Reconciliation Update: Senate Releases Amended Budget Bill
The Senate released its updated version of the “big, beautiful” budget reconciliation bill on Saturday. While AHCA/NCAL continues to review the revised language, there are several important updates for members outlined below.
As background, all provisions must meet what’s known as the Byrd Rule to ensure they remain focused on fiscal matters for the legislation to pass with a simple majority rather than the traditional 60 votes in the Senate. Certain provisions in the first draft of the Senate bill did not pass the Byrd Rule, and this new version attempts to fix that while also build consensus among Republican lawmakers.
What’s Included
Medicaid Provider Taxes
The revised language continues to exclude nursing homes and intermediate care facilities from provider tax reductions.
For expansion states, provider taxes are still being reduced from the 6% ceiling to 3.5% by a half percentage point each year. But the implementation of this reduction now starts in FY 2028 instead of FY 2027.
For non-expansion states, existing provider tax arrangements may continue under current thresholds. However, no new taxes may be added after enactment.
Retroactive Coverage
Like the first draft of the Senate bill, retroactive coverage for Medicaid beneficiaries other than expansion new adults is revised to 60 days. This is an improvement from the House bill that would universally reduce retroactive coverage for all Medicaid enrollees to 30 days.
Staffing Mandate
The updated bill now offers a 10-year delay of the federal staffing mandate for nursing homes in order to pass the Byrd Rule. However, a 10-year delay by Congress is essentially a repeal.
What Happens Next
President Trump is pushing for swift action on this bill, and Republicans continue to strive to get the bill to the President’s desk by July 4. The Senate is working through the weekend and attempting to get through some procedural hurdles, including the vote-a-rama where amendments can be proposed, but are unlikely to change the bill. Since the Senate’s version is different than the House’s, if it passes, it must go back to the House to be considered once again. With a slim majority in both the House and Senate, it remains to be seen if this new version will ultimately pass.
This has been a long process, and we’re now approaching the final inning. Between hundreds of meetings on the Hill and facility tours, as well as the ongoing outreach and phone calls, our advocacy efforts have made all the difference. Reconciliation has shed a light on the unique needs of our residents, and we’re encouraged by this ongoing dialogue with lawmakers.
We will continue to keep you informed as this bill progresses and will follow up with additional analysis.
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