Washington — Traditional Medicare covers roughly 30 million Americans, but it’s the only major health program in the country with no annual limit on what beneficiaries pay out of their own pockets. A new Senate bill aims to fix that. The Medicare Cost Cap Act, introduced last week by Senators Lisa Blunt Rochester (D-Del.), Ron Wyden (D-Ore.), and Chuck Schumer (D-N.Y.), would set a $5,000 annual ceiling on out-of-pocket spending under Medicare Parts A and B. Right now, a senior who gets hospitalized or needs extended skilled nursing care can face unlimited costs — there’s simply no cap. Medicare Advantage…
Author: Chaya S
Indianapolis, Indiana — When Indiana launched PathWays for Aging in July 2024, state officials promised a streamlined Medicaid program that would deliver better care at lower cost. Two years later, Governor Michael Braun is signing legislation to kill it. The state’s mandatory managed Medicaid program for long-term care will revert to fee-for-service by July 2027, marking one of the most significant policy reversals in recent memory — and a cautionary tale for the 27 states currently experimenting with similar models. The $91 million question An independent analysis by Clifton Larson Allen found Indiana was spending $91 million annually more on…
Washington, DC — The Supreme Court handed the Trump administration a major immigration win on June 25, ruling that federal law blocks courts from reviewing decisions to end Temporary Protected Status for roughly 350,000 Haitian and Syrian workers. For nursing homes, the decision removes the legal shield protecting caregivers who in some facilities make up 8 percent or more of the entire workforce. The 6-3 ruling in Mullin v. Doe rejected arguments that the administration’s termination of TPS was motivated by unconstitutional racial animus. Justice Alito, writing for the majority, held that Homeland Security’s designation and termination decisions are largely…
Washington, D.C. — The Medicare Payment Advisory Commission delivered its latest message to Capitol Hill this week, and skilled nursing operators aren’t going to like what it says. In its June 2026 report to Congress, MedPAC recommended increasing payments for physicians and hospitals while cutting rates for post-acute care providers — including a substantial reduction for nursing homes. The commission didn’t mince words. Citing profit margins of 24% for skilled nursing facilities, 21% for home health agencies, and 17% for inpatient rehabilitation facilities, MedPAC argued that post-acute providers are being paid too much relative to their costs. “To bring fee-for-service…
Salyersville, Kentucky — A family in Magoffin County has filed a wrongful death lawsuit against a nursing home that the federal government already fined nearly $450,000 for serious resident neglect, according to court records and a state inspection report. The case centers on Salyersville Nursing and Rehabilitation Center, a small facility in eastern Kentucky that drew immediate jeopardy citations after a 2025 federal inspection. Immediate jeopardy is the most severe deficiency category that regulators can issue. Investigators tied two federal fines totaling $447,485 to the findings, according to public records cited by industry reports. The lawsuit was filed by the…
Hartford, Connecticut — Connecticut nursing homes saw a sharp jump in the state’s most serious safety citations at the same time lawmakers moved to tighten oversight of who owns and controls facilities. State health officials issued 14 “immediate jeopardy” citations in the first quarter of federal fiscal 2026, up from eight in the same period a year earlier, according to data presented at an April meeting of the Nursing Home Financial Advisory Committee. Connecticut reported five such citations in the first quarter of 2024 and seven in 2023. Across all of fiscal 2025, the state logged 26 immediate jeopardy findings.…
Honolulu, Hawaii — The federal government has stripped Hawaii of its Medicaid Fraud Control Unit, the state body that prosecutes nursing home abuse and provider fraud, in a move that could ripple far beyond the islands. HHS Inspector General March Bell told Hawaii Attorney General Anne Lopez this week that the agency would no longer recognize the unit, also known as an MFCU, cutting off about $3 million in annual federal funding. Without certification, the state’s broader Medicaid funding could also be at risk, according to industry reports. For nursing homes, the implications are immediate. MFCUs are the agencies that…
Washington, District of Columbia — Ten nursing organizations have sued the U.S. Department of Education over a new student loan rule they say could narrow the pipeline of advanced nursing talent just as nursing homes are fighting to staff up for sicker, more complex residents. The case targets the department’s final Reimagining and Improving Student Education, or RISE, rule, which is set to take effect July 1. The lawsuit argues that the rule wrongly excludes post-baccalaureate nursing degree programs from the federal definition of “professional degree” programs. That matters because the exemption determines who can borrow above the government’s graduate…
Boston, Massachusetts — The former chief executive of a long-struggling Mission Hill nursing home will spend six months in federal prison for steering pandemic relief money away from the facility he was supposed to be saving. Tony Francis, who ran the Edgar P. Benjamin Healthcare Center for roughly a decade, was sentenced May 20 in U.S. District Court of Massachusetts. Judge Indira Talwani also ordered three years of supervised release and more than $43,600 in restitution to the home, according to the Bay State Banner. Francis pleaded guilty in February to misapplying federal funds tied to COVID-19 relief. As part…
Washington, D.C. — When a nursing home enters a federal enforcement cycle, the medical director can be the difference between a corrective plan and a closure order. Two state regulators say too many of them are missing in action when it counts. Lisa Davies, chief operating officer for the Medical Assistance Plans Division at the Georgia Department of Community Health, and Heather Chamizo, staff services manager for California’s Department of Public Health Center for Health Care Quality, told industry sources the role has changed sharply since 2016, when CMS revised its requirements of participation in Medicare and Medicaid. The job…
