By capping the provider taxes and state-directed payments that help fund nursing homes as well as hospitals and other providers, the One Big Beautiful Bill Act removes $340 billion in federal Medicaid money over ten years, and Brad Knott of North Carolina's 13th District voted for it on July 3, 2025; the same law also keeps the federal nursing-home staffing standard unenforceable through September 30, 2034.
The House version that passed on May 22, 2025 needed Knott's yes, and it froze a rule that helps low-income seniors get their Medicare premiums paid, along with a broader Medicaid enrollment rule; three months earlier, the budget resolution calling for $880 billion from the committee over Medicaid had also turned on his vote. In North Carolina, 60% of the 35,329 residents of certified nursing facilities count on Medicaid as their primary payer.
Brad Knott's Votes on Nursing-Home Staffing, Premium Help and Medicaid Long-Term Care
- Knott Voted to Put the Nursing-Home Staffing Rule on Ice Until 2034 While Cutting the Medicaid Money Nursing Homes Run On. Brad Knott's July 3, 2025 yes helped carry the final One Big Beautiful Bill Act, 218-214. KFF says its Medicaid cuts "could affect the 22 million people ages 50 and older with coverage under the Medicaid program." The law forbids federal enforcement of the 2024 nursing-home staffing rule through September 30, 2034, a step KFF says cements a federal court ruling that struck down central parts of the rule. KFF tallies the federal Medicaid savings from shelving the rule at $23 billion over a decade, and Consumer Voice, which advocates for residents of long-term care facilities, says "The minimum staffing rule was estimated to save 13,000 lives annually." Caps on provider taxes and state-directed payments, money that flows to nursing homes among others, account for $340 billion of the law's federal cuts over the decade.
- Knott's Deciding Vote Passed a House Bill That Freezes Two Enrollment Rules, One for the Programs Paying Low-Income Seniors' Premiums, in May 2025. The House version of H.R. 1 passed 215-214 on May 22, 2025 with Knott's yes, a vote it could not spare. Its moratorium on most of two Biden-era enrollment rules, one easing low-income seniors' sign-up for the programs covering their Medicare premiums and cost sharing and one streamlining Medicaid enrollment more broadly, carried into the final law. Under the final law, KFF reports, the two moratoriums are "collectively estimated to reduce federal Medicaid spending by $122 billion," money that would otherwise pay for coverage of low-income enrollees, among them the premiums and copays of seniors with little income.
- Knott's Deciding Budget Vote Ordered $880 Billion From the Medicaid Committee, Putting Optional Home Care in the Line of Cuts, in February 2025. Knott's February 25, 2025 yes adopted H.Con.Res. 14, the House budget resolution, 217-215, a margin his switch alone would have turned into a tie that fails. It directed the Energy and Commerce Committee to "reduce the deficit by not less than $880,000,000,000". Home care is where those cuts can land first: "Medicaid pays for almost 70% of all home care spending in the U.S., nearly all of which is provided through optional services," KFF reports, and the Bipartisan Policy Center says that optional status makes home care "more vulnerable to reductions during periods of state or federal budget constraints."
What the Elder Care Cuts Brad Knott Voted For Mean for Older North Carolinians
- 20,900 seniors in North Carolina's 13th District rely on the Medicaid program the law cuts. KFF counts 20,900 seniors on Medicaid in North Carolina's 13th District in 2025, older residents whose nursing-home stays, home aides and Medicare cost sharing Medicaid helps pay, now from a shrinking pool of federal money.
- Medicaid pays for most of North Carolina's 35,329 nursing-home residents, and their homes lose money while the staffing floor stays shelved. Medicaid is the first-line payer for 60% of North Carolina's 35,329 certified nursing-facility residents, KFF data show. As the law's provider-tax and payment caps cut the Medicaid dollars those homes run on, the 2024 federal staffing standard cannot be enforced until September 30, 2034, so the minimum nurse and aide hours it set do not protect residents.
- 22,300 North Carolinians already wait for Medicaid home care, and the hospital assessments that fund it may shrink. In 2026, 22,300 North Carolinians were on waiting lists for Medicaid home and community-based services, by KFF's count. The North Carolina Medical Journal reported that with the law's lower provider-tax ceiling, the assessments that now help pay for home and community-based services could be cut back or ended over time, which would lengthen the wait for an aide who lets a person stay at home.
Frequently Asked Questions About Brad Knott on Elder care
What is Brad Knott's record on elder care under Trump?
Brad Knott voted on July 3, 2025 for the One Big Beautiful Bill Act, which blocks the federal nursing-home staffing standard until 2034 and cuts $340 billion in provider-tax and payment funding that helps pay for nursing care and also pays hospitals and other providers. Earlier, the House bill could not have passed without his May 2025 vote, and the Medicaid cuts trace to a budget plan his February 2025 vote decided. In North Carolina, six in ten nursing-home residents depend on Medicaid as their primary payer.
What does shelving the staffing rule, which Brad Knott voted for, mean for a nursing-home resident in North Carolina?
Because the law Brad Knott voted for keeps Washington from enforcing the staffing standard until September 30, 2034, a resident in one of North Carolina's certified nursing facilities does not get the minimum nurse and aide hours that the 2024 standard set. On December 2, 2025 the administration followed with an interim final rule that repealed the staffing standards, LeadingAge reported, and Consumer Voice says the rule had been expected to save 13,000 lives a year.
How could the Medicaid cuts Brad Knott voted for affect North Carolinians waiting for home care?
Brad Knott voted for a law that cuts North Carolina's federal Medicaid funding by $22.5 billion over ten years, and most Medicaid home care is optional for states, so it is among the first services trimmed when money tightens. KFF found that "44 out of the 50 responding states constrain spending" on home care already, and North Carolina had 22,300 people waiting for it in 2026; for someone on that list, in-home help that could keep them out of a nursing home stays out of reach.
Last updated: 2026-10-27