What is Medicaid, and why does it matter to nurses? 

  

What is Medicaid? 

Medicaid provides health care coverage for millions of Americans, with nearly 72 million enrolled in 2024. The program is jointly funded by the federal government and states—states administer their own programs, while the federal government provides the majority of Medicaid’s funding and sets parameters that states must meet. The states are federally required to provide coverage for low-income families, qualified pregnant women and children, as well as people with certain disabilities. Every state can choose to offer Medicaid coverage to other populations beyond the federal requirements.   

Why is Medicaid under threat now? 

The Trump Administration’s agenda includes reducing federal spending, which is being echoed by the new Congress. The U.S. House of Representatives passed a budget resolution in February that would require the House Committee on Energy and Commerce, which oversees Medicare and Medicaid, to cut $880 billion in federal spending from its jurisdiction through 2034. Achieving that level of savings would be nearly impossible without targeting the Medicaid program. Fast forward to the beginning of April—the U.S. Senate passed a framework for budget cuts and the House narrowly adopted it on April 10, 2025. Now, both chambers can work on tax and spending legislation to advance President Trump’s agenda through budget reconciliation—which allows lawmakers to bypass the Senate’s 60-vote filibuster rule and allow bill passage with a simple majority. We will know the true extent of the threat to Medicaid once this process gets underway. 

Why should nurses care about Medicaid cuts? 

Nurses should care about protecting Medicaid for a number of reasons. Medicaid accounts for 19% of hospital revenues and serves as the primary payer for long term care services and supports. Therefore, these cuts would lead to job losses across the health care sector—one estimate holds that 477,000 health care workers will lose their jobs as a result of Medicaid cuts. This could potentially include nurses in both hospitals and long-term care settings. Or, if nurses’ jobs are spared from these cuts, nurses will likely face other workplace challenges from other staffing reductions. 

For nurses, Medicaid cuts would likely further exacerbate workplace challenges such as higher nurse-to-patient ratios, which result in increased burnout and decreased job satisfaction. Nurses in nonprofit settings could see reduced wages as states grapple with how to meet the needs of their Medicaid beneficiaries within the constraints of statutory balanced budget requirements. States may have little choice but to decrease provider payments or eliminate coverage of optional benefits, further limiting access to care for Medicaid beneficiaries. 

Finally, Medicaid cuts would impact patient access and health outcomes. Medicaid cuts will result in beneficiaries losing their coverage and access to needed care. Beneficiaries will face difficult decisions about their finances—leading to delayed care and nurses seeing sicker patients. Cuts to Medicaid could threaten health care facilities’ abilities to provide access to critical services and serve patients. Medicaid funding cuts could also lead to facility closures, especially in rural and underserved areas that are currently struggling to meet the needs of their communities. Closures would devastate communities where health care facilities are critical not only for health care services, but also for contributing to the overall economic health of a community by providing jobs.  

Nurses know that protecting Medicaid protects patients, providers, and communities.  

What comes next? 

When it comes to Medicaid, we do not know what is coming next—how lawmakers will target reductions or reforms simply is unknown at this time. But the American Nurses Association’s Policy and Government Affairs Team is steadfast in its focus on educating policymakers on the importance of Medicaid for our nurses and their patients—and how any reductions will impact nurses across the country.  

Learn More and Tell Us Your Story! 

For more information on Medicaid and how it works, check out Why Medicaid Matters and Understanding Medicaid and CHIP: A Comprehensive Overview. 

Help protect Medicaid by telling your legislators to protect Medicaid, as well as sharing your Medicaid story with ANA.  

New Year, New Congress and Administration, Same Mission.

  

The American Nurses Association (ANA) continues to advocate on behalf of the nation’s nearly 5 million registered nurses (RNs) to federal policymakers. With a new Congress and Administration comes change and a level of uncertainty. However, our priorities remain centered around the following goals: building and preserving a robust nursing workforce; improving health care outcomes and access; removing practice barriers for advanced practice registered nurses (APRNs); shaping payment strategies to account for the direct impact of nursing care; preserving the relationship between nursing and public health; and utilizing health care technology appropriately. 

We detailed these priorities and positions in a letter to Congress, sent to both Senate and House leadership. For our regulatory advocacy, ANA’s Policy Team has crafted a priorities document to share with internal and external stakeholders and policymakers and recently sent a letter to Secretary Kennedy.

Building and Preserving a Robust Nursing Workforce 

We believe that federal policymakers must take action to address current workforce challenges and ensure the health care workforce is able to meet future challenges by protecting our nurses and creating healthy work environments. We continue to call on Congress to address workplace violence for nurses, as well as limit mandatory overtime. Congress must take action to improve nurse staffing and reduce burnout, such as investing in mental health and substance use dependence support for nurses. Additionally, we encourage HHS to engage with nurses to implement measures that will protect a robust nursing workforce, address the current nursing shortage, and make the workplace safer for nurses.  

