After a 26-hour markup session, the House Energy and Commerce Committee voted Wednesday to advance a budget reconciliation package that includes historic cuts to Medicaid. The nearly $912 billion package proposes deep reductions across programs in the committee’s jurisdiction—most notably in the Health title, which accounts for the bulk of the savings.
The Medicaid provisions alone would significantly alter the program, including:
- Imposing mandatory community engagement requirements;
- Pausing implementation of the Nursing Home Minimum Staffing Rule and Medicaid Eligibility and Enrollment rules;
- Increasing the frequency of eligibility redeterminations;
- Limiting retroactive eligibility at 30 days; and
- Modifying provider taxes.
Republicans argued these changes are needed to ensure Medicaid’s long-term sustainability and prioritize resources for the most vulnerable. Democrats expressed alarm over the projected loss of coverage and framed the cuts as a tradeoff for extending tax breaks in the Ways and Means reconciliation bill.
What This Means for Providers and States
LeadingAge is deeply concerned about the implications of these cuts. At a time when most states are already facing capacity and funding challenges, this package would create substantial new administrative burdens and financial pressures. Notably, Ohio relies heavily on a tax on Medicaid managed care plans to draw down federal funding. It appears that this mechanism will be prohibited under the proposed language. Additionally, in Ohio’s recent history, its backlog in Medicaid applications peaked at 110,000, with many of those applications taking many months to clear. With the proposed policy in place now, it would have constituted many millions in losses – and likely many closures– of Ohio nursing homes. Even under the best circumstances, Medicaid applications are processed in around 45 days– not 30.
Ohio could be forced to respond by limiting coverage, lowering provider reimbursement rates, or scaling back optional services—moves that would directly affect older adults and the providers who serve them.
What’s Next
The bill now moves to the House Budget Committee, which is scheduled to mark it up today. LeadingAge submitted a formal statement for the record outlining opposition, and our full analysis of the bill is available here.
The Budget Committee will compile the reconciliation bills before the House Rules Committee prepares the final version for floor consideration, which could happen as early as May 22. LeadingAge will remain fully engaged throughout the process and will issue an advocacy alert next week urging members to oppose the bill when it reaches the House floor. Members can read LeadingAge’s analysis of the bill here and stay find the latest information in this serial post.
Stay in-the-know on national policy during the weekly National Policy Pulse Calls, Mondays at 3:30 PM. Visit this page to sign up. Top You Asked:
If a facility post “No Smoking” signs at all exterior doors, are they still required to post them on individual resident doors for those using oxygen?
We Answered:
No, according to the Ohio Department of Health (ODH), if the facility is entirely smoke-free and “No Smoking” signs are prominently posted at all entrances, additional signage on individual resident doors is not required.
However, ODH offers this important caution: The facility must be completely smoke-free—meaning no designated smoking areas for residents or staff, either indoors or outdoors. If any smoking is permitted on the premises, even in designated outdoor areas, additional signage may be required to ensure compliance. Additional guidance can be found in the K-tag 741 and on the CMS Life Safety Code & Health Care Facilities Code Requirements webpage. Top Join the LeadingAge Ohio policy team on Monday, May 19 for an Advocacy in Action update on Senate activity on the state operating budget, how the proposed federal cuts impact the state of Ohio, and whether this may impede efforts to protect Medicaid. LeadingAge’s policy team will share amendments that LeadingAge Ohio submitted, and what to expect next.
The call is free to members, but advanced registration is required. In the newest episode of Another Word for Living…, host Susan Wallace explores the remarkable life of Rohini Mulchandani—a woman whose journey spans continents, careers, and causes - as part of our Older Americans Month series. Though Rohini now calls Friendship Village of Dublin home, her story begins in an idyllic town in India. Her pursuit of higher education in Food Technology brought her to the U.S., where she went on to have a distinguished career at Ross Labs/Abbott Nutrition. If you've ever used Similac or Ensure, you've experienced the impact of her work firsthand. After retiring early, Rohini successfully ventured into entrepreneurship and continues to give back through her philanthropic efforts. Tune in to hear about her inspiring path, the values that guide her, and the legacy she’s building.
Listen to this episode of Another Word for Living… here or on any major podcasting platform. We’re excited to announce the launch of the DON Network, an exclusive space for Directors of Nursing to connect, collaborate, and grow together. Join your peers and Stephanie DeWees, LeadingAge Ohio’s Quality and Regulatory Specialist, for the network’s kickoff session on Thursday, May 29 at 2:00 PM.
The DON Network provides a valuable forum to exchange ideas and insights on critical topics such as:
- Survey preparedness and regulatory trends
- Staffing challenges and retention strategies
- Time management and workflow optimization
- Falls with major injury
- Rehospitalizations
- Leadership development and best practices
- And much more!
This network is free and open to all LeadingAge Ohio members. Don’t miss this opportunity to engage with fellow nursing leaders, share resources, and strengthen your impact.
Join the conversation via Zoom on May 29! Yesterday, LeadingAge Ohio hosted its largest STARS Awards Ceremony of the year at Good Shepherd Home in Fostoria, where 85 outstanding employees were honored for their dedication, compassion, and commitment to the older adults they serve.
