WASHINGTON, D.C. — A broad coalition of 93 national and state organizations has formally opposed the Centers for Medicare & Medicaid Services' decision to repeal federal minimum staffing standards for nursing homes, joining attorneys general from 18 states and seven U.S. senators in challenging the regulatory rollback that researchers estimated could have prevented 13,000 deaths annually.
The National Consumer Voice for Quality Long-Term Care led the coalition in submitting formal comments to CMS on February 4, 2026, according to documents published by the Center for Medicare Advocacy. The coalition argued that CMS's justification for rescinding the regulation was unsupported by evidence and that the agency maintains a statutory obligation to ensure adequate staffing levels at nursing facilities nationwide.
The repealed regulation would have required nursing homes to provide 3.48 hours of direct nursing care per resident daily, including 0.55 hours from registered nurses and 2.45 hours from certified nursing assistants, according to the coalition's submission. The rule also mandated 24-hour registered nurse coverage at all facilities serving the nation's 1.2 million nursing home residents.
Among the organizations joining the effort were the American Association on Health and Disability and the Lakeshore Foundation, according to materials published on the AAHD website. The coalition called on CMS to adopt what it termed an evidence-based enforcement strategy rather than eliminating staffing requirements entirely.
On the same day, attorneys general from Arizona, California, Colorado, Delaware, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, and Washington submitted their own comments to the agency, as reported by Skilled Nursing News. The state officials urged CMS to implement targeted staffing mandates specifically for for-profit nursing homes engaged in related-party transactions or under private equity ownership.
Arizona Attorney General Kris Mayes joined the multi-state effort, according to KJZZ reporting from February 3, 2026. The attorneys general cited research from the National Bureau of Economic Research indicating that private equity ownership of nursing homes resulted in more than 22,000 deaths over a 12-year period.
In their submission, the state attorneys general referenced multiple fraud cases involving nursing home operators including Philip Esformes, Joseph Schwartz, Paul Walczek, Bob Dean Jr., Kevin Breslin, and Rocky Lemon, according to the Center for Medicare Advocacy. The officials argued that facilities with certain ownership structures required heightened staffing oversight to prevent what they characterized as fraud schemes.
The third prong of opposition came from Capitol Hill, where Senate Finance Committee Ranking Member Ron Wyden introduced the Nurses Belong in Nursing Homes Act on February 12, 2026, according to a statement from the Senate Finance Committee. Co-sponsors include Senators Andy Kim, Cory Booker, Richard Blumenthal, Chris Murphy, Elizabeth Warren, and Ben Ray Lujan.
The proposed legislation would mandate 3.5 hours of nursing care per resident daily and require 24-hour registered nurse presence at all facilities. The bill would also provide permanent funding for nursing home inspections and redirect civil monetary penalties toward workforce recruitment initiatives, according to the legislative text.
"This bill would establish basic minimum standards for how many of these workers are there for each of the patients — to avoid bed sores, falls, or starvation," Senator Richard Blumenthal stated, as reported by the Center for Medicare Advocacy.
University of Pennsylvania researchers estimated the staffing standards would save approximately 13,000 lives annually among nursing home residents, according to findings cited by Senator Wyden's office and multiple advocacy organizations.
CMS issued an interim final rule on December 3, 2025, repealing the Biden administration's nursing home staffing requirements, according to KJZZ. The coalition's comments characterized the agency's reasoning as misplaced and insufficiently supported by data demonstrating the connection between staffing levels and resident health outcomes.
David Voepel of the Arizona Healthcare Association defended the repeal, telling KJZZ the original mandate was never serious public policy given workforce shortage challenges facing the industry. However, the attorneys general countered that available data demonstrates higher staffing rates correlate with improved health outcomes across approximately 200 Arizona nursing home facilities.
The state officials requested that any replacement regulations include exemptions for tribal facilities and government or nonprofit-operated nursing homes, according to Skilled Nursing News. The attorneys general proposed applying stricter staffing mandates selectively to for-profit facilities with complex ownership arrangements.
Federal regulations require nursing homes to maintain sufficient staffing to meet residents' needs, though specific numerical requirements had not been federally mandated until the now-repealed rule. The coalition argued that CMS retains legal authority and obligation to enforce adequate staffing levels despite rescinding the specific hourly standards.
Resources for Families
Families concerned about staffing levels at nursing facilities can contact the Arizona Long-Term Care Ombudsman at 1-602-542-4446 or reach the national ombudsman hotline at 1-800-677-1116. Additional information and resources are available through the National Long-Term Care Ombudsman Resource Center at https://ltcombudsman.org.
Residents and family members can also file complaints directly with CMS or state health departments regarding inadequate staffing or quality of care concerns at nursing facilities.
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