The One Big Beautiful Bill Act reshapes Medicaid, staffing rules and transparency for senior care, with major implications for providers and residents.
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On July 3, 2025, the House of Representatives passed the One Big Beautiful Bill Act (OBBBA). Below is a high-level overview published by AHCA/NCAL of what is included that impacts long-term care providers, health care coverage, nutritional assistance and other financial supports that older Americans may depend on.
Medicaid provider taxes: The new law makes changes to provider taxes, with specific carve-outs for nursing homes and intermediate care facilities to maintain their status. Other provider types – such as hospitals and managed care organizations — taxed in expansion states will see their allowable percentage of revenues reduced by 0.5% annually beginning in 2028 through federal Fiscal Year 2032. Additionally, no state is allowed to establish any new provider taxes as of the bill's passage.
Retroactive coverage: Retroactive coverage for Medicaid beneficiaries, excluding new adults enrolled through the expansion, was revised from 90 days to 60 days. An earlier version of the bill had aimed to reduce retroactive coverage to 30 days.
Staffing mandate: There is a 10-year delay of the federal staffing mandate for nursing homes.
Nursing home staffing and transparency: Mixed outcomes
The bill explicitly bars the federal government (i.e., CMS) from enforcing minimum staffing ratios or national mandates for nursing or aide hours per resident.
Impact: Nursing homes will not be federally required to meet specific staffing levels. States may still set their requirements, but federal oversight is being curtailed.
The law preserves and expands public access to staffing and ownership information.
While enforcement of staffing adequacy is weakened, families and advocates retain essential tools to evaluate and compare nursing home performance through public data.
Consumers will have more visibility, but potentially lower staffing ratios may occur in skilled nursing centers or nursing homes. It will be critically important for consumers to review facility data and ask detailed questions when considering nursing home placement or admission.
Key points of the OBBBA
Below are some key points that can affect seniors.
The OBBBA tries to trim safety net programs, and older adults are not exempt, including people who are 65 or older and on Medicare.
Medicare itself was not cut in this law — these changes mostly hit pre-65 individuals and certain supplemental services. For individuals who rely on Medicaid (for example, many seniors use Medicaid to cover nursing home costs or home care), be aware that stricter income and asset checks are coming.
Biannual redeterminations: Instead of the annual eligibility review, or “redeterminations,” required under current law, Medicaid enrollees will now be subject to redetermination every six months. This could potentially result in increased paperwork and documentation, as well as a higher risk of coverage lapses due to simple mistakes or delays.
According to Rothkoff Law Group, “biannual redeterminations apply only to Medicaid expansion services, not to Medicaid benefits received by Assisted Living Facility Residents, Home & Community Based Services, or Nursing Home Residents.”
States must implement new asset verification rules by 2026 to ensure seniors aren’t hiding assets to qualify for long-term care coverage.
Downstream effects of the bill
The downstream effects of the OBBBA can be significant for senior living operators, impacting financial performance, operational efficiency, regulatory compliance and resident satisfaction. AARP cited one area of concern as follows:
The new law exempts people with severe or complex medical conditions from work requirements; however, it remains unclear which conditions will qualify.
Navigating 12 risk management processes for the OBBBA
Senior living risk management programs can play a vital role in helping senior living operators navigate the complexities of the OBBBA.
Proactive assessment of potential risk associated with financial changes, regulatory compliance and quality of resident care
Ongoing background checks of residents and staff
Instill sound financial screening systems
Ongoing review of facility staffing levels to meet resident acuity needs
Ongoing review of resident complaints and grievance filings
Educating residents and families about new regulations and federal and state-level regulatory changes
Meet regularly with legal counsel to ensure compliance with regulatory changes and healthcare laws
Analyze data and trends to aid in financial forecasting and budgeting and to assist in informed decision making on service offerings and resource allocation.
Analyze resident outcomes, financial performance and operational efficiency to enhance resident care and service delivery (for skilled nursing, providers, regularly review the Nursing Home Compare reports for accuracy)
Refine and redevelop internal quality assurance programs focusing on resident safety and continuous improvement
Training and education on emerging regulatory changes, changes to billing, and procedures for resident admission and continued stay screening procedures
Implement a crisis management and response readiness program to mitigate unforeseen challenges and crises that may arise from new systems, resident benefit changes and other operational changes
Transparent stakeholder communications, including staff, residents and families, regarding changes, benefits and potential challenges
While many parts of the OBBBA will take effect over the following six to 18 months, much remains unknown. Agencies are still releasing implementation guidelines, and states may take different approaches to enforcement and exemptions.
Healthcare risk management programs are essential for senior living operators to manage any changes effectively. While the effects of the OBBBA are yet to be seen, a sound understanding of the importance of risk management programs can steer senior living communities on a successful directional path for the future.
Contact your WTW broker for assistance with the risk management process and or questions.
Disclaimer
WTW hopes you found the general information provided here informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, WTW offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).
