ANA launches campaign on Student Nurses Loan Cap and other recent Federal Rulings

Weekly ANA Government Affairs & Policy Update

December 11, 2025

ANA Launches Grassroots Campaign Against Student Loan Caps for Nurses

After a successful petition campaign with more than 236,000 signatures to protest the proposed caps on federal student loans for post-baccalaureate nurses, the American Nurses Association (ANA) officially launched our grassroots efforts by asking nurses to logon to RNAction.org and write to their members of Congress. So far, supporters of this effort have made more than 1,330 phone calls and sent more than 14,900 letters to members of Congress. In addition, nurses have submitted 710 stories on how these caps would affect the nursing professions and the workforce pipeline if they were to take effect.

Bi-Partisan, Bi-Cameral Effort to Stop Cap on Federal Student Loans to APRNs

Sen. Jeff Merkley (D-OR), Rep. Jen Kiggans (R-VA), and Rep. Suzanne Bonamici (D-OR) have launched a "Dear Colleague" letter in Congress to advocate against the caps on federal student loans to post-baccalaureate nurses. A "Dear Colleague" is a letter that members of Congress sign that is delivered to Congressional leaders, the White House, or a federal agency-in this case, the Department of Education-to encourage or discourage certain actions. This bi-partisan effort will carry more weight with President Trump's Department of Education. Further strengthening the call for the inclusion of nurses in this letter is the fact that Rep. Kiggans is a Nurse Practitioner and can speak to potential impacts directly. ANA remains committed and active in engaging with our partners, Congress, and other key stakeholders to ensure nurses can access needed federal loan support to advance their clinical education and training.  

ACIP Recommends Changes to Hep B Vaccine, President Trump Issues Memo on Childhood Vaccines. Members of the Advisory Committee on Immunization Practices (ACIP) voted 8-3 to update the universal birth dose recommendation for the Hepatitis B virus (HBV) vaccine for infants born to mothers who are HBV negative. The updated recommendation allows for individual-based decision-making for parents to decide whether to give their infant an HBV vaccine at birth or to wait until at least two months of age to begin the vaccine series. The recommendation for infants of HBV positive mothers, or those who are at-risk, to receive the vaccine at birth remains unchanged. The acting director of the Centers for Disease Control and Prevention (CDC), Jim O'Neill, has yet to sign off on these recommendations. In response, ANA issued a statement reaffirming our support of evidence-based immunization practices.

Following the ACIP meeting and discussions about the United States' childhood vaccination schedule, President Trump issued a Presidential Memorandum directing the Secretary of Health and Human Services and the Acting CDC Director to review core childhood vaccination recommendations from peer, developed nations, and to determine if other recommendations and the science informing those schedules warrant an update to the U.S. childhood vaccine schedule. ANA will monitor discussions and actions stemming from the memo.

CMS Provides Guidance on Medicaid Work Requirements. The Centers for Medicare & Medicaid Services (CMS) issued December 8 a new guidance for states on the work and community engagement requirements that some Medicaid beneficiaries will have to meet to be eligible for Medicaid coverage. The work and community engagement requirements were included in the One Big, Beautiful Bill Act (OBBBA or H.R.1) and go into effect January 1, 2027. The new guidance reiterates OBBBA definitions of what qualifies as a community engagement requirement, including 80 hours of work, 80 hours of community service, or 40 hours of coursework for an educational program per month, among other criteria. CMS clarifies that beneficiaries count as compliant with community-engagement requirements if they show any engagement during the state's eligibility period, for however many months the state requires. States cannot require those months to be consecutive or tied to specific dates. CMS will issue more guidance on how states should verify compliance, but for now it has listed acceptable data sources-such as payroll records, college enrollment, community-service verification, and job-training participation. CMS also states that states may not ask enrollees for extra documents unless those documents are needed to confirm compliance. ANA anticipates further rulemaking to fully implement the work and community engagement requirements and is monitoring the process closely.

CMS Rescinds LTC Staffing Rule. CMS issued December 3 an interim final rule rescinding the minimum staffing standards for long-term care (LTC) facilities that were finalized through 2024 rulemaking. The rescission follows a 10-year implementation moratorium included in OBBBA. The repealed requirements had mandated 3.48 hours of nursing care per resident per day, including 24/7 registered nurse coverage. With the rescission, LTC facilities must only provide RN services for eight consecutive hours daily and maintain an RN director of nursing. ANA strongly supported the original staffing rule and will submit further comment on this interim final rule to ensure resident safety and nursing standards remain a priority in LTC facilities.

CMS Releases Final Home Health Payment Rule. CMS released the final calendar Year (CY) 2026 Home Health payment rule. Provisions in the final rule make changes to quality reporting and clinical policy, including the removal of the COVID-19 vaccination measure and four OASIS-based social determinants of health (SDOH) items from the Home Health Quality Reporting Program. Further, the rule aligns the face-to-face encounter requirements with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, allowing physicians, nurse practitioners, clinical nurse specialists, and physician assistants to conduct the encounter regardless of their role in certifying eligibility. The rule also summarizes feedback from CMS's request for information on future quality measurements such as, digital quality measures, interoperability, and potential new metrics on cognition, nutrition, and patient well-being-signaling the agency's intent to modernize reporting. The rule reflects several wins that ANA advocated for in our comments, including expanded face-to-face attestation flexibility and removal of the COVID-19 vaccination measure for healthcare personnel. ANA was disappointed to see CMS not accept our recommendations to preserve key SDOH items that nurses view as essential for equitable, person-centered care.