On February 5, 2018, the Government Accountability Office, a nonpartisan investigative arm of Congress, found that there are huge gaps in regulation of assisted living facilities. The report, entitled “Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare is Needed,” comes on the heels of years of discussion as to whether assisted living facilities are sufficiently regulated by individual states, or whether further federal oversight is warranted.

The suggestion of the need for federal regulation of assisted living came from GAO’s finding that more than $10 billion a year is spent from federal and state funds for assisted living services for more than 330,000 Medicaid beneficiaries. With demand for additional Medicaid assisted living funding, and the potential increase in demands of the senior population in the next 5 years, these numbers will continue to rise significantly as noted by the GAO: “Medicaid spending on long-term care is significant, representing about one quarter of Medicaid spending annually and is expected to grow with an aging population.”

If the federal government is paying in part for these Medicaid assisted living beneficiaries (almost 25% of Medicaid spending), the GAO asks the obvious question: why wouldn’t the Federal government want to regulate the assisted living industry?

The GAO report also called out the lack of abuse and neglect or critical incident reporting for what the GAO calls a “particularly vulnerable” elderly population in assisted living facilities. The conclusion: that CMS has done little to provide guidance to states, and little to monitor state uses of funds for assisted living.

It remains to be seen how this much anticipated GAO report will affect Congress, and whether Congress will move to regulate assisted living as they did with skilled nursing homes back in 1987.