Following the President's lead, Fed delegation held strong to support nursing homes & prioritize medicaid for those for whom program was established.

…Time for the Oklahoma legislature to follow Trump's lead

‘This Isn’t Partisan’: AHCA’s Clif Porter Warns of Long-Term Challenges for Nursing Homes Amid Wins”

By Zahida Siddiqi | October 17, 2025

Clif Porter, president and CEO of the largest advocacy group for nursing homes in America, said that among the year’s major wins for the sector – such as the freeze on provider taxes – were hard-won battles, but certainly a welcome development amid looming challenges and the current economic climate.

In an exclusive interview with Skilled Nursing News ahead of the American Health Care Association and National Center for Assisted Living’s (AHCA/NCAL) annual convention in Las Vegas, Porter called the One Big Beautiful Bill Act’s (OBBBA) provider tax freeze for nursing homes a historic achievement.

“We actually were the only sector in all of health care that was insulated from that policy by having provider taxes frozen,” he said, crediting AHCA/NCAL’s work behind the scenes in convincing lawmakers that Medicaid already underfunds nursing home care and further cuts would harm patients. “[T]hat result took a lot of work on our team’s part to get policymakers to really understand ‘the why.’”

Despite that win, Porter warned of long-term challenges for skilled nursing facilities (SNFs), particularly at the state level.

Medicaid pressures tend to worsen during economic downturns, he said, and OBBBA’s financial impact could grow in three years. Given that, AHCA is prioritizing support for states like Idaho and North Carolina, where proposed Medicaid cuts are already emerging.

“This isn’t partisan,” Porter said, noting that both red and blue states face risks.

On the federal government shutdown, Porter said the impact has been minimal so far but could grow if it drags on.

He also flagged tariffs as a top concern for suppliers to nursing home providers, with rising costs likely to hit providers.

“You’ve got spiking inflation, a cooling economy so you need more [Medicaid] increases to keep pace with that. Yet there’s less resources to do it. That’s where the friction is.”

Porter cited the repeal of the federal staffing mandate as another major win for his organization. “Every branch affirmed our position that we were right,” he said.

And while proud of these victories, Porter stressed the need for continued advocacy and support at both the state and national levels as economic and policy pressures mount.

The annual convention for AHCA/NCAL, which represents more than 15,000 non-profit skilled nursing centers and long-term care facilities, kicks off this Sunday.

Editor’s note: This is the second part of SNN’s interview with Porter. The the first story ran earlier in the week.

The following conversation has been edited for length and clarity.

SNN: How have the new administration’s policy agenda and the One Big Beautiful Bill Act impacted the industry in 2025?

Porter: With OBBBA, there were a variety of implications, but most of the impact was around Medicaid. There were no real regulatory implications with the bill. But for the first time in history, or at least the time I’ve been around, we actually were the only sector in all of health care that was insulated from a policy by having provider taxes frozen, whereas everyone else has had to dial down. So we were really proud of that result that took a lot of work on our team’s part to get policymakers to really understand ‘the why’ behind that. And the main reason we got policymakers to understand that is by convincing them that Medicaid underfunds care to nursing homes, and so if you cut provider taxes, that’s further compromising that deficit, and that’s not good for patients.And thank goodness we got support.

We’ve still got a lot of issues ahead of us. Medicaid is always a challenge. Cyclically speaking, when the economy cools off, Medicaid becomes a sore point in the states because it’s just less money to pay for things. So that’s just a normal sort of challenge that I’ve seen a few of these cycles in my career, and we’re coming up on another one, so that is the main driver.

And then, we have the consequences of OBBBA – particularly three years from now – which will also exacerbate some of those issues. So we got a lot of work to do, but I think a lot of it moves much more locally to the state level.

Turning to the state-level impact of these Medicaid cuts, are there certain states that you’re watching more closely than others? Or, are you just looking ahead to the future on a national level?

It’s both. We’re providing additional support to help solve some of the unique problems that each state may have.

Every state in America is different. Every economy in the state is driven by different metrics. If you go to Oklahoma, it’s all about oil revenue, right? So if the oil wells are rolling and the prices are good, Oklahoma is usually going to be all right regardless. And if there’s a problem with oil, then they could be in a massive Medicaid crisis. And then you go to another state, and it’s a different issue. So again, it varies state by state. Obviously, the states that expanded Medicaid did not have any reductions to their [Medicaid reimbursement] so they’re in a less vulnerable position. We’re not ignoring them, but they’re definitely in a better starting position than the rest.

