Washington, D.C. — While the White House’s proposed fiscal year 2027 budget slashes billions from the Department of Health and Human Services, it carves out one notable exception: nursing home inspections.
The administration is asking Congress for nearly $90 million more in survey and enforcement funding — a significant increase that, if approved, would allow federal regulators to complete mandatory inspections at 78% of nursing homes and 85% of hospices nationwide. That would actually exceed recent completion rates, which have been sliding for years.
“This funding request will allow CMS to complete mandatory surveys for 78% of nursing homes and 85% of hospices, which exceeds recent completion rates,” the Department of Health and Human Services said in budget documents.
A Widening Gap in Oversight
The numbers tell a troubling story. In fiscal year 2024, CMS completed standard surveys at just 74% of nursing homes. By fiscal year 2026, that figure was projected to fall to 65%. That means roughly one in three nursing homes was going without a routine federal inspection in any given year.
The proposed funding boost would reverse that trend — at least on paper. Whether Congress approves the request is another matter entirely, especially given the broader push to cut domestic spending.
The contrast is striking. The same budget that proposes a 12.5% cut to HHS overall — roughly $16 billion — is simultaneously asking for more money to inspect the facilities where some of the country’s most vulnerable residents live. Critics have noted the tension between those two positions, arguing that cuts elsewhere in the budget could undermine the very care quality that inspections are meant to protect.
Why It Matters for Operators
For nursing home operators, more survey funding means more inspections — and more exposure to citations and civil monetary penalties. The proposal comes on the heels of sweeping changes to nursing home survey rules that toughened enforcement standards and raised the bar for what constitutes an immediate jeopardy violation.
Together, the two moves signal that the administration — despite its deregulatory posture in other sectors — isn’t backing off nursing home oversight. If anything, it’s doubling down.
Industry groups have long argued that survey completion rates are an imperfect measure of care quality, and that the inspection process itself can be inconsistent across states. But advocates for residents say the drop in completion rates has left too many facilities operating without adequate federal scrutiny.
The budget proposal still needs to clear Congress, where healthcare spending fights are expected to be fierce. But the signal from the White House is clear: nursing home inspections aren’t on the chopping block — even when almost everything else is.
