On March 11, 2025, the House Ways and Means Health Subcommittee held a hearing on Ensuring Access to Quality Post-Acute Care. Democratic members centered their questions on potential Medicaid and Medicare budget cuts, while Republicans concentrated on the nursing home staffing rule and home health services. Both parties addressed the need for telehealth services. Both parties agreed that there should be quality post-acute care.
OPENING STATEMENTS
WITNESS TESTIMONY
- Dr. Dana Madison, DNP, MBA, BSN, RN, Compassion Home Health Care
- Paul Dongilli, Jr., PH.D. CEO, Madonna Rehabilitation Hospitals
- Jonathan Fleece, President and CEO, Empath Health
- Lisa Grabert, MPH, Visiting Research Professor, Marquette University
- Eric Carlson, Director of Long-Term Services and Supports Advocacy, Justice in Aging
MEMBER DISCUSSION
Medicaid and Medicare Budget Cuts
Democratic members focused their discussion on potential Medicaid and Medicare budget cuts. Rep. Judy Chu (D-CA) emphasized her view that Republicans are planning to cut $880 billion from Medicaid and that would negatively impact seniors’ ability to access long-term care. She pointed out that Medicaid already only covers a limited number of rehabilitation days and asked how cuts would affect seniors relying on both Medicaid and Medicare. Mr. Carlson responded by highlighting that Medicaid assists millions of Americans in covering Medicare premiums, with 10 million relying on it to manage significant health care expenses. He emphasized that long-term care costs are a major burden for individuals across various income levels and that Medicaid serves as a critical safety net. He warned that any cuts would be devastating.
Rep. Steven Horsford (D-NV) added that Medicaid is the primary payer for 60% of long-term care spending. He expressed his concerns that cuts would force providers to reduce hours, increasing the risk of inadequate care. He then asked what steps were being taken to protect nursing home workers from the impact of Medicaid cuts and what the consequences of cuts would be for the long-term care workforce. Mr. Carlson warned that if cuts of the magnitude described by Democratic representatives were implemented, providers would struggle to continue operating, with the consequences ultimately falling on the health care providers and workforce.
Rep. Don Beyer (D-VA) expressed his concerns about what he described as cuts to health care services in the continuing resolution (C.R.). He argued that the bill was not a clean proposal but rather one that would cut $280 million from Alzheimer’s, kidney, and heart disease research. He questioned whether patient care would be impacted by budget cuts of this size. Mr. Carlson’s response was straightforward: “The simple answer is no.” He emphasized that the research programs could not continue to provide the necessary support under such severe budget reductions.
Nursing Staffing Rule
Rep. Scott Fitzpatrick (R-PA) highlighted the staffing shortages in his home district, noting the increased pressure on health care providers. He asked how staffing has changed in recent years and what challenges these shortages pose in treating patients. Dr. Madison responded that the shortage of registered nurses (RNs) has been a persistent issue, with a deficit of about 1,000 RNs in the past. She emphasized that telehealth could help alleviate some of these challenges but noted that many nurses left the profession during the COVID-19 pandemic.
Ranking Member Lloyd Doggett (D-TX) referenced a 2023 Medicare Payment Advisory Commission (MedPAC) report that found skilled nursing facilities had funds exceeding 22% more than necessary, yet 20% of facilities relied on Medicaid to cover costs. He questioned whether there were enough workers to meet the required staffing standards. Mr. Carlson responded that regulations must be practical. He noted that while the staffing standard is not as high as some advocates had pushed for, 60% of facilities nationwide already meet it. He also argued that rural facilities have an extended phasing period until 2027 and 2029 to comply. Additionally, he also argued that if facilities demonstrate that labor shortages prevent them from meeting staffing requirements, they are exempt from penalties in that region.
Rep. David Kustoff (R-TN) then inquired about workforce shortages, asking whether many certified nursing assistants (CNAs) pursue higher levels of nursing education. Mr. Fleece acknowledged the challenges in recruiting and retaining workers, particularly given the pressures of runaway inflation. He stressed that hiring staff remains a significant challenge in the current health care landscape.
Home Health Services
Rep. Lloyd Smucker (R-PA) discussed the importance of occupational therapy (OT) as a service available to patients through Medicare Part A for home health and introduced a bill aimed at streamlining the process for accessing home health care. He asked how the bill would improve patient access to care and what the financial implications might be. Dr. Madison responded that the bill would allow payment for any episodes of care, and if OT services were to be provided independently, they would be able to deliver the necessary care. She explained that this approach could lead to cost savings for agencies by reducing the expenses they would otherwise need to spend on other services.
Rep. Kustoff inquired about how home health services are provided in rural areas and how rural-based services align with the national average. Dr. Madison explained that home health services currently offer patient monitoring, such as blood pressure management, but pointed out that these services are not reimbursed at all, which presents a significant challenge.
There was concern from Rep. Greg Steube (R-FL) about the drastic decline in the number of home health providers and he asked for insights into the widespread closure of home health agencies. Mr. Fleece responded by emphasizing that home-based care is a key solution to today’s health care challenges. He discussed various models within the home-based care environment, noting that larger, not-for-profit agencies play a significant role in providing care, especially in underserved areas.
Telehealth
Rep. Carol Miller (R-WV) discussed the challenges rural patients face due to a lack of critical support, noting that the absence of central care increases recovery time and raises the risk of complications. She suggested expanding telehealth usage in post-acute care settings, which would allow for face-to-face visits via telehealth, as a solution to address these gaps. She asked about the impact of limited access to care, and the difficulties families face when visiting their loved ones. Dr. Dongilli acknowledged that this is a real issue for families, highlighting the challenges they face in relocating and accessing the necessary resources to care for their loved ones. He emphasized the importance of making it easier and more helpful for families to receive payments and support, with the goal of improving care for both patients and families.
Rep. Fitzpatrick pointed out that his home district is facing staff shortages, which are compounded by increasing pressure. He asked how staffing has changed in recent years and how these challenges impact the ability to treat patients. Dr. Madison responded by noting that there used to be a shortage of around 1,000 registered nurses (RNs), and that telehealth could help alleviate some of the strain. She also noted that many nurses left the profession during the COVID-19 pandemic, further exacerbating the shortage.
Rep. Blake Moore (R-UT) added that in most cases, telehealth is the best option for ensuring access to care and asked how the quality of telehealth services could be improved. Mr. Fleece emphasized that his organization serves rural communities and noted that telehealth is the primary means of ensuring access to care, especially for individuals suffering from chronic or acute conditions. He stressed the importance of maintaining and expanding telehealth services to ensure these patients receive the care they need.