What states are on your radar as top concerns for Medicaid cuts?

We’ve not ranked them to be honest with you. Obviously, the cuts that were announced in Idaho and North Carolina are sort of the immediate focus and we’re offering help there. These states are the ones that sort of first stepped out with some proposals that are deleterious, to say the least, so we are really focused on those two. Now, there are other states like New York, as an example, that have a lot of risk just based on some of the structure that they have as it relates to how their Medicaid program is funded. There are other states, both red and blue … so this isn’t partisan. We’ve got some red states that are equally, if not in some cases, more significantly impacted. We’re going to continue to support those states and obviously focus on them, and think about ways where we can nationally help address some of the concerns, particularly with the red states with this administration, and to make sure that they know what’s going on, how it’s impacting their constituencies there, and using that maybe as a lever to help get relief when the time comes.

Is the government shutdown having a tangible impact on SNFs?

Not a lot of immediate impacts at the moment, but the longer it goes, the higher the risk of it having impact. Again, there’s been a significant reduction in workforce with the HHS. Lots of jobs have been impacted there. We’re just not clear yet how that impacts us. But, you know, we’re not Pollyannish, so the short answer is, not yet, but we’re watching it very, very, closely.

There’s been elimination of [government] jobs since the shutdown … We’re just hopeful that it’s not significant, but you just don’t know how that ripples back to our operators.

In other government actions, have higher tariffs hit the SNF pocketbook yet?

The tariffs definitely have had an impact, particularly on our suppliers. I spent some time last week with one of our major suppliers, and the tariff issue is their number one issue, and that is going to cut through to the purchaser, which is us.

And, I think that inflation is going to continue to grow higher over time, and that’s going to be in the face of an environment with a cooling economy. You’ve got spiking inflation, a cooling economy so you need more [Medicaid] increases to keep pace with that. Yet, there’s less resources to do it. That’s where the friction is, and that’s what makes all of our lives that much more difficult. So a lot of inflation relates to tariffs.

To end on a more positive note, what are some of AHCA/NCAL’s big wins from this past year under your leadership?

The [repeal of the] staffing mandate was a hallmark win. If you think about it, we got validation of our position from every sphere of government, the courts too, as you referenced, the legislature when it comes to the moratorium, with the administration actually repealing the rule in its entirety. So every branch affirmed our position that we were right. That feels good, because we knew we were right, and ultimately we won on that issue.

The provider tax freeze in the OBBBA was a milestone, allowing actual insulation to our long-term inflation. No other space in health care, not hospitals, no one, got insulation from provider tax cuts other than SNFs. That’s never happened before in history. So we’re super proud of that as well. It doesn’t solve the problem completely, but we’re very proud of that result.

So those are a couple things, and I’m hopeful that as we rack up more wins – it’ll be on the regulatory front, and I will be in a position over the next 12 months to be able to have a lot more to report to you on that as well.

https://skillednursingnews.com/2025/10/this-isnt-partisan-ahcas-clif-porter-warns-of-long-term-challenges-for-the-sector-amid-wins/

States Are Cutting Medicaid Provider Payments Long Before Trump Cuts Hit

By Bram Sable-Smith and Sarah Jane Tribble

Every day for nearly 18 years, Alessandra Fabrello has been a medical caregiver for her son, on top of being his mom.

“It is almost impossible to explain what it takes to keep a child alive who should be dead,” said Fabrello, whose son, Ysadore Maklakoff, experienced a rare brain condition called acute necrotizing encephalopathy at 9 months old.

Through North Carolina’s Medicaid program, Maklakoff qualifies for a large slate of medical care in the family’s home in Chapel Hill. Fabrello said she works with staffing agencies to arrange services. She also learned to give the care ordinarily performed by a doctor, skilled nurse, or highly trained therapist because she often can’t get help.

Now, broad cuts to North Carolina Medicaid will make finding and paying for care even more difficult.

