The U.S. Government Accountability Office (GAO) recently released a new report, Assisted Living Facilities: Information on Federal Spending and Medicaid Coverage.
The report includes several key findings:
- Assisted living facilities serve as a residential alternative to in-home care and nursing homes for individuals needing assistance with activities of daily living (ADLs), such as eating and bathing.
- Federal Medicaid and Medicare spending for services delivered in assisted living totaled at least $12 billion in 2024, though GAO notes this is likely an undercount due to data limitations and inconsistent provider definitions.
- Medicaid: At least $3.5 billion in federal Medicaid spending for assisted living services, including ADL support and other services such as physical therapy.
- Medicare: $8.5 billion in traditional Medicare spending for services delivered in assisted living settings (e.g., hospice), though Medicare does not cover assisted living services themselves.
- Other federal programs (HUD, VA) may help beneficiaries cover certain costs, including room and board, but spending levels are unknown.
- 44 states cover assisted living services through Medicaid for older adults and people with disabilities; 29 of these rely on HCBS waivers that allow enrollment targeting and participant caps.