Missouri
Feds set higher nursing home staffing mandates. Many Missouri facilities don’t meet them • Missouri Independent
The Biden administration finalized nursing home staffing rules Monday that will require thousands of them to hire more nurses and aides — while giving them years to do so.
The new rules from the Centers for Medicare & Medicaid Services are the most substantial changes to federal oversight of the nation’s roughly 15,000 nursing homes in more than three decades. But they are less stringent than what patient advocates said was needed to provide high-quality care.
Spurred by disproportionate deaths from COVID-19 in long-term care facilities, the rules aim to address perennially sparse staffing that can be a root cause of missed diagnoses, severe bedsores, and frequent falls.
“For residents, this will mean more staff, which means fewer ER visits potentially, more independence,” Vice President Kamala Harris said while meeting with nursing home workers in La Crosse, Wisconsin. “For families, it’s going to mean peace of mind in terms of your loved one being taken care of.”
When the regulations are fully enacted, 4 in 5 homes will need to augment their payrolls, CMS estimated. That includes roughly two-thirds in Missouri.
But the new standards are likely to require slight if any improvements for many of the 1.2 million residents in facilities that are already quite close to or meet the minimum levels.
“Historically, this is a big deal, and we’re glad we have now established a floor,” Blanca Castro, California’s long-term care ombudsman, said in an interview. “From here we can go upward, recognizing there will be a lot of complaints about where we are going to get more people to fill these positions.”
The rules primarily address staffing levels for three types of nursing home workers. Registered nurses, or RNs, are the most skilled and responsible for guiding overall care and setting treatment plans. Licensed practical nurses, sometimes called licensed vocational nurses, work under the direction of RNs and perform routine medical care such as taking vital signs. Certified nursing assistants are supposed to be the most plentiful and help residents with daily activities like going to the bathroom, getting dressed, and eating.
While the industry has increased wages by 27% since February 2020, homes say they are still struggling to compete against better-paying work for nurses at hospitals and at retail shops and restaurants for aides. On average, nursing home RNs earn $40 an hour, licensed practical nurses make $31 an hour, and nursing assistants are paid $19 an hour, according to the most recent data from the Bureau of Labor Statistics.
CMS estimated the rules will ultimately cost $6 billion annually, but the plan omits any more payments from Medicare or Medicaid, the public insurers that cover most residents’ stays — meaning additional wages would have to come out of owners’ pockets or existing facility budgets.
The American Health Care Association, which represents the nursing home industry, called the regulation “an unreasonable standard” that “creates an impossible task for providers” amid a persistent worker shortage nationwide.
“This unfunded mandate doesn’t magically solve the nursing crisis,” the association’s CEO, Mark Parkinson, said in a statement. Parkinson said the industry will keep pressing Congress to overturn the regulation.
Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based advocacy nonprofit, said “it is hard to call this a win for nursing home residents and families” given that the minimum levels were below what studies have found to be ideal.
The plan was welcomed by labor unions that represent nurses — and whom President Joe Biden is counting on for support in his reelection campaign. Service Employees International Union President Mary Kay Henry called it a “long-overdue sea change.” This political bond was underscored by the administration’s decision to have Harris announce the rule with SEIU members in Wisconsin, a swing state.
The new rules supplant the vague federal mandate that has been in place since the 1980s requiring nursing homes to have “sufficient” staffing to meet residents’ needs. In practice, inspectors rarely categorized inadequate staffing as a serious infraction resulting in possible penalties, federal records show.
Starting in two years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, a KFF analysis found.
The rules give homes breathing room before they must comply with more specific requirements. Within three years, most nursing homes will need to provide daily RN care of at least 0.55 hours per resident and 2.45 hours from aides.
CMS also mandated that within two years an RN must be on duty at all times in case of a patient crisis on weekends or overnight. Currently, CMS requires at least eight consecutive hours of RN presence each day and a licensed nurse of any level on duty around the clock. An inspector general report found that nearly a thousand nursing homes didn’t meet those basic requirements.
Nursing homes in rural areas will have longer to staff up. Within three years, they must meet the overall staffing numbers and the round-the-clock RN requirement. CMS’ rule said rural homes have four years to achieve the RN and nurse aide thresholds, although there was some confusion within CMS, as its press materials said rural homes would have five years.
Under the new rules, the average nursing home, which has around 100 residents, would need to have at least two RNs working each day, and at least 10 or 11 nurse aides, the administration said. Homes could meet the overall requirements through two more workers, who could be RNs, vocational nurses, or aides.
Homes can get a hardship exemption from the minimums if they are in regions with low populations of nurses or aides and demonstrate good-faith efforts to recruit.
Democrats praised the rules, though some said the administration did not go nearly far enough. Rep. Lloyd Doggett (D-Texas), the ranking member of the House Ways and Means Health Subcommittee, said the changes were “modest improvements” but that “much more is needed to ensure sufficient care and resident safety.” A Republican senator from Nebraska, Deb Fischer, said the rule would “devastate nursing homes across the country and worsen the staffing shortages we are already facing.”
