Is More Government Oversight on Assisted Living Coming?

US Senators Kirsten Gillibrand (D-NY), Ron Wyden (D-OR), and Elizabeth Warren (D-MA) wrote in a March 31, 2025 letter to the Government Accountability Office (GAO) that a new review is warranted for assisted living facilities. "Given the threats to residents' health and safety revealed by GAO's 2018 report, a new review is necessary to evaluate the extent to which the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies have improved their capacity to protect the hundreds of thousands of seniors and individuals with disabilities who reside in these facilities," the letter demanded. The GAO's 2018 report found that state Medicaid agencies had spent more than $10 billion in federal and state funds on assisted living services in 2014. The report also raised the alarm that 26 of the 48 state Medicaid agencies studied could not report the number of "critical incidents" - such as abuse, neglect, or exploitation - that occurred in the assisted living communities located in their states.

The letter also requested the GAO to investigate four questions:

1. How do state Medicaid programs currently oversee and monitor the health and welfare of beneficiaries that receive services in assisted living communities, and how has this oversight changed since GAO’s 2018 report was written?

2. What types of deficiencies and critical incidents have state Medicaid programs or other state or local regulatory agencies identified at assisted living communities in recent years?

3. How is CMS implementing the requirements for state Medicaid programs to meet new standards for monitoring and reporting on critical incidents in home- and community-based settings such as assisted living communities, and what other steps has the agency taken to improve federal oversight of beneficiary health and welfare in assisted living facilities?

4. Is there a need for additional federal oversight of assisted living?