Earlier last month, a Government Accountability Office (GAO) report provides results of a nationwide survey of Medicaid state agencies containing data specifically focused on assisted living services. The report showed only 22 of 48 participating states were able to provide meaningful information on the number of "critical incidents" in assisted living facilities (ALFs). Critical incidents include physical abuse, neglect, or exploitation. Additionally, the report showed that more than $10 billion dollars in federal and state Medicaid funding is spent annually on providing Americans access to assisted living.
Under federal law, Medicaid beneficiaries must require nursing home level care in order to qualify for coverage for assisted living care under a state’s waiver program or other Medicaid plan, resulting in ALF residents with significant needs and higher acuity levels. A growing number of individuals opt for ALF care in lieu of nursing home care. Despite requiring that beneficiaries need nursing home level care, federal standards governing how care should be delivered in ALFs do not exist. Instead, standards of care are entirely regulated at the state level. The statistics in the GAO report show that Medicaid state agency oversight is scarce. In fact, the GAO recognizes the Centers for Medicare and Medicaid Services may be unaware of problems because guidance on reportable deficiencies is lacking and reporting critical incidents is not mandatory.
Multiple Congressional members are urging the GAO to provide oversight and review the quality of care provided to Medicaid enrollees in assisted living. The Center for Medicare Advocacy stated, "…the dramatic increase in public funding of assisted living facilities over the past decade and the inadequate regulatory system at the state level indicate a need for federal oversight of the assisted living industry.” At this point, the assisted living industry can only wait and assess whether federal standards of care will be developed in the future.