It has been a year since President Trump signed the much-hyped One Big Beautiful Bill Act. When it became law on July 4, 2025, the consensus was that the OBBBA would inevitably bring cuts to Medicaid, not only to those beneficiaries who rely on the program for medical care but to long-term care beneficiaries as well.
Now we’re starting to see the impact of this legislation, and senior care advocates are expressing alarm. While every state administers Medicaid differently, it appears that nursing homes and those they care for are in for some severe belt-tightening – and residents will be affected.
Our source for this report, which first appeared online in June, is this article published by Morningstar. We’re presenting it here so that seniors and their families can be better informed about cuts to Medicaid that could adversely impact staffing, putting residents at potential risk of harm or neglect. The source of the article is an advocacy group called the Nursing Home Abuse Center.
“Most Sweeping Rollback” in Modern History for Nursing Homes
The article from Morningstar reminds us that it has been a full year since President Trump’s so-called One Big Beautiful Bill became law. This legislation, says Morningstar, “set in motion one of the most sweeping rollbacks of nursing home protections in modern history.”
Of course, the impact of those cuts wasn’t felt immediately. But now, as 2026 state budget cycles take full effect, care facilities have started “absorbing the financial shock” of the OBBBA. Advocates from the Nursing Home Abuse Center (NHAC), who authored the Morningstar article, are urging families to understand what these changes could mean.
“The consequences for the country’s most vulnerable nursing home residents are already taking shape,” the NHAC warns, “and experts warn the worst may still be ahead.”
OBBBA Cuts Nearly $1 Trillion in Federal Medicaid Dollars Through 2034
The potential effects of these “rollbacks” are alarming to senior advocates.
“The nonpartisan Congressional Budget Office (CBO) estimates the OBBBA will cut approximately $911 billion from federal Medicaid spending through 2034,” says the Morningstar release.
Because Medicaid is the single largest payer of nursing home costs in the United States, covering the bills for more than 6 in 10 residents, the impact will be widespread.
OBBBA Cuts Will Shift More Medicaid Cost Burden to States
Because Medicaid is a joint federal and state program, when Uncle Sam cuts his share, states will either have to pick up the slack or trim programs further. Facilities and families will end up with higher costs and/or reduced levels of care.
“States now face an impossible choice,” the article states: “raise their own revenue, cut Medicaid services, tighten eligibility requirements, or reduce how much they reimburse nursing homes for each resident’s care. Some states have already indicated lower Medicaid provider rates or are considering cuts heading into the 2026-2027 fiscal year, with further pressure expected in 2027.”
Real and Immediate Risk for Families and Residents
Cuts will clearly affect staffing, the Morningstar article says, and that means potentially risky cuts in resident services.
“For families of nursing home residents, this translates into real and immediate risk,” the article warns. “Facilities operating on reduced Medicaid reimbursements may cut staffing hours, reduce therapy and activity programs, delay maintenance and safety repairs, or – in the worst cases – close entirely.”
The press release makes it clear that this threat is not theoretical. According to an analysis from Protect Our Care published in April, “more than 800 hospitals, nursing homes, and other health care facilities across the country have closed, reduced services, or been identified as at serious risk of closure” in the year under the OBBBA.
Enforcement of Federal Minimum Staffing Standards Delayed Until 2034
Writing in the Morningstar release, the Nursing Home Abuse Center zeroes in on one key area: staffing.
Under the Biden administration, nursing homes were going to be required to boost their core minimum staffing requirements, and to have a higher required level of professional nursing personnel on site for more hours. But last December, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) rescinded those standards.
“The federal numeric staffing floor is now gone,” the NHAC claims: under the OBBBA, any enforcement of enhanced staffing requirements is delayed until October 1, 2034. As a result, “Chronic understaffing – already one of the leading contributors to nursing home neglect and abuse – is now likely to worsen.”
Lauren Ryan of AARP called the delay “damaging and devastating for many residents.” Families should anticipate declining levels of patient care, the NHAC predicts.
Washington State Faced with Legal Action Over Care Cuts
In researching this article, we discovered that the legal fight related to Medicaid cuts has broken out right here in Washington State, home to Life Point Law and AgingOptions.
As this press release from the Washington State Standard explains, the Washington Health Care Association and LeadingAge Washington have sued the state. Reporter Jake Goldstein-Street explains the background.
“Faced with a budget shortfall this year, Washington Democratic lawmakers relied on spending cuts and other maneuvers to make ends meet,” he writes. “For one, they trimmed tens of millions of dollars in state funding for assisted living facilities that care for patients on Medicaid. The state is now being sued over that decision.”
We lack the space here to deal fully with the case, which was filed largely on procedural grounds. But the suit represents the kind of legal turmoil that can be anticipated across the country as the impact of the OBBBA trickles down to budgets of individual states.
Barriers to Care Could Create Roadblocks and Delays
The Morningstar release includes additional information for families and residents that we lack the space to include. We encourage you to check out the article online.
For example, there are new restrictions under the One Big Beautiful Bill Act that could affect residents’ ability to maintain continuous coverage. Work and reporting requirements may affect some Medicaid enrollees. Stricter citizenship and immigration status verification rules may require more documentation issues and longer wait times for approval.
Some Medicaid programs will also begin requiring more frequent eligibility redeterminations, shifting from annual reviews to semi-annual beginning in 2027. It’s not fully clear how these new rules will affect those beneficiaries in long-term care. But there could be an unforeseen impact.
“For families already managing a loved one’s nursing home placement, these paperwork requirements introduce new risks of coverage gaps, billing disputes, and potential disruptions to care,” says the article.
If Staffing is Cut, Families Should Remain Extra Vigilant
The Nursing Home Abuse Center article ends with the observation that nursing home neglect isn’t a new problem, nor was it created by any single piece of legislation.
Still, the agency advises, “as financial pressure on facilities intensifies, advocates and researchers warn that the conditions that give rise to neglect and abuse are likely to become more prevalent. Reduced staffing can lead to less-frequent bathing, longer waits for basic assistance, and call lights going unanswered. Overmedication or unexplained injuries can result when staff is stretched beyond safe limits.
If families note a loved one exhibiting withdrawn behavior, sudden emotional changes, or reports of mistreatment, or if they observe facility conditions deteriorating, it’s time to act. Contacting the Nursing Home Abuse Center is one option.
“The cuts embedded in the One Big Beautiful Bill Act do not change a nursing home’s legal obligation to provide safe, adequate care,” the release concludes. “Facilities that allow residents to be harmed due to understaffing or financial mismanagement can be held accountable.”
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