Sixteen member organizations from across the region were in attendance to celebrate their nominees and the vital role frontline professionals play in aging services. The room was filled with pom pom shakes, gratitude, pride, and heartfelt stories that captured the impact of each STARS honoree.
Melissa “Lisa” Stahl of Good Shepherd Home was named the 2025 Northwest Ohio STARS Heartstrings Award recipient. Lisa’s warmth, empathy, and steadfast care embody the very spirit of the Heartstrings Award—offering comfort, connection, and dignity in every interaction.
To all of our Northwest STARS: thank you. Your dedication goes beyond tasks or titles—it creates real moments of connection, care, and compassion. You make the difference, and aging services are better because of you. There's always something happening at LeadingAge Ohio, and we don’t want you to miss a moment. From educational opportunities to networking events, our calendar is packed with ways for members to stay informed, engaged, and connected.
Explore what's ahead and make plans to join us—whether you're looking to expand your knowledge, connect with peers, or get involved in shaping the future of aging services in Ohio.
View all upcoming events here and mark your calendar today!
May 29, 2:00PM - DON Network Kickoff LeadingAge Ohio members have access to a robust insurance and risk management program through Epic Insurance Brokers, one of the largest firms in the country and a dedicated partner to senior living providers.
Epic helps members reduce insurance costs—often by 15–20%—while maintaining strong coverage. The program also provides strategic support with claims management, carrier negotiations, and guidance through today’s challenging insurance landscape.
Offerings include water sensor technology to prevent property damage, cybersecurity assessments to help providers identify vulnerabilities, and management liability coverage with pre-negotiated, nonprofit-specific rates. Members may also qualify for premium rebates in the second year based on adherence to safety protocols.
Epic’s team understands the operational pressures facing aging services providers and brings focused solutions to help members protect their people, property, and mission.
Learn more at www.epicbrokers.com Top The Centers for Medicare and Medicaid Services (CMS) finalized two Medicare Advantage rules governing 2026. The 2026 MA Rate Notice will increase the amounts paid to MA plans by an average of 5.06% and clarifies that all MA plan coverage determinations must follow the rules –including concurrent reviews -- related to how quickly a determination is made, reinforcing beneficiary appeal rights, provider notifications and distinguishing between payment and service determinations. The key elements of the final rules are analyzed in this LeadingAge article.
Top CMS has updated survey guidance in QSO-25-14- NH, adding specific instructions for investigating Minimum Data Set (MDS) assessment accuracy when reviewing residents receiving antipsychotic medications. This change impacts how surveyors assess compliance under F641, Accuracy of Assessments. Surveyors are now instructed to:
- Use the MDS assessment to guide their review and determine what portion of the medical record is needed to review documentation of a GDR attempt or a clinical contraindication rationale
- Review the most recent Resident Assessment Instrument or MDS Section N, item N0450 for a date that a GDR was attempted or a date that the physician determined that a GDR was contraindicated. Review the portion of the medical record that corresponds with the MDS dates to ensure the GDR was attempted or that a clinical contraindication rationale was provided.
- If there is no documented date for a GDR or a clinical contraindication on the most recent MDS assessment, review the medical record to determine if a GDR may have been attempted or a clinical contraindication rationale provided since the last MDS assessment and the time of the survey. If there is no evidence of a GDR and there is no description of the clinical contraindications, then noncompliance exists.
- Additionally, surveyors should investigate compliance with F641 if there are discrepancies in GDR documentation between the medical record and the MDS assessment(s).
CMS has updated the survey resources on the CMS Nursing Home webpage in accordance with the revised QSO-25-14- NH memo. LeadingAge Ohio encourages facilities to monitor compliance using the surveyor guidance found in the State Operations Manual Appendix PP. Additionally, the survey pathways can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. LeadingAge has developed webinars and resources on the requirements of participation which are located on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups. Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.
For more information about the requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the June 11 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org. Top While some of the most threatening proposals previously under discussion—such as changes to 501(c)(3) eligibility or repeal of municipal bond tax exemption—were left out of the latest House tax package, several provisions remain.
Treasury Empowered to Revoke Tax-Exempt Status
A provision (Section 112209) provides the Secretary of the Treasury broad new authority to revoke the tax-exempt status of any organization alleged to have provided “material support” to a designated terrorist organization in the past three years. While organizations would receive notice of the proposed designation, there is no requirement that Treasury provide full documentation or explanation, and the burden would fall on the organization to prove its innocence.
Though the intent is to ensure tax-exempt status does not shield illegal activity, there is concern that this provision opens the door to subjective and politically motivated decisions, especially without robust procedural safeguards.
Steep Increases in Foundation Investment Taxes
Another section (112022) would dramatically increase the excise tax on net investment income for private foundations with more than $50 million in assets. Rates would jump from the current 1.39% to as high as 10%, depending on asset level. This change could affect philanthropic capacity of major foundations at a time when nonprofit health and aging services rely heavily on charitable support.
A similar increase would apply to certain private colleges and universities, though religious institutions are exempted.
