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A Medicaid official tried to walk a fine line Tuesday as House Republicans expressed their displeasure with new Medicaid rules implementing minimum nursing home staffing requirements and higher pay for home care workers.

"While I agree that we need to do more to ensure our frontline caregivers and clinical care providers are compensated commensurately with the care they're providing, and offer a better quality of life for our most vulnerable, this approach simply won't work," Rep. Brett Guthrie (R-Ky.), chair of the House Energy & Commerce Health Subcommittee, on proposed legislation to increase Medicaid access and crack down on improper Medicaid payments. "These rules come at a time where we have seen more than 500 nursing home facilities close since the start of the pandemic and where we have 150,000 fewer long-term care workers than we did before 2020."

Referring to new rules requiring nursing homes to have an RN on staff 24 hours a day, 7 days a week and requiring them to have enough nursing staff to provide about 3.5 hours of personalized care per resident per day, Rep. Cathy McMorris Rodgers (R-Wash.), chair of the full Energy & Commerce Committee, noted that "by setting unattainable staffing requirements, I fear that the minimum staffing rule will force nursing homes to close or reduce the number of seniors served."

"And the Medicaid access rule's so-called '80/20 policy' will lead to home care agencies reducing the amount of care that they can provide," she continued, referencing a rule requiring home care agencies to pay 80% of the money collected for home care worker services directly to the workers rather than using it for administration or overhead.

Republicans have already introduced measures to counter the new regulations, which were announced last week. would stop the nursing home staffing rules from going into effect, while would block the 80/20 pay rule for home care workers.

But Daniel Tsai, director of the Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services (CMS), said the nursing home rules made sense. "I don't think we need to choose between nursing home economics -- recognizing legitimate workforce challenges that we all need to work out creatively together -- and safe, dignified care," he said. "The rule upholds a standard but creates time [delays] and exceptions as well."

Tsai was referring to provisions that give the facilities several years to implement the staffing rules, and the fact that the rules include exceptions for nursing homes in several categories, including those located in workforce shortage areas.

Committee Democrats praised the rule. "I don't know about all of you, but I think if I were in a nursing home, I would want those standards," said Rep. Anna Eshoo (D-Calif.), the subcommittee's ranking member. "I support the administration's recent rulemaking to improve nursing home quality and raise the wages of care workers, and I oppose both of the aforementioned bills" that would block the new rules.

Subcommittee members also used the hearing to discuss other Medicaid-related bills they were proposing. Rodgers noted that she and Rep. Frank Pallone (D-N.J.), ranking member of the full Energy & Commerce Committee, had developed a bipartisan bill to address some states' long waitlists for home- and community-based services.

"I've met with too many people over the years who've struggled to get off these waitlists, or who have been afraid to pursue jobs out of state and risk being moved to the back of a new state's waitlist," she said, adding that the bill she and Pallone developed "will increase flexibility for states to offer more care by reducing these waitlists, and [will make] sure each state is tracking and reporting waitlist statistics uniformly."

Rep. Debbie Dingell (D-Mich.) said she sponsored a bill, , to make permanent a demonstration program called "The Money Follows the Person," which makes it easier for patients to transition from nursing home to home- or community-based care. "This program has demonstrated it works, has strong bipartisan support, and saves taxpayers money," she said. "Currently the program will expire in 2027, and my bill would authorize it permanently and take away a lot of doubt and insecurity."

Tsai said he couldn't comment on any specific bill but agreed that the program has worked well and "it's cost-effective and common-sense."

Rep. Jan Schakowsky (D-Ill.) wanted to discuss the Medicaid Estate Recovery Program, in which states try to collect money from the estate of a deceased Medicaid recipient to cover the cost of his or her care. "I think it needs to be ended," she said. "Families grieving because of the death of their loved one are suddenly hit with a bill that can amount to thousands of dollars. Medicaid covers low-income people, and their families are often low-income as well."

"In 2021, in the state of Illinois alone, 17,000 families have lost their homes" because of this program, she said. "One of my constituents who was taking care of her mother was told [that she owed] about $77,000 now that her mother has died. This program is so cruel." And what's more, she added, "the return on this has been less than 1% -- it's not working. They aren't getting the money back."

Tsai told Schakowsky that although CMS has to allow the recovery program because it's a federal law, "we would gladly work with your office on this."

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