Nursing homes
Federal watchdog looks at how New York and three other states make nursing homes spend money on care
Four states, including New York, require nursing homes to put a set share of their money into resident care. A new federal review says the rules work differently in each state and are hard to track.
Key facts
- A federal review looked at nursing home care spending rules in four states, including New York.
- Nationwide reporting on Medicaid dollars spent on care workers starts in 2028.
What happened
The Office of Inspector General at the U.S. Department of Health and Human Services posted a report on October 28 looking at nursing home "minimum spending" rules in Massachusetts, New Jersey, New York and Pennsylvania. As of January 2026, those were the only four states that required nursing homes to spend at least a set share of their revenue, expenses or costs on resident care. There is no federal rule like this today.
Each state built its rule differently. New York's regulation, in effect since 2022, says 70% of a nursing home's revenue should go to direct resident care, with 40% going to staff who work directly with residents. Homes with too much left over, or that fall short of those levels, must send money back to the state. The OIG found that three of the four states had trouble collecting and checking the financial data needed to measure compliance, and some nursing homes in every state described problems such as staffing shortages and tight reporting deadlines.
Starting in 2028, every state will have to report to the Centers for Medicare & Medicaid Services, facility by facility, how much of its Medicaid nursing home payments goes to pay for direct care workers and support staff. The OIG recommended that CMS use what the four states learned as it builds that reporting, and CMS agreed.
What it means for families
These rules are meant to keep more nursing home dollars going to the people who give hands-on care. For families, they are one more reason to ask how a home staffs its floors.
For example: a daughter comparing two nursing homes for her father can ask each one how many aides work on the evening shift and how often agency staff fill in.
Staffing and inspection results are already posted for every certified nursing home on Medicare's Care Compare website.
What this means in New York: New York is one of only four states with a minimum spending rule, so nursing homes here already report their direct care spending to the state Department of Health.
What to do this week
- Look up any nursing home you are considering on Medicare's Care Compare.
- Ask about staffing levels on day, evening and weekend shifts.
- Ask how often the home relies on agency or temporary staff.
Sources
More from Nursing homes
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