Advocates for nursing home residents have been pressing CMS for years to adopt a higher standard than what it ultimately settled on. A CMS-commissioned study in 2001 found that the quality of care improved with increases of staff up to a level of 4.1 hours per resident per day — nearly a fifth higher than what CMS will require. The consultants CMS hired in preparing its new rules did not incorporate the earlier findings in their evaluation of options.
CMS said the levels it endorsed were more financially feasible for homes, but that assertion didn’t quiet the ongoing battle about how many people are willing to work in homes at current wages and how financially strained homes owners actually are.
“If states do not increase Medicaid payments to nursing homes, facilities are going to close,” said John Bowblis, an economics professor and research fellow with the Scripps Gerontology Center at Miami University. “There aren’t enough workers and there are shortages everywhere. When you have a 3% to 4% unemployment rate, where are you going to get people to work in nursing homes?”
Researchers, however, have been skeptical that all nursing homes are as broke as the industry claims or as their books show. A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors.
Charlene Harrington, a professor emeritus at the nursing school of the University of California-San Francisco, said: “In their unchecked quest for profits, the nursing home industry has created its own problems by not paying adequate wages and benefits and setting heavy nursing workloads that cause neglect and harm to residents and create an unsatisfactory and stressful work environment.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
The Missouri Lottery offers several draw games for those aiming to win big.
Here’s a look at April 21, 2026, results for each game:
Winning Mega Millions numbers from April 21 drawing
01-36-43-56-58, Mega Ball: 07
Check Mega Millions payouts and previous drawings here.
Winning Pick 3 numbers from April 21 drawing
Midday: 0-0-9
Midday Wild: 9
Evening: 0-7-4
Evening Wild: 0
Check Pick 3 payouts and previous drawings here.
Winning Pick 4 numbers from April 21 drawing
Midday: 4-2-2-8
Midday Wild: 4
Evening: 9-4-7-5
Evening Wild: 9
Check Pick 4 payouts and previous drawings here.
Winning Cash Pop numbers from April 21 drawing
Early Bird: 14
Morning: 05
Matinee: 03
Prime Time: 02
Night Owl: 12
Check Cash Pop payouts and previous drawings here.
Winning Show Me Cash numbers from April 21 drawing
17-19-22-25-29
Check Show Me Cash payouts and previous drawings here.
Feeling lucky? Explore the latest lottery news & results
Are you a winner? Here’s how to claim your lottery prize
All Missouri Lottery retailers can redeem prizes up to $600. For prizes over $600, winners have the option to submit their claim by mail or in person at one of Missouri Lottery’s regional offices, by appointment only.
To claim by mail, complete a Missouri Lottery winner claim form, sign your winning ticket, and include a copy of your government-issued photo ID along with a completed IRS Form W-9. Ensure your name, address, telephone number and signature are on the back of your ticket. Claims should be mailed to:
Ticket Redemption
Missouri Lottery
P.O. Box 7777
Jefferson City, MO 65102-7777
For in-person claims, visit the Missouri Lottery Headquarters in Jefferson City or one of the regional offices in Kansas City, Springfield or St. Louis. Be sure to call ahead to verify hours and check if an appointment is required.
For additional instructions or to download the claim form, visit the Missouri Lottery prize claim page.
When are the Missouri Lottery drawings held?
- Powerball: 9:59 p.m. Monday, Wednesday and Saturday.
- Mega Millions: 10 p.m. Tuesday and Friday.
- Pick 3: 12:45 p.m. (Midday) and 8:59 p.m. (Evening) daily.
- Pick 4: 12:45 p.m. (Midday) and 8:59 p.m. (Evening) daily.
- Cash4Life: 8 p.m. daily.
- Cash Pop: 8 a.m. (Early Bird), 11 a.m. (Late Morning), 3 p.m. (Matinee), 7 p.m. (Prime Time) and 11 p.m. (Night Owl) daily.
- Show Me Cash: 8:59 p.m. daily.
- Lotto: 8:59 p.m. Wednesday and Saturday.
- Powerball Double Play: 9:59 p.m. Monday, Wednesday and Saturday.
This results page was generated automatically using information from TinBu and a template written and reviewed by a Missouri editor. You can send feedback using this form.
The Missouri House passed a bill Monday that would force entities receiving state funding to restrict usage of restrooms, changing areas, and sleeping accommodations based on biological sex and codify definitions for “female,” “male,” and “sex” throughout state statute.
State Rep. Becky Laubinger, a Republican from Park Hills, pitched the legislation as a “vital protection for women.” Lax policies and all-gender restrooms, like facilities in the Kansas City International Airport, invite predators, she argued.
“This is about our government facilities forcing people to share those spaces by creating all gender spaces where you don’t have the option in those spaces to go to a single sex space,” Laubinger said.
But during a House debate over the bill’s language last week, Democrats raised numerous issues with the legislation, saying it would be used to target transgender people.
