Provider taxes and state-directed payments help finance nursing homes' Medicaid revenue, and the One Big Beautiful Bill Act caps both, a change KFF links to $340 billion in federal cuts over ten years that reach hospitals and other providers as well; Derrick Van Orden, who holds Wisconsin's 3rd District seat, voted for the law on July 3, 2025, and it also puts the 2024 nursing-home staffing standard beyond federal enforcement until September 30, 2034.
Before that, Van Orden's deciding House vote in May 2025 advanced a freeze on two enrollment rules, one for the Medicare Savings Program and one for Medicaid more broadly, both meant to ease sign-up for older adults and people with disabilities, and his deciding February 2025 vote for the budget resolution fixed an $880 billion savings demand on the Medicaid committee that leaves optional benefits such as home care exposed. Medicaid is the main payer for 55% of the people living in Wisconsin's nursing homes, and 9,160 Wisconsinites are on the waiting list for Medicaid home care.
Derrick Van Orden's Votes on Nursing Homes, Home Care and Help for Low-Income Seniors
- The Law Shelves the Nursing-Home Staffing Standard and Caps Nursing-Home Financing, With Van Orden's July 2025 Vote. The Senate-amended H.R. 1 cleared the House 218 to 214 on July 3, 2025, and Derrick Van Orden was a yes. KFF warns that its Medicaid reductions "could affect the 22 million people ages 50 and older with coverage under the Medicaid program." The law also stops federal enforcement of the 2024 minimum staffing rule for nursing homes through September 30, 2034, which in KFF's reading cements a federal judge's ruling against the rule's core requirements. KFF tallies the federal Medicaid savings from leaving the staffing rule unenforced at $23 billion across ten years. The provider-tax and state-directed-payment caps, two tools states use to pay hospitals, nursing homes and other providers, account for $340 billion in federal reductions over the decade.
- A Freeze on Two Medicaid Enrollment Rules Cuts Off Premium Help for Low-Income Seniors, Advanced by Van Orden's Deciding House Vote in May 2025. Van Orden's yes on May 22, 2025 was part of the 215-to-214 margin that passed the House version of H.R. 1, so it could not have passed without him. Both that bill and the final law halt most of two rules: a Medicare Savings Program enrollment rule, for the Medicaid help that pays Medicare premiums, deductibles and copays, and a broader Medicaid enrollment rule aimed especially at older adults and people with disabilities. KFF reports that halting the two rules is "collectively estimated to reduce federal Medicaid spending by $122 billion," savings that come from people, many of them older adults, who would otherwise have been enrolled.
- An $880 Billion Savings Target for the Medicaid Committee Puts Optional Home Care at Risk, Adopted by Van Orden's Deciding Vote in February 2025. The House adopted H.Con.Res. 14 on February 25, 2025 by 217 to 215 with Van Orden voting yes, a two-vote margin that his switch would have turned into a tie, and a tied resolution does not pass. It ordered the Energy and Commerce Committee to "reduce the deficit by not less than $880,000,000,000". Home care sits in the most exposed part of Medicaid: KFF notes that "Medicaid pays for almost 70% of all home care spending in the U.S., nearly all of which is provided through optional services," and the Bipartisan Policy Center says optional services are "more vulnerable to reductions during periods of state or federal budget constraints."
What Derrick Van Orden's Elder Care Votes Mean for Older Wisconsinites
- The law's Medicaid cuts reach a program that 20,100 seniors in Wisconsin's 3rd District count on. Medicaid enrolled 20,100 seniors in Wisconsin's 3rd District in 2025, along with 17,500 people with disabilities, according to KFF's district count. They are among the older and disabled enrollees KFF expects the law's Medicaid reductions to reach.
- Over half of Wisconsin's 17,668 nursing-home residents rely on Medicaid as the main payer, and the law caps financing that helps pay for their care. Some 17,668 people lived in Wisconsin's certified nursing facilities in 2025, and for 55% of them Medicaid was the main source of payment, with Medicare at 16%, by KFF's tally. Part of that Medicaid money comes through the provider taxes and directed payments the law limits.
- 9,160 Wisconsinites already wait for Medicaid home care that budget pressure puts at risk. KFF counts 9,160 people on Wisconsin's waiting list for Medicaid home and community-based services, the aides and supports that let people stay in their own homes. Because states offer that care at their option, it is the benefit the Bipartisan Policy Center calls more vulnerable to cuts when budgets tighten.
Frequently Asked Questions About Derrick Van Orden on Elder care
What is Derrick Van Orden's record on elder care under Trump?
Derrick Van Orden's July 3, 2025 yes helped pass a law that keeps the federal nursing-home staffing rule unenforced until 2034 and caps Medicaid financing that helps pay nursing homes and hospitals, $340 billion in federal reductions by KFF's count. His deciding May 2025 House vote advanced a freeze on two Medicaid enrollment rules, one of them for the premium help low-income seniors rely on. And with his deciding February 2025 budget vote he helped set the $880 billion savings instruction for the committee that writes Medicaid law, which puts optional care such as home services under pressure.
What does shelving the staffing rule in Derrick Van Orden's vote mean for a nursing-home resident in western Wisconsin?
The law Derrick Van Orden voted for bars federal regulators from enforcing the 2024 staffing minimums through September 30, 2034, so until then that rule sets no floor for a Wisconsin nursing home. The Consumer Voice, which advocates for residents, says "The minimum staffing rule was estimated to save 13,000 lives annually."
How much could a low-income senior in western Wisconsin pay for Medicare after Derrick Van Orden's vote?
A senior living on $967 a month who loses Medicaid's premium help because of the enrollment freeze Derrick Van Orden's deciding May 22, 2025 vote advanced would face Medicare premiums of $185 a month, about 20% of income, by KFF's estimate.
Last updated: 2026-10-27