Nationwide, states are scrambling to close budget shortfalls and are eyeing Medicaid, generally one of a state’s biggest costs — even before President Donald Trump’s hulking tax-and-spending law decreases federal spending on Medicaid by about $1 trillion over the next decade.

North Carolina and Idaho have already announced plans to cut Medicaid payments to health care providers, including hospitals, doctors, and caregivers.

In Michigan and Pennsylvania — where lawmakers have yet to pass budgets this year — spending on Medicaid is part of those debates. In Washington state, lawmakers approved cuts to the program that will not affect who is eligible, said Hayden Mackley, a spokesperson for the state’s Office of Financial Management.

Medicaid is government health insurance for people with low incomes or disabilities and both state and federal dollars pay for the program.

North Carolina’s Medicaid agency announced it will institute on Oct. 1 a minimum 3% reduction in pay for all providers who treat Medicaid patients. Primary care doctors face an 8% cut and specialty doctors a 10% drop in payments, according to the North Carolina Department of Health and Human Services.

Fabrello said her son’s dentist already called to say the office will not accept Medicaid patients come November. Fabrello fears dental work will become another service her son qualifies for but can’t get because there aren’t enough providers who accept Medicaid coverage.

Occupational and speech therapy, nursing care, and respite care are all difficult or impossible to get, she said. In a good week, her son will get 50 hours of skilled nursing care out of the 112 hours he qualifies for.

“When you say, ‘We’re just cutting provider rates,’ you’re actually cutting access for him for all his needs,” Fabrello said.

Shannon Dowler, former chief medical officer for North Carolina Medicaid, said that reduced payments to dentists and other providers will lower the number of providers in the state’s Medicaid network and result in “an immediate loss of access to care, worse outcomes, and cause higher downstream costs.”

The imminent cuts in North Carolina “don’t have anything to do” with the new federal law that cuts Medicaid funding, Dowler said.

“This is like the layers of the onion,” she said. “We are hurting ourselves in North Carolina way ahead of the game, way before we need to do this.” North Carolina alone is projected to lose about $23 billion in federal Medicaid dollars over the next decade.

More than 3 million North Carolinians are enrolled in Medicaid. Deadlocked state lawmakers agreed to a mini budget in July to continue funding state programs that gave the Medicaid agency $319 million less than it requested. Lawmakers can choose to reinstate funding for Medicaid this fiscal year, Dowler said.

“We all hope it changes,” Dowler said, adding that if it does not, “you’re going to see practices dropping coverage of Medicaid members.”
Each year since at least 2019, North Carolina’s Medicaid agency has asked for more money than it received from the state legislature. A variety of federal resources, including money provided to states during the covid-19 pandemic, helped bridge the gap.

But those funds are gone this year, leaving the agency with a choice: Eliminate some optional parts of the program or force every provider that accepts the public insurance to take a pay cut. The state opted mostly for the latter.

“It’s a difficult moment for North Carolina,” said Jay Ludlam, deputy secretary for North Carolina Medicaid. The cut in the budget is “absolutely the opposite direction of where we really want to go, need to go, have been headed as a state.”

For Anita Case, who leads a small group of health clinics in North Carolina, the cuts make it harder to take care of the “most vulnerable in our community.”

Western North Carolina Community Health Services’ three clinics serve about 15,000 patients in and around Asheville, including many non-English-speaking tourism workers. Case said she will look at staffing, services, and contracts to find places to trim.

Idaho has about 350,000 people enrolled in Medicaid. This month, state leaders there responded to an $80 million state budget shortfall by cutting Medicaid pay rates 4% across the board.

The broad cuts have raised backlash from nursing home operators and patient advocacy groups. Leaders of one nursing home company wrote in a recent op-ed in the Idaho Statesman newspaper that 75% to 100% of the funding at their facilities comes from Medicaid and the cuts will force them to “to reduce staff or accept fewer residents.”

Idaho Department of Health and Welfare spokesperson AJ McWhorter said the state faced tough choices. It forecasted 19% growth in Medicaid spending this year.
The Idaho Hospital Association’s Toni Lawson said the financial strain will be greatest at about two dozen small hospitals — ones with 25 or fewer beds — that dot the state. Lawson, the organization’s chief advocacy officer, said one hospital leader reported they had less than two days’ cash on hand to make payroll. Others reported 30 days’ cash or less, she said.