Ensuring a robust nursing workforce requires new, well-trained nurses. We urge Congress to invest in nursing education to ensure that a new generation of nurses are ready to work in the changing health care landscape. Investments in nursing education and recruitment will attract more nurses, nurse faculty, and nurse preceptors.  

Improving Health Care Outcomes and Access 

ANA believes that all people in America deserve access to high quality health care and care options. One area where ANA is working to improve health care outcomes and access is in the field of maternal health—working with Congress to enact legislation to expand the perinatal nursing workforce to ensure that women have access to the perinatal care they need and recommending that HHS keep nurses central to addressing maternal health challenges. Additionally, we are currently working with allies in the health care community to defend Medicaid to ensure that our most vulnerable patient populations have access to health care providers, such as trusted nurses.  

Removing Practice Barriers for APRNs 

We believe that removing practice barriers for advanced practice registered nurses (APRNs) will promote quality care and help provide proper payment for nurses. We encourage HHS to issue rulemaking to implement provider nondiscrimination protections, while urging the Centers for Medicare & Medicaid Services (CMS) to use its administrative authority to remove regulatory barriers to APRN practice in Medicare. Bolstering access to APRNs only serves to increase health care access, especially for our most vulnerable patient populations.  

Additionally, we are actively engaging members and other stakeholders to urge Congress to pass the bipartisan Improving Care and Access to Nurses (ICAN) Act to permanently remove longstanding Medicare and Medicaid restrictions that limit Advanced Practice Registered Nurses (APRNs) from practicing to the full extent of their education and clinical training. By addressing these barriers, the ICAN Act will enhance access to essential health care services, particularly in rural and underserved communities. We encourage our members to take action and show support for the ICAN Act. 

Shaping Payment Strategies to Account for the Direct Impacts of Nursing Care 

At ANA, we understand just how essential APRNs and RNs are to the provision of patient care and how they deserve fair compensation for the services they provide. We call on HHS to support CMS in taking regulatory and administrative steps to account for nursing care under Medicare and Medicaid payment methodologies and to align reimbursement and quality rewards with the provision of high-value nursing care. Additionally, ANA is ready and willing to engage with Congress on future efforts or roundtables to reform parts of the Medicare payment system. 

Preserving the Relationship Between Nursing and Public Health 

The COVID-19 pandemic demonstrated how intertwined the fields of nursing and public health are. We stand firm in our position that HHS must continue to promote vaccinations, in order to protect nurses and their patients, as well as to relieve overburdened health systems. ANA knows how important federal medical research and its impacts are for nurses leading research, the provision of health care, and the nursing profession. Additionally, we continue to underscore to HHS the importance of international relationships and partnerships in public health preparedness and have stressed the need to keep federal government public health datasets accessible.  

Utilizing Health Care Technology Appropriately 

New technologies can be used to improve health care outcomes and access, but they must be used ethically. ANA believes that HHS must investigate how artificial intelligence (AI) can best be used in the medical and health spaces, while underscoring how critical it is that AI should neither substitute licensed practitioners, nor should it be the only diagnostic tool that practitioners use. At the same time, we want to see HHS promote the use of telehealth to increase access to health care, especially to increase access to care in rural areas. Currently, there is a proposed rule on special telehealth registration from the Drug Enforcement Agency (DEA), and ANA has advocated for HHS to lead efforts to encourage the DEA to revisit their proposed rule and to issue a new rule that better reflects the needs of APRN practice. Additionally, we are working with allies to advocate for the permanent extension of telehealth flexibilities.

Looking at the Year Ahead 

A new Congress and Administration provides ANA with new opportunities and challenges to advance our priorities and to advocate for our members. ANA is ready to work with the 119th Congress on improving health care delivery and advancing the nursing perspective. We will seek common ground with the new Administration, so that we can continue to advance the nursing profession and the wellbeing of America’s nurses. As always, ANA stands ready to respond to emerging policy issues that impact nurses and their patients, while remaining steadfast in our mission to lead the profession to shape the future of nursing and health care. 

ANA Weighs in on Annual Medicare Payment Rulemaking

  

UPDATE: CMS released four final rules on Friday, 11/1.

Starting each Spring, the Centers for Medicare & Medicaid Services (CMS) begins its annual rulemaking process to determine payment for Medicare services by provider type. These payment rules also include proposals for quality measurement and improvement, addressing health equity, and other CMS policy priorities.  

