Senators Urge Federal Government To Explore More Oversight Of Medicaid In Assisted Living

Three U.S. senators are calling for a new investigation into the quality of assisted living communities across the country that participate in Medicaid.

Sens. Elizabeth Warren (D-Mass.), Ron Wyden (D-Ore.) and Kirsten Gillibrand (D-N.Y.) have filed a letter to the Government Accountability Office (GAO) to review and update its 2018 report on state and federal oversight of assisted living facilities that participate in Medicaid. U.S. states currently regulate assisted living communities, unlike nursing homes, which are regulated on the federal level.

“This lack of federal requirements and variation in state requirements may impede efforts to identify patterns of incidents in assisted living facilities that affect resident health and welfare, such as abuse and neglect, or other problems affecting residents, such as evictions,” the March 31 letter reads.

A 2018 GAO report found that the majority of state Medicaid agencies didn’t track critical incidents affecting beneficiaries living in assisted living communities.

“In its report, GAO concluded that CMS may be unaware of widespread problems affecting Medicaid beneficiaries at assisted living facilities due to a lack of clear federal guidance on reportable deficiencies and no uniform requirement for state Medicaid agencies to report critical incidents,” the letter reads. “Troublingly, this may hinder efforts to hold assisted living facilities accountable for endangering residents. It also poses challenges for federal agencies, elected officials, or other groups who seek to evaluate state agencies’ oversight of assisted living facilities.”

The senators are asking GAO to update its findings on oversight of assisted living communities. Specifically, they are seeking to know how state Medicaid programs currently oversee and monitor the health and welfare of beneficiaries that receive services in assisted living facilities; what types of deficiencies and critical incidents state Medicaid programs or other state or local regulatory agencies have identified at assisted living communities; how Centers for Medicare & Medicaid Services (CMS) is implementing requirements for state Medicaid programs to meet new standards for monitoring and reporting on critical incidents; and whether there is a need for additional federal oversight of assisted living facilities, either through existing programs like Medicaid or via new regulatory efforts.

The senators’ letter follows years of heightened public scrutiny of senior living. A 2023 report from the Washington Post found thousands of cases since 2018 where senior living residents wandered away from their communities, including some cases where they died as a result. That reporting helped prompt a 2024 Senate review that included testimony from Gardant co-president Julie Simpkins.

A statement from Argentum said the organization is in favor of various oversight and accountability measures to require state Medicaid agencies to meet transparency requirements, including reporting substantiated incidents to CMS and accompanying regulatory action when appropriate, but worries federal oversight could have negative impacts for the residents and the industry, particularly for communities that have Medicaid assisted living waiver programs.

An immediate impact, the statement reads, would be care falling to “other settings that would be quickly overwhelmed with demand and limited capacity.”

“We call on policymakers to expand access and make care more affordable, invest in programs that are already saving the government money on long-term care, not restrict resident choice or institute more regulations that would cause providers to be discouraged from participation or discontinue participation altogether,” the statement said. 

While the GAO report found inconsistencies, it also didn’t make recommendations for the regulation of the industry, according to Jeanne Delgado, vice president of government affairs for the American Seniors Housing Association (ASHA), who added the organization is interested in the findings of the request.

“ASHA supported then as now, their recommendations to improve effectiveness, including coordination between CMS and state Medicaid agencies to improve key reporting requirements,” Delgado told Senior Housing News. “These efforts coupled with the protection already provided by the state licensing bodies and agencies, will help to ensure the health and well-being of Medicaid beneficiaries living in assisted living.”

This is not the first time Warren has called for additional oversight into assisted living communities. In 2020, she was among two senators and a Congressional representative sought answers from some of the industry’s largest providers about their Covid-19 infection rates and response measures. In 2015, she was among a group of four bipartisan senators who sought additional federal oversight in a similar manner to the letter filed March 31.

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