“Hopefully, none of them will close,” Lawson said, adding that she expects labor and delivery and behavioral health units, which often lose money, to be the first to go because of this latest state reduction in payments. Several hospitals in mostly rural areas of the state closed their labor and delivery units last year, she said.

Nationwide, Medicaid makes up an average of 19% of a state’s general fund spending, second only to K-12 spending, said Brian Sigritz, director of state fiscal studies for the National Association of State Budget Officers.

States generally had strong revenue growth in 2021 and 2022 because of economic growth, which included federal aid to stimulate the economy. Revenue growth has since slowed, and some states have cut income and property taxes.

Meanwhile, spending on Medicaid, housing, education, and disaster response has increased, Sigritz said.

In North Carolina, Fabrello has been unable to work outside of caring for her son. Her savings are almost exhausted, Fabrello said, and she was on the brink of financial ruin until North Carolina began allowing parents to be compensated for caregiving duties. She’s received that income for about a year, she said. Without it, she worried about losing her home.

Now, if the state reductions go through, she faces a salary cut.

“As parents, we are indispensable lifelines to our children, and we are struggling to fight for our own survival on top of it,” Fabrello said.


https://kffhealthnews.org/news/article/state-medicaid-cuts-reimbursement-big-bill-north-carolina-idaho-budgets/

AHCA/NCAL Releases Statement on the End of the Public Health Emergency

For Immediate Release
May 9, 2023
Contact: AHCAPressOffice@ahca.org 

WASHINGTON, D.C. – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and other long term care facilities across the country that provide care to approximately five million people each year, released a statement preceding the end of the COVID-19 Public Health Emergency on Thursday, May 11.

The following statement is attributable to Mark Parkinson, president and CEO of AHCA/NCAL:

“This pandemic took an enormous toll on our staff and residents, and we will forever carry in our hearts the hundreds of thousands of lives in long term care that were lost due to this vicious virus. It is a relief to know that we are well on the other side of this clinical nightmare thanks to lifesaving vaccines, therapeutic treatments, and our amazing providers and caregivers who didn’t give up even during the most challenging times. Our nation’s public health response has come a long way since 2020, and we now have the tools to help protect our precious seniors.

“The Public Health Emergency waivers have been a critical lifeline, as nursing homes have struggled to keep their doors open and fight against an unprecedented, once in a century crisis. We appreciate the support we have received from the Administration and the time they have granted providers to prepare for these changes. As we move forward, we will carry on advocating to eliminate Medicare’s three-day-stay requirement and creating a realistic career pathway for temporary nurse aides. We will also maintain our commitment to educating and encouraging our residents and staff on the importance of staying up to date on their COVID-19 vaccinations.

“The Public Health Emergency may be ending, but the recovery from the pandemic continues. For long term care, that recovery has been slow, especially in rebuilding our workforce. Our main priority is to encourage Congress and the Administration to make meaningful investments that will help us attract and retain a pipeline of caregivers and protect access to care for our nation’s seniors. Nursing homes cannot solve this crisis on their own, and we will continue to urge policymakers to pass supportive policies that prepare for a growing elderly population.” 

Following the end of the PHE waivers, AHCA/NCAL will continue to prioritize:

• Eliminating the three-day-stay requirement: For years, AHCA/NCAL has advocated to eliminate Medicare Part A’s three-day-stay requirement or recognize observation stays as qualifying stays. Seniors who receive care in the hospital, regardless of their inpatient or observation designation, must be able to access post-acute care in a skilled nursing facility when they need it without fear of considerable out-of-pocket costs. Eliminating this policy best meets the beneficiary’s access to care needs, reduces out-of-pocket costs, and is fiscally prudent for the Medicare Trust fund. 

• Support of the Building America’s Health Care Workforce Act: Starting May 11, temporary nurse aides in nearly 20 states and hundreds of nursing homes will have only four months to earn their certified nursing assistant (CNA) certification, but many states are experiencing training and testing backlogs. Thousands of direct caregivers may be out of a job if they can’t complete their certification in four months. The profession is already facing a historic labor crisis, and residents deserve continuity of care. Congress should pass the Building America’s Health Care Workforce Act, which gives temporary nurse aides a more realistic path – 24 months – to earn their certification and build a permanent career in long term care.

