Senior Living Alert – In the Thick of It: With Battles Raging in Statehouses, Where Do Senior Living Facilities Sit?

April 30, 2024

State legislatures nationwide are engaged in a flurry of activity as lawmakers, journalists, interest groups and citizens converge to address diverse policy issues. Debates and advocacy campaigns on topics such as social media regulation, taxation and wage policies are center stage. While senior living facilities may not be a central focus, legislation with implications for their operations and business models is under consideration.

Last year, McGuireWoods Consulting looked at what was on the horizon for the sessions in the first half of this year. Let’s dive back into seven states — Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia and Pennsylvania — to see what passed both chambers.

McGuireWoods Consulting recognizes that some of this new legislation could create complex challenges for your business. Its team of government relations and advocacy professionals leverages a depth of experience to help clients effectively support, mitigate or counterbalance legislation impacting their business goals.


Florida’s 2024 legislative session, which concluded on March 11, enacted significant budgetary changes impacting senior care. The Legislature increased Medicaid reimbursement rates and personal care allowances, enhancing financial accessibility for seniors in need. Additionally, Assisted Care Services, a program of the Florida Agency for Health Care Administration, received a $1.3 million funding increase, bolstering resources for Florida’s assisted living communities.

The state budget further addressed the affordable senior housing crisis by allocating new funds to the SHIP and SAIL programs, with the goal of reducing the five-year waitlist.

One piece of legislation (HB 995 / SB 238) died in committee. Sponsored by Sen. Colleen Burton, R-Lakeland, this pair of bills would have protected passive investors — or those not involved in day-to-day operations — from being sued. There has been an increase in lawsuits against senior living facilities in Florida and the legislation was hoped to curb that.


Georgia’s recently concluded legislative session yielded less extensive senior living legislation than Florida, but a significant compromise was reached regarding staffing requirements. HB 1335 introduces flexibility to staffing models, removing the per-floor mandate and allowing movement within the facility. This bill awaits the governor’s signature or veto.


Maryland is poised to implement a significant change, and join a growing trend, for healthcare acquisitions. Effective Oct. 1, 2024, HB 1122 / SB 1000 would necessitate the filing of a formal request with the Maryland Health Care Commission a minimum of 60 days before closing for acquisitions. Additionally, the bill mandates notice given to residents and staff of affected facilities prior to the finalization of an acquisition. It establishes specific criteria for the commission’s approval or denial of such transactions and provides a mechanism for judicial review of final determinations.

The bill is pending the governor’s signature or veto before a mid-May deadline. Failure by the governor to act will result in the bill’s automatic passage into law.

North Carolina

The North Carolina Legislature is convening the week of April 22, but anticipated actions are confined to budgetary adjustments due to the biennial budgeting cycle. While no significant initiatives targeting senior living facilities are expected, the projected $1.4 billion surplus could spark unanticipated debates on policy priorities.

South Carolina

Deep in the second half of the session, no single bill has emerged as a dominant focus for senior living facilities this legislative session, but two smaller measures are progressing:

  • SB 1084 establishes a call-check service and notification system operated by the Department on Aging.
  • SB 558 outlines revised requirements for tuberculosis testing upon admittance to senior living facilities.

With less than a month until adjournment, passage of these two pieces of legislation remains a possibility. Additional bills addressing telehealth regulations are also under consideration.


Earlier this month, Gov. Glenn Youngkin vetoed a piece of legislation adjacent to senior living facilities. HB 26 would have allowed senior citizens to use their senior living facility ID for identification when going to vote.

Despite that, several pieces of legislation were passed by both the Legislature and governor:

  • HB 511 allows eligible healthcare practitioners licensed, certified or registered in a different state to practice for one 90-day period within the commonwealth.
  • HB 349 requires advanced aides who administer drugs in a certified nursing facility to register with the Board of Nursing. Additional studies and regulation proposals are included in the text.
  • HB 995 allows a temporary two-year license to be issued to physicians licensed in a foreign country and includes provisions for a full license to be redeemed after two years of practice in a medically underserved area.
  • SB 155 establishes the Virginia Health Care Career and Technical Training and Education Fund, changes certain educational requirements for nursing faculty, and creates a new licensing procedure for psychological practitioners, among other things.

With the Virginia General Assembly adjourned and a special session scheduled to consider a negotiated compromise budget on May 13, with a vote likely on May 15, no other related legislation is anticipated.


The 2024 Pennsylvania legislative session is underway, with lawmakers focused on addressing the state’s nursing workforce crisis. After a delay caused by a leaking pipe, the House passed a HB 1853 requiring annual meetings between the Department of Health’s nursing care field officers and nursing facility staff. The goal is to improve communication and understanding of survey findings and overall best practices. The bill now moves to the Senate Aging & Youth Committee for further consideration.

Additionally, a coordinated effort in both chambers is addressing the workforce shortage with three proposed bills:

  • SB 1102 / HB 2113 reduces the waiting period for nursing graduates to take the certified nurse aide exam.
  • SB 1103 / HB 2114 revises educational requirements, supplementing the mandatory high school diploma or GED for aspiring CNAs with other options.
  • SB 1104 / HB 2115 encourages high school students to gain early exposure to the healthcare field by working in congregate care settings.

These measures are supported by state Sens. Dave Argall and Michele Brooks and state Reps. Tim Twardzik, Dane Watro, Joanne Stehr and Jamie Barton. A separate bill, SB 668, would also expand the role of certified nurse aides by allowing them to administer prescribed medications after completing additional training.

Additional proposed legislation highlights:

  • HB 1931 reintroduces legislation for a registry of medical directors in nursing facilities, personal care homes and assisted living residences — a measure previously approved by the House.
  • SB 520 aims to ease the conversion of personal care homes into assisted living residences by addressing barriers related to Medicaid coverage and physical requirements.
  • SB 117 expands mandatory reporting and Department of Human Services oversight to include contract healthcare services agencies.

Some of this new legislation may create complex challenges for businesses in the senior living space. McGuireWoods Consulting stands ready to assist with any legislative or regulatory issue impacting your business model and goals.



This insight was originally posted on the website of our parent firm – McGuireWoods LLP – here.