums are gone, but a web of long-standing federal requirements still shapes who must be on the floor, when, and with what skills. Here's a plain-English look at what changed, what didn't, and how to check staffing at any facility you're considering.

What changed at the federal level

In May 2024, CMS finalized a rule setting specific minimum staffing hours in nursing homes — 0.55 hours per resident day from registered nurses (RNs), 2.45 hours from nurse aides, and 3.48 total nurse staffing hours per resident day — along with a requirement that an RN be onsite 24 hours a day, 7 days a week.

Those requirements are now gone. On December 3, 2025, CMS published an interim final rule with comment period (CMS-3442-IFC, 90 FR 55687), effective February 2, 2026, repealing them. The rule points to Section 71111 of the 2025 budget reconciliation law (Public Law 119-21, signed July 4, 2025), which bars HHS from implementing, administering, or enforcing those staffing provisions from enactment through September 30, 2034. CMS also noted that two federal district courts had already vacated the hours-per-resident-day and 24/7 RN requirements in 2025.

What facilities must still do

Repealing the newer minimums restored the earlier federal baseline, which has been in place for years. Every participating nursing home must:

• Use the services of an RN for at least 8 consecutive hours a day, 7 days a week.
• Designate an RN to serve as director of nursing on a full-time basis.
• Designate a licensed nurse as charge nurse on each tour of duty.
• Provide licensed nurses and other nursing staff on a 24-hour basis (except when waived).

Beyond those bright-line rules, federal regulations require a facility to have sufficient nursing staff with the competencies and skills to meet residents' needs, based on the number, acuity, and diagnoses of its residents, as identified in a required facility assessment. In other words, "sufficient" is tied to who actually lives there, not a one-size-fits-all number.

Waivers aren't automatic

A state can waive the 24-hour licensed nurse requirement or the 8-hour RN requirement only in narrow circumstances. The facility must show it couldn't recruit staff despite diligent efforts, and the state must find that the waiver won't endanger residents' health or safety. Waivers are reviewed every year, and any facility operating under a waiver must notify its residents and their resident representatives. If you're touring a facility, it's fair to ask whether a waiver is in place.

Staffing information you can see for yourself

Federal rules require every nursing home to post its nurse staffing data daily, at the start of each shift, in a prominent spot that residents and visitors can easily access. The posting must show the number and actual hours worked by RNs, licensed practical or vocational nurses (LPNs/LVNs), and certified nurse aides, plus the resident census for that day. Facilities must make this data available to the public on request and keep it for at least 18 months (longer if state law requires).

You can also look up nursing homes on Medicare.gov, where CMS publishes the Five-Star Quality Rating System. Staffing is one component of that rating.

A new federal push on recruiting

On October 23, 2026, CMS announced Nurses for Nursing Homes, a $275 million initiative funded through civil monetary penalties collected from nursing homes ($100 million from CMS and at least $175 million from states). It offers eligible nurses and nursing students up to $40,000 in student loan repayment and/or a $10,000 stipend in exchange for a three-year commitment to work in a qualifying nursing home in a rural or higher labor-shortage area. CMS says all 50 states and the District of Columbia are participating.

While you're thinking about Medicare, a few 2027 reminders

Nursing home decisions often come up alongside bigger Medicare questions. A few program-level facts for 2027:

• The Part D out-of-pocket cap rises to $2,400 (it is $2,100 in 2026).
• The maximum Part D deductible any plan may charge in 2027 is $700.
• The Part D base beneficiary premium used in the late-enrollment penalty calculation is $41.33 for 2027; actual plan premiums vary.
• Annual Enrollment runs October 15 – December 7, 2026, with choices effective January 1, 2027.
• Social Security announced a 3.6% COLA for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible and the 2027 IRMAA income brackets have not yet been announced; CMS typically releases them in the fall.

If you have Medicaid or Extra Help, since 2025 you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. If you're a full-benefit dual-eligible, you can join an integrated D-SNP in any month.

As you weigh coverage choices, remember that Medicare Advantage and Original Medicare with a Medigap policy and stand-alone Part D each have real trade-offs — networks, cost-sharing patterns, extra benefits, and flexibility to see any Medicare provider all differ. There's no universally "best" option; the right fit depends on your health, finances, and preferences.

Where can you get help with Medicare questions?

For official Medicare information, including nursing home ratings and staffing data, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24/7.