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Who is actually representing the 15,000 skilled nursing facilities and 1.5 million residents across the country when a new law, a Medicaid rule, or an AI regulation lands on a state capital's desk?
In this episode of Care, Code, and Capital, Dan sits down with JJ Rabinowich, Founder and Executive Director of the Ambassadors Group, to explore how advocacy, artificial intelligence, and capital are converging to reshape skilled nursing operations across the country.
JJ's path into long-term care advocacy started far from a nursing home. After running the West Coast office of a national advocacy organization in California and attending law school in Philadelphia, he landed in Chicago doing state level lobbying, much of it on behalf of nursing homes. Six years in, he left to open his own regulatory consulting practice, advising lenders and operators on which states were safer bets for long-term care investment and why.
That work exposed a gap. A new wave of operators was entering skilled nursing, but many of them were not speaking the same language as the people lobbying on their behalf in Washington, D.C. JJ and a group of operators set out to close that gap, founding what became the Ambassadors Group on January 1, 2020, with the belief that an operator with two buildings in a small state can shape the industry just as much as an operator with a hundred and fifty.
The Ambassadors Group launched with a modest agenda. Then COVID hit two months later. For nearly six months, JJ became the central node relaying daily regulatory guidance to operators nationwide over WhatsApp, who then passed it along to their own teams. What started as an advocacy group became critical infrastructure for an industry trying to keep up with rules that changed by the day.
That same instinct for unifying fractured voices later led the Ambassadors Group to help consolidate competing lobbying efforts in states like Texas and Illinois, on the theory that a single, unified voice gets heard by legislators in a way that several competing ones never will.
JJ offers a grounded look at how operators are putting artificial intelligence to work. Some are using two AI tools against each other, one to draft a plan of correction after a state survey, the other to argue the state's side and stress test it before it is ever submitted. Others are using AI to comb through operational data and flag where a building is underperforming.
He is careful to separate genuine value from noise. With new AI vendors appearing every week, evaluating what is real and what is not has become its own full time job for operators, many of whom stick with proven, established platforms rather than chase the newest tool on the market.
The conversation turns to the parts of AI adoption that have not caught up to reality. JJ points to a court ruling that stripped attorney client privilege from information an attorney had disclosed to an AI tool, and to a proposed HIPAA addendum that would end "we didn't know staff were using AI" as an acceptable excuse. With one survey finding that more than 90 percent of healthcare operators believe someone in their building is already using AI, often without HIPAA compliant tools, the regulatory catch-up cannot come fast enough.
JJ lays out the math behind the industry's biggest long-term challenge. By 2030, a majority of baby boomers will be over 65, even as the caregiving workforce continues to shrink. His view is direct: no other model of care is more efficient or cost effective for an aging population than a well-run skilled nursing facility, and nursing homes are not going anywhere. What is more likely to change is acuity, with both skilled nursing and assisted living taking on more complex residents over time.
JJ also unpacks why states are starting to question managed Medicaid. He points to Indiana, which pulled its long-stay population out of managed care after realizing it was paying a middleman roughly 100 million dollars without seeing better outcomes. He expects more states to follow, shifting future Medicaid investment away from flat rate increases and toward rewarding operators for measurable quality.
For operators looking to go out on their own, JJ's advice centers on partnership. The most successful operations pair someone focused entirely on operations with someone focused entirely on finance, backed by a capital partner who understands the regulatory realities of the business. Above all, he keeps coming back to one point: quality care is eighty percent of the battle, and getting involved in the political process is what protects the ability to keep providing it.
This episode offers a rare look at the intersection of policy, technology, and capital in long-term care, from the founding of a national advocacy organization to the legal gray areas of AI adoption to the Medicaid decisions that will shape skilled nursing for the next decade.
Topics covered in this episode include:
• JJ Rabinowich's path from advocacy work to long-term care lobbying
• Founding the Ambassadors Group and its January 2020 launch
• Becoming the industry's information hub during COVID
• Unifying fractured lobbying voices in states like Texas and Illinois
• Using AI to prepare and stress test state survey plans of correction
• The legal gray areas around AI, attorney client privilege, and HIPAA
• Why evaluating new AI vendors has become a full time job for operators
• The silver tsunami and the case for skilled nursing as a care model
• Why states like Indiana are rethinking managed Medicaid
• Advice for young operators on partnerships and capital
• The future of skilled nursing and assisted living acuity
Care, Code, and Capital explores the three forces redefining healthcare: care, technology, and capital. One conversation at a time.