• Policies and programs that invest in our workforce: Rather than unfunded staffing mandates, AHCA/NCAL has laid out comprehensive solutions to bolster the long term care workforce and build a pipeline of caregivers in the Care For Our Seniors Act,which includes: common-sense immigration reform that increases opportunities for foreign-born individuals to work in the long term care profession;loan forgiveness for new graduates who work in long term care;assistance programs for caregivers, such as affordable housing, housing down payments and childcare;direct incentives to states that invest in nursing education programs; andcareer ladder scholarships that would encourage staff to become registered nurses, among others.

Learn more about the Care for Our Seniors Act here.

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ABOUT AHCA/NCAL

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit www.ahcancal.org.

Pandemic Waivers Set to Expire on May 11, Will Drastically Affect Oklahoma’s Nursing Homes

As the COVID-19 pandemic continues to recede in the United States, nursing homes are bracing themselves for the end of pandemic waivers that have helped them operate during this crisis. According to a Bloomberg Law report, many of these waivers are set to expire as early as May 11, posing significant challenges for nursing homes.

During the pandemic, nursing homes were granted waivers to relax certain regulations, allowing them to operate in ways that more easily accommodated for the hardships brought by the pandemic. For example, they were able to waive regulations that furthered long term care provider’s access to labor, lessened the financial hardship, and implement telehealth services. These waivers were intended to help nursing homes manage the increased demand for care and keep residents and staff safe during the pandemic.

However, with the end of the pandemic’s emergency status, these waivers are set to expire, leaving nursing homes to navigate a new regulatory environment. For many nursing homes, this may mean returning to pre-pandemic regulations, which could make it difficult for them to continue operating effectively. In a time where nursing homes are already underfunded and understaffed, this creates additional hurdles to overcome when providing quality care for seniors across the country – and in Oklahoma. 

One of the biggest challenges that nursing homes will face is related to staffing. During the pandemic, nursing homes were able have easier access to nursing staff, prioritizing staffing levels over regulatory restrictions to help meet the increased demand for care. However, with the end of the waivers, nursing homes will need to return to pre-pandemic staffing levels and regulations, creating difficulties for nursing homes looking to meet sufficient staffing requirements to meet the needs of residents. In addition to staffing challenges, nursing homes will also face financial implications with the end of pandemic waivers. Many facilities invested in additional staff, personal protective equipment, and other resources to manage the pandemic. With the end of the waivers, these expenses will continue, but without the financial assistance that the waivers provided.

It is important to note that the expiration of these waivers does not mean that nursing homes will be returning to a completely pre-pandemic regulatory environment. Many of the changes that were implemented during the pandemic, such as telehealth services, are likely to continue. However, nursing homes will need to navigate new burdensome regulations as they move forward, taking time and energy away from providing senior care.

As we consider the challenges that nursing homes will face in the coming weeks and months, it is important to remember that these facilities provide an essential service to our communities. Nursing homes care for some of our most vulnerable populations, including elderly individuals and those with chronic health conditions. It is critical that we support these facilities as they navigate new regulations and work to ensure the safety and well-being of their residents.

In Oklahoma, the state government has been taking steps to support nursing homes during the pandemic. In March 2021, the Oklahoma State Department of Health announced that it would be partnering with long-term care facilities to provide COVID-19 vaccines to residents and staff. This partnership helped to ensure that the most vulnerable members of our communities were able to receive the vaccine and stay safe during the pandemic.

Moving forward, it will be important for state and local governments to continue supporting nursing homes as they navigate the challenges of the post-pandemic world. This may include providing financial assistance, offering training and education to staff, and implementing policies that support the well-being of nursing home residents. Oklahoma Health Action Network has been advocating for nursing homes throughout the state, looking to push the legislature to increase funding and close the gap in Medicaid assistance – $54/day per patient – through state investment. Help OHAN support our seniors by joining the coalition and making your voice heard today.

 The end of pandemic waivers poses significant challenges for nursing homes in Oklahoma. As we move forward, it is critical that we support these facilities and the essential services they provide to our communities. By working together, we can ensure that nursing homes continue to provide high-quality care to those we love most.

To read more on the upcoming removal of COVID-19 waivers, visit Bloomberg Law