U.S. Senators Elizabeth Warren (D-MA), Susan Collins (R-ME), Claire McCaskill (D-MO), and Orrin Hatch (R-UT) requested in a letter dated July 8, 2015 that the U.S. Government Accountability Office (GAO) undertake a review of Medicaid spending and federal and state oversight of care provided to Medicaid enrollees in assisted living facilities. The senators, all members of the Senate Special Committee on Aging, noted that while the federal government monitors aspects of care provided to Medicaid and Medicare enrollees in nursing facilities, it is typically (and historically) the states that oversee and monitor care provided to individuals in assisted living facilities. States cover assisted living services through Medicaid home and community-based services waivers, state plans, or Medicaid comprehensive demonstration waivers.

The four senators also noted that the information such an investigation would produce is needed because of the “growth in federal Medicaid spending for long-term care services and expected program growth caused by the aging and expansion of the population and program . . .” The letter then shifts from the “big picture” to requesting that the GAO address three specific questions:

  1. What is known about the number of Medicaid enrollees in Assisted Living facilities and the amount of Medicaid spending for related care?
  2. What is known about state Medicaid coverage for Assisted Living, payment levels, and eligibility requirements?
  3. How do the federal government and states, particularly state Medicaid programs, oversee the care provided to individuals in Assisted Living facilities, and how, if at all, does this differ from oversight of care provided to Medicaid-covered individuals in nursing facilities?

In addition, the signatories explain that they are seeking to understand how states have structured their Medicaid programs to cover assisted living services. Depending on the content of the final report, the debate over how much federal oversight of assisted living is appropriate may become the subject of greater attention and focus.