Abolition of "Additional Payment for Extra Caregiver Staffing" Is Lawful

The court has ruled that the Ministry of Health and Welfare's notice, which strengthened the staffing standards for caregivers at nursing homes and abolished the additional payment for extra staff, is lawful. The court stated that because service quality and the sustainability of public finances must be considered comprehensively, the Ministry of Health and Welfare is granted broad discretion in setting such standards.

On May 28, the Administrative Division 5 of the Seoul Administrative Court (Presiding Judge Lee Jeongwon) dismissed all claims filed by 11 social welfare foundations and one non-profit foundation operating nursing homes, who had brought an administrative lawsuit against the Minister of Health and Welfare seeking to annul the notice (2025Guhap53089).

[Facts]

The defendant, the Ministry of Health and Welfare, revised the "Notice on the Standards for the Provision of Long-Term Care Benefits and the Calculation Method of Benefit Costs" on December 31, 2024. As a result, the additional payment system for extra caregiver staffing at nursing homes was abolished, and the range of maximum additional payments available for hiring personnel beyond the minimum staffing standards (including positions other than caregivers) was reduced.

On the same day, the Ministry of Health and Welfare also revised the enforcement regulations of the Elderly Welfare Act to strengthen the staffing requirement for caregivers in nursing homes from one caregiver per 2.3 residents to one caregiver per 2.1 residents. The amended regulations took effect on January 1, 2025, with a grace period granted to existing facilities until December 31, 2026, to comply with the new standards.

The plaintiff organizations argued that if they could not meet the new standards within the grace period, they would have to accept a reduction in benefit payments or discharge existing beneficiaries and that, in principle, they would not be eligible for additional payments even if they employed more caregivers than the standard. They further claimed that the notice revision process was procedurally flawed because the Ministry of Health and Welfare did not hold a public hearing or give the plaintiffs a specific opportunity to submit opinions, and that the content of the notice violated the principles of proportionality, protection of trust, and equality.

[Court Ruling (Main Points)]

- At the Long-Term Care Committee held by the Ministry of Health and Welfare on September 13, 2021, a representative of long-term care providers participated as the supplier's representative. In 2024, there were three meetings with provider groups, and before revising the notice, an administrative pre-announcement was made to provide the general public with an opportunity to submit opinions. Not providing individual opportunities for submission of opinions to the plaintiffs, when the disposition applies to a large number of unspecified long-term care institutions, does not constitute a procedural flaw.

- Less restrictive means could be available to the plaintiffs, but those alternatives would require greater financial resources and could increase the burden on society as a whole. Since the increase in staffing standards was accompanied by a corresponding increase in the basic benefit rates, it cannot be concluded that the plaintiffs' private interests have been infringed. The public interest served by the notice cannot be considered less significant than the private interests of the plaintiffs, and thus there is no violation of the principle of proportionality.

- The fact that the Ministry of Health and Welfare maintained the additional staff payment system for 16 years alone cannot be regarded as an explicit public statement guaranteeing that it would continue. Even if any expectation of trust was formed, it cannot be seen as warranting protection that outweighs the public interest in providing high-quality long-term care services and ensuring the soundness of long-term care insurance finances. Therefore, there is no violation of the principle of protection of trust.

- While the additional staff payment system is maintained for day care centers and short-term care institutions, these entities differ from nursing homes in terms of their nature, the types of beneficiaries served, the content of long-term care benefits, the basic staffing standards, and the basic benefit rates. The other positions cited by the plaintiffs as grounds for discrimination, such as social workers and nurses, also differ in their duties and staffing standards, meaning these are not valid comparison groups. Thus, there is no violation of the principle of equality.

Baek Jinwoo, Law Times Reporter

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