These proposed rules typically have a 60-day comment period—allowing stakeholders to review the proposals and submit comments through regulations.gov. ANA’s Policy Team reviews each proposed rule, determines which proposals impact nurse practice and/or profession, and submits comment letters detailing the association’s positions on the proposed provisions.   

Comments on the last proposed rule of the 2025 Medicare payment rulemaking cycle were submitted to CMS in early September. Below we detail the payment rules ANA focused on during this year’s rulemaking process and highlight our comments on each. 

Physician Fee Schedule (PFS) 

The PFS sets payment rates for physicians and other billing professionals, such as Advanced Practice Registered Nurses (APRNs). This year’s proposed rule included several proposals around billing codes, telehealth, screening for social determinants of health (SDOH), vaccines, quality programs, and bolstering access to behavioral health services. ANA comments focused on ensuring that the agency adequately and appropriately value the nurse in all payments, urged CMS to make permanent all telehealth flexibilities, recognize the critical role of the nurse and nurse practice, and continue to provide incentives to support and bolster the nurse workforce. Comments were due at the beginning of September, and we expect CMS to release the final rule in the coming months. 

Hospital Inpatient Prospective Payment System (PPS) 

CMS issued the proposed IPPS rule, which covers significantly more than inpatient hospital visits, in May. ANA’s comments covered a wide range of issues including payment incentives, health equity, public health, maternity care, climate change, and access to essential medicines. Additionally, ANA urged CMS to ensure access and payment parity for APRNs in maternal health. CMS issued the final IPPS final rule in early August, which largely finalized CMS’ proposals.   

Hospital Outpatient Prospective Payment System (HOPPS) 

In late July, CMS issued their calendar year 2025 HOPPS proposed rule. In addition to provisions related to outpatient care, the rule included a proposal to create an obstetric-specific Conditions of Participation (CoP). ANA’s comments urged the agency to ensure that any CoP include safe staffing levels for nurses and ensure access to APRNs, who are critical to patient access to obstetric and maternal health care. ANA also commented on raising the reimbursement rate for Esketamine, which ANA staff met with CMS about earlier this year. In addition, the comment letter included ANA’s positions on provisions related to telehealth, PPE, and health equity. Comments on this proposed rule were due in early September, and we expect CMS to issue a final rule in the coming months. 

Skilled Nursing Facility (SNF) PPS 

CMS issued the SNF proposed rule in May—updating SNF payment rates, quality programs, and enforcement policies. ANA expressed support for CMS’ proposals the Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) programs to address gaps in quality across SNFs and health inequities experienced by Medicare beneficiaries. In addition, we urged the agency to leverage SNF quality data to inform implementation of separate rulemaking instituting minimum staffing standards in SNFs and explore options to increase transparency on SNF spending on nursing care. CMS issued the final rule in late July, largely finalizing provisions as proposed. 

Home Health (HH) PPS 

The HH proposed rule, issued in late June, targets payments to HH agencies (HHAs) for services provided to beneficiaries. CMS’ proposals focused on timely admission to home health services, quality reporting and improvement programs, health equity, and other agency priorities. ANA detailed support for the proposed provisions regarding advancing health equity and improving quality. ANA also weighed in on the need for CMS to ensure nurses are part of any process or requirements to determine HHA availability and to bar therapists from conducting nursing care assessments. Comments were due at the end of August, and we expect CMS to release the final rule in the coming months. 

Hospice PPS 

CMS issued a May proposed rule updating hospice payments and proposing changes to quality reporting programs. ANA focused its comments on urging the agency to address gaps in quality to reduce health disparities for hospice beneficiaries. ANA also highlighted the key role of the nurse in the new Hospice Outcomes and Patient Evaluation (HOPE) assessment tools. CMS finalized the rule in July, adopting its proposed changes. 

Inpatient Psychiatric PPS 

In April, CMS released their annual proposed rule updating payment and policy in inpatient psychiatric programs. ANA’s comments supported CMS’ continued attention to health equity focused interventions and highlighted the importance of psychiatric mental health nurses (PMHN) to implementing patient assessment data collection. ANA also supported a new quality measure tracking a patient’s visit to an emergency room within 30 days of discharge from an inpatient psychiatric facility. Finally, we urged CMS to update this payment system to accurately account for the value of nurses and appropriately reimburse nursing care. The final rule was released in August adopting these proposals. 

End-Stage Renal Disease PPS 

CMS’ ESRD proposed payment rule was released in July and continues to try and fix pervasive access issues to in home dialysis. ANA comments remind CMS every year that solutions to in home access and staffing problems in the ESRD program must be created with nephrology nurses’ leadership. The agency proposed a health equity payment adjustment for clinicians that serve beneficiaries dually eligible for Medicare and Medicaid that ANA strongly supported. The final rule should be released in the next few months.