Biden mandates nursing homes require COVID vaccine or lose Medicare, Medicaid funds

Associations representing Kansas and Missouri facilities expressed concern a mandate may drive away staff during a shortage

By: , and - August 18, 2021 5:31 pm
A national survey indicated 36.1% of long-term care facilities in Kansas were experiencing staffing shortages that had worsened since 2020. The state ranked fourth worst in terms of the staffing shortage. (Katarzyna Bialasiewicz/Getty Images)

A national survey indicated 36.1% of long-term care facilities in Kansas were experiencing staffing shortages that had worsened since 2020. The state ranked fourth worst in terms of the staffing shortage. (Katarzyna Bialasiewicz/Getty Images)

WASHINGTON — Nursing homes will be required to ensure their staffers are vaccinated against COVID-19, or risk losing federal Medicare and Medicaid dollars, the Biden administration announced Wednesday in a major move on vaccinations as the Delta variant sweeps many states.

Under the new nursing home policy, the U.S. Department of Health and Human Services will develop regulations to require vaccinations of nursing home staffers as a condition of participating in Medicare and Medicaid programs.

“I’m using the power of the federal government as a payer of health care costs to ensure we reduce those risks for our most vulnerable seniors,” President Joe Biden said during a news conference Wednesday detailing new federal actions.

“If you visit, live or work in a nursing home, you should not be at a high risk of contracting COVID from unvaccinated employees,” Biden added.

The new federal mandate is the latest vaccine requirement from the Biden administration. The Department of Veterans Affairs has required health care workers to get vaccinated, and all federal workers must either prove they have been vaccinated or face masking and testing requirements.

It also comes amid rising COVID cases in both Kansas and Missouri facilities, where vaccination rates among health care staff at CMS-licensed facilities remain low.

Missouri trails nearly every state in COVID-19 vaccinations for nursing home health care staff. Only 46.7% of the workforce is vaccinated, putting the state ahead of just Louisiana and Florida. Kansas is closer to the middle of the pack with 57% of its health care personnel vaccinated. 

Only 7.8% of Missouri nursing homes reported having vaccinated more than 75% off their health care staff as is the industry’s goal. In Kansas, just over 14% of homes reported meeting that mark.

Biden acknowledged that while he has limited authority to require COVID-19 vaccines, he will be looking for additional ways to boost vaccination rates.

He praised governors and mayors in Maryland, California, New York and other states for enacting certain vaccine requirements, and said the federal government will be covering all costs related to National Guard missions related to the coronavirus pandemic.

The nursing home vaccination requirement that Biden announced Wednesday will apply to staffers in 15,000 facilities, which employ approximately 1.3 million workers and serve approximately 1.6 million residents, according to the White House.

Some states and some nursing homes already have required staffers at long-term care facilities — where they may be in close contact with patients at high risk of a serious infection — to get a COVID-19 shot.

Maryland Gov. Larry Hogan was the latest on Wednesday, announcing that nursing home staffers in his state will be required to show proof of vaccination, or adhere to ongoing COVID-19 screening and testing.

Nursing homes and other long-term care facilities accounted for a substantial share of the earliest COVID-19 infections and deaths.

Residents of those facilities were among the earliest to be eligible for COVID-19 vaccines, and the latest data from the Centers for Medicare & Medicaid Services shows 82% of residents are vaccinated.

But only 60% of the staffers in nursing homes are vaccinated, according to CMS data.

Since the beginning of the pandemic, more than 133,000 nursing home residents and nearly 2,000 nursing home staffers have died as a result of COVID-19 infections.

Kansas and Missouri

Neither Kansas nor Missouri has mandated COVID-19 vaccinations in nursing homes, but one chain with several locations in Kansas is requiring its employees to get vaccinated this fall or face dismissal.

Associations that represent Missouri and Kansas’ long-term care facilities said they support and encourage vaccinations among staff and residents, but expressed concern that a mandate may impact staffing levels amid a shortage exacerbated by the pandemic.

“One member said to me, specifically, when they heard of the mandate, ‘That we've now gone from crisis to catastrophe,’” said Nikki Strong, the executive director of the Missouri Health Care Association, which represents over 65% of Missouri's licensed skilled nursing care facilities.

The organization’s Kansas counterpart has yet to discuss the issue, its president and CEO, Linda MowBray, said in an email. 

“Staffing is already at a crisis level and singling out nursing homes will only compound the issue,” MowBray said.

Mark Parkinson, the president and CEO of The American Health Care Association and National Center for Assisted Living, said in a statement that the administration shouldn’t single out nursing homes because it will cause vaccine-hesitant workers to leave for other health care jobs.

“The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents,” Parkinson said.

LeadingAge Missouri, a trade association that represents health care and housing providers that serve the elderly, is encouraging its members to mandate vaccination as a condition of employment for staff. Bill Bates, the group’s CEO, said staffing shortages will likely worsen, especially in rural areas, but that requiring vaccinations is the right call.

Bates estimated about half of LeadingAge Missouri’s members receive CMS funding, but because facilities can offer multiple forms of care — with some services not reimbursed through CMS — it may make implementation of the mandate less straightforward.

“So parts of a campus like that will have to mandate their employees. Other parts of a campus like that won't. And many employees go back and forth between levels of care,” Bates said. “So it's going to be confusing to implement. But it's the right thing to do.”

Masks in schools

The president also criticized Republican governors who have prohibited school boards from requiring students to wear masks.

He said he has directed Secretary of Education Miguel Cardona to use his oversight authority and legal action, if appropriate, to push back against governors who block or intimidate local educators from taking safety precautions in schools.

The New York Times reported that the administration will use the department’s civil rights office for enforcement, and send letters to staters including Arizona, Iowa and Tennessee “admonishing governors’ efforts to ban universal masking in schools.” Biden said he would be discussing schools again next week.

Cardona already has written Florida Gov. Ron DeSantis saying that if his administration withholds state funding from school districts that enact mask mandates, those schools can use federal coronavirus relief dollars to make up for the penalties.

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Laura Olson
Laura Olson

Laura covers the nation's capital as a senior reporter for States Newsroom, a network of nonprofit outlets that includes Kansas Reflector. Her areas of coverage include politics and policy, lobbying, elections, and campaign finance.

Allison Kite
Allison Kite

Allison Kite is a data reporter for The Missouri Independent and Kansas Reflector, with a focus on the environment and agriculture. A graduate of the University of Kansas, she’s covered state government in both Topeka and Jefferson City, and most recently was City Hall reporter for The Kansas City Star.

Tessa Weinberg
Tessa Weinberg

Tessa Weinberg covers education, health care and the legislature for the Missouri Independent. She previously covered the Missouri statehouse for The Kansas City Star and The Columbia Missourian, where her reporting into social media use by the governor prompted an investigation by the Attorney General’s office. She most recently covered state government in Texas for The Fort Worth Star-Telegram.