Other Nonprofit-Specific Changes
- Expanded Tax on Executive Compensation: Section 112020 would expand the existing excise tax on salaries over $1 million from just the top five earners at a nonprofit to any employee at that pay level.
- Broadened Definition of Unrelated Business Income (UBTI):
- Section 112024 would include qualified transportation benefits (e.g., transit passes) as taxable UBTI.
- Section 112025 would also treat revenue from selling or licensing a nonprofit’s name or logo as UBTI.
These changes could increase the tax burden and compliance requirements for nonprofit organizations that are already operating on tight margins.
Charitable Giving Incentives—Mixed News
On a more positive note, the bill includes a temporary universal charitable deduction (Section 110112), allowing non-itemizing taxpayers to deduct modest cash donations—up to $150 for individuals, $300 for couples—through 2028. This is a scaled-back version of the Charitable Act that LeadingAge has supported.
However, a new restriction for corporate donors (Section 112028) would impose a 1% floor for charitable deductions relative to taxable income, which could reduce corporate giving overall.
What’s Next
LeadingAge Ohio will continue monitoring the progression of this package closely and will work with our national partner to advocate for the removal or revision of provisions that threaten the financial health and mission of nonprofit providers. We’ll share additional updates as the legislation advances.
If you have questions about how these changes could affect your organization, please reach out to the LeadingAge Ohio policy team.
Read more about what was included in the House Ways and Means Committee’s May 14 tax legislation package here. On May 14, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. appeared before both the House Appropriations Subcommittee on Health and the Senate Health, Education, Labor and Pensions (HELP) Committee to defend his department’s proposed fiscal year 2026 budget—which includes more than $30 billion in cuts, representing over 25% of the total HHS budget.
In his testimony, Secretary Kennedy stated that the proposed reductions are part of a broader effort to streamline agency operations, eliminate duplicative programs, and shift the department’s focus toward more efficient management of chronic disease. “We intend to do more, a lot more, with less,” he told House appropriators.
He emphasized a goal of improving service delivery across key programs, including Medicare and Medicaid, stating: “We are committed to delivering more efficient, responsive, and effective services to the over 100 million Americans who rely on Medicare, Medicaid, and other programs.”
Lawmakers Raise Legal and Policy Concerns
Several lawmakers expressed concern over the scale of the proposed cuts and questioned the administration’s legal authority to withhold congressionally approved funds—a practice known as impoundment. While no formal legal challenges have been made, members of both committees signaled they would continue to scrutinize the administration’s budget actions in the weeks ahead.
What This Means for Providers
LeadingAge will continue to monitor the budget process and advocate to protect essential funding for Medicaid, Medicare, and aging services. With over 100 million individuals relying on HHS programs, deep cuts could have far-reaching consequences for nonprofit providers and the individuals they serve. We will provide members with further updates and opportunities to engage as the budget debate continues. The Centers for Medicare & Medicaid Services (CMS) has issued a new Request for Information (RFI) focused on how technology can be better leveraged to improve the health care experience for Medicare beneficiaries.
Released on May 13, the RFI invites input from a wide range of stakeholders—including providers, caregivers, older adults, payers, and technology developers—on how to:
- Advance the use of digital health and care navigation tools
- Improve the secure, seamless exchange of health information across systems
- Strengthen data interoperability and access
- Reduce administrative burden
- Support a more patient-centered, value-based care system
Comments are due June 16, 2025.
Webinar Opportunity
CMS will host a live webinar on May 20 at 1 p.m. ET to walk through the RFI and answer questions from stakeholders. Several key CMS officials will be available to provide clarification and hear feedback from participants.
Register for the webinar here. West Health, in partnership with a steering committee of federal and state officials, has launched a National Aging Readiness Dashboard to help policymakers, researchers, and advocates better understand how well the U.S. is prepared to meet the needs of an aging population.
The interactive tool compiles publicly available data from key federal sources—such as the American Community Survey (ACS) and the Behavioral Risk Factor Surveillance System (BRFSS)—and allows users to view aging-related indicators at both the national and state level. The dashboard offers a comprehensive look at a wide range of factors affecting older adults, including:
- Demographics: Age, race/ethnicity, household composition, and disability status
- Economic Security: Income sources and financial stressors among older adults
- Healthcare Access: Insurance coverage, care access, internet access, and discrimination experiences
- Health Status: Chronic conditions and overall health measures
- Healthcare Costs: Total spending, per capita Medicare costs, and out-of-pocket expenses
- Mental Health: Life satisfaction, social isolation, stress, and depression
- Caregiving: Trends in both paid and unpaid caregiving
- Dementia: Cognitive decline, caregiving, and dementia-related mortality
- Housing and Homelessness: Affordable housing availability and homelessness among older adults
- Transportation: Access to private and public transportation and the impact of unreliable transit options
The dashboard is designed to identify disparities, track trends over time, and support evidence-based policy and program development.
If you're interested in a deeper dive into the data, the dashboard includes an Explore the Data feature that allows for customizable views of indicators by geography and year.
Explore the dashboard here. Access Ohio-specific data here. Top LeadingAge Ohio holds valuable education webinars and in-person events throughout the year. Opportunities are added weekly. See the complete Schedule of Events. Top
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