“If you can just call the police and accuse someone of using the wrong bathroom, think about the implications of that,” said state Rep. Wick Thomas, a Kansas City Democrat and the House’s first transgender member.
The bill lacks an enforcement mechanism, other than allowing people to sue state-funded entities that do not “take reasonable steps” to designate single-sex spaces.
The bill’s fiscal note reflects concerns about costly litigation, though state departments could not estimate how much they will be impacted.
The University of Central Missouri projected “an indeterminate fiscal impact,” pointing to the “costs associated with enforcement of the regulations.”
The bill would require public universities to restrict dorm rooms, bathrooms, and locker rooms based on biological sex. It states that, “no individual shall enter a restroom, changing room or sleeping quarters that is designated for females or males unless he or she is a member of that sex.”
State Rep. Keri Ingle, a Democrat from Lee’s Summit, asked if this would bar college students from having students of the opposite sex in their dorm rooms overnight.
Laubinger said she had heard complaints from college students who felt uncomfortable when their roommate allowed a significant other to sleep over.
“I understand someone not wanting a boy over,” Ingle said. “I don’t know why we would legislate that. I don’t know why we would put that in the statute.”
State Rep. Mark Boyko, a Democrat from Kirkwood, said the bill would bar men from visiting women’s dorm rooms at any time. He wouldn’t be allowed to help his daughter set up her dorm room as a man, he said.
“I understand the intention you’re having,” he told Laubinger. “But the words don’t match your intention of this bill.”
House Republicans offered broad support, calling the bill a basic safety measure.
State Rep. Carolyn Caton, a Blue Springs Republican, said she thinks the legislation would be a “good protection.
“If nothing else, I think it just eases some young ladies’ minds,” she said.
The bill passed along party lines Monday, apart from a lone Republican “nay” from state Rep. Tara Peters of Rolla, who also voted against the bill at the committee level.
The Missouri Lottery offers several draw games for those aiming to win big.
Here’s a look at April 20, 2026, results for each game:
Winning Powerball numbers from April 20 drawing
09-17-36-47-64, Powerball: 26, Power Play: 3
Check Powerball payouts and previous drawings here.
Winning Pick 3 numbers from April 20 drawing
Midday: 6-4-7
Midday Wild: 1
Evening: 0-2-2
Evening Wild: 2
Check Pick 3 payouts and previous drawings here.
Winning Pick 4 numbers from April 20 drawing
Midday: 5-1-9-1
Midday Wild: 9
Evening: 2-5-8-0
Evening Wild: 4
Check Pick 4 payouts and previous drawings here.
Winning Cash Pop numbers from April 20 drawing
Early Bird: 12
Morning: 10
Matinee: 09
Prime Time: 03
Night Owl: 06
Check Cash Pop payouts and previous drawings here.
Winning Show Me Cash numbers from April 20 drawing
01-11-14-16-18
Check Show Me Cash payouts and previous drawings here.
Winning Powerball Double Play numbers from April 20 drawing
04-29-35-40-43, Powerball: 21
Check Powerball Double Play payouts and previous drawings here.
Feeling lucky? Explore the latest lottery news & results
Are you a winner? Here’s how to claim your lottery prize
All Missouri Lottery retailers can redeem prizes up to $600. For prizes over $600, winners have the option to submit their claim by mail or in person at one of Missouri Lottery’s regional offices, by appointment only.
To claim by mail, complete a Missouri Lottery winner claim form, sign your winning ticket, and include a copy of your government-issued photo ID along with a completed IRS Form W-9. Ensure your name, address, telephone number and signature are on the back of your ticket. Claims should be mailed to:
Ticket Redemption
Missouri Lottery
P.O. Box 7777
Jefferson City, MO 65102-7777
For in-person claims, visit the Missouri Lottery Headquarters in Jefferson City or one of the regional offices in Kansas City, Springfield or St. Louis. Be sure to call ahead to verify hours and check if an appointment is required.
For additional instructions or to download the claim form, visit the Missouri Lottery prize claim page.
When are the Missouri Lottery drawings held?
- Powerball: 9:59 p.m. Monday, Wednesday and Saturday.
- Mega Millions: 10 p.m. Tuesday and Friday.
- Pick 3: 12:45 p.m. (Midday) and 8:59 p.m. (Evening) daily.
- Pick 4: 12:45 p.m. (Midday) and 8:59 p.m. (Evening) daily.
- Cash4Life: 8 p.m. daily.
- Cash Pop: 8 a.m. (Early Bird), 11 a.m. (Late Morning), 3 p.m. (Matinee), 7 p.m. (Prime Time) and 11 p.m. (Night Owl) daily.
- Show Me Cash: 8:59 p.m. daily.
- Lotto: 8:59 p.m. Wednesday and Saturday.
- Powerball Double Play: 9:59 p.m. Monday, Wednesday and Saturday.
This results page was generated automatically using information from TinBu and a template written and reviewed by a Missouri editor. You can send feedback using this form.
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