Senate Democrats Want Nursing Homes to Spend More of Their Funding on Actual Care — and Providers Aren’t Fighting Back

Washington, D.C. — Senate Democrats are pressing for a sweeping overhaul of how the nation funds long-term care, and the industry’s response is striking: providers largely agree with the direction, even as they push back on one familiar piece of it.

Ranking Member Ron Wyden and his colleagues on the Senate Finance Committee issued a formal request for information this week, laying out proposals to make nursing home ownership more transparent, rein in private equity involvement, and rebuild staffing standards after last year’s rollback of the federal mandate. According to the committee, nearly $1 trillion in Medicaid cuts enacted under the 2025 reconciliation bill have left the sector badly strained, and changes can’t wait.

A spending floor for direct care

The proposal drawing the most attention would require nursing homes to spend a specific minimum share of their Medicare and Medicaid reimbursement on direct resident care — not management fees, not rent paid to affiliated companies, not corporate profit. States like Massachusetts, New York and New Jersey have already adopted similar rules, and the committee is now asking what a federal version should look like, including what percentage threshold would actually work.

Industry groups aren’t treating it as a threat. Clif Porter, who leads the American Health Care Association, said his organization remains “committed to working with lawmakers” on policies that expand access and drive quality. Nonprofit provider group LeadingAge likewise called the effort a step in the right direction.

Staffing, without the mandate

The sticking point is staffing. The 2024 federal rule that would have required 3.48 nursing hours per resident per day and a registered nurse on-site around the clock was rescinded in December 2025, and providers don’t want it revived. Zach Shamberg, a government affairs executive at Saber Healthcare, was blunt: the mandate “was rejected by the courts, by Congress and by CMS because there are not enough nurses to meet it and no funding to pay for it.”

Instead, the industry is pointing to incentives. Illinois ties its Medicaid payments to staffing ratios, and staffing there grew 11% between 2022 and 2026 — four times faster than the national average. That’s the model providers want Washington to follow, alongside fixes like modernizing the 75-hour CNA training standard, only 16 hours of which are clinical, and opening legal immigration pathways for caregivers.

The committee is also weighing changes to the Five-Star Quality Rating system, including giving staffing more weight and adding a new measure of day-to-day staffing instability — a nod to concerns that self-reported data can be manipulated without improving actual care.

It’s rare to see this much agreement on long-term care policy. Whether it survives contact with the legislative process is another question, especially with occupancy climbing and operators still struggling to fill beds.