Argentum Response to GAO Report on Assisted Living Federal Spending
The Government Accountability Office (GAO) recently published a long-anticipated report examining federal spending associated with services delivered in assisted living settings. The report stems from a request made in January 2024 by several Democratic lawmakers on the U.S. Senate Aging Committee, following negative and misleading national media coverage of assisted living.
Most importantly, Argentum fundamentally disagrees with the findings of this report, as assisted living is primarily a residential and social model, not a clinical health care setting, and does not primarily receive Medicare payments. The report indicates that federal Medicaid and Medicare spending on services delivered in assisted living settings totaled at least $12 billion in 2024, with 44 states using Medicaid to cover assisted living services through a variety of home- and community-based care programs. It’s important to note that the federal spending is associated with assisted living settings, but those expenditures overwhelmingly flow to already regulated healthcare providers or through state-administered Medicaid programs, rather than to assisted living communities themselves.
Based on a press release issued on Monday, led by U.S. Senator Kirstin Gillibrand (D-NY), the ranking member of the Aging Committee, it is evident that some lawmakers plan to use this report to justify significantly expanded federal oversight and regulation of the sector. The press release includes quotes by Senator Gillibrand, “[T]hey are subject to little federal oversight to guarantee resident safety. That’s unacceptable,” and by Senator Elizabeth Warren (D-MA) who said, “This report identifies a huge federal oversight gap…there is no federal role in ensuring that they are providing high quality care.”
In response, Argentum developed a new draft white paper: The Case for State Regulation of Assisted Living: Why the State-Based Framework Works — and What a Federal Overlay Would Cost Seniors. This white paper directly counters the GAO report through five core arguments: (1) assisted living is a residence, not a medical facility, and Congress itself has defined it that way; (2) the GAO report documents a modest, already-regulated federal footprint — not an oversight gap; (3) assisted living’s model preserves Medicaid and Medicare budgets; (4) the state regulatory framework is rigorous, responsive, and accountable; (5) imposing a federal nursing home-style regime would raise costs, shrink Medicaid participation, and reduce options for seniors during the largest age wave in American history.
Argentum anticipated this report and Congressional follow-up since national media reporting began in late 2023, which was followed by hearings on assisted living led by then Aging Committee Chairman Bob Casey (D-PA), who lost re-election in 2024. While legislation was not introduced to impose new federal regulations of the sector, Senator Mark Kelly (D-AZ), drafted the ASSISTED in Assisted Living Act, federal legislation intended to help consumers and providers have information on best practices in assisted living with the goal of helping set expectations and improving quality and value. This legislation has not been formally introduced. Senator Kelly had also signed onto the January 2024 letter led by Senator Casey, prompting this GAO report.
It is worth noting that the report does affirm that assisted living operates within a layered system of oversight, where states license, inspect, and regulate assisted living communities, while Medicare- and Medicaid-certified providers remain subject to comprehensive federal regulation when delivering services to residents. It notes that assisted living provides an important residential alternative to nursing homes and institutional care, while allowing residents to receive supportive services in a more home-like environment.
The findings underscore the increasing importance of assisted living within the broader long-term care continuum and that assisted living plays in promoting independence, dignity, and choice for seniors who need help with daily activities. Importantly, it demonstrates how assisted living helps support individuals in community-based settings while reducing pressure on more expensive care environments. It notes the increasing reliance on assisted living settings as demand for long-term care continues to grow, and acknowledges challenges related to affordability, workforce capacity, and Medicaid reimbursement—issues that cannot be solved through additional federal regulation.
Separate but related to the report, Argentum is monitoring legislation introduced in Congress that could drastically increase federal oversight of assisted living by creating a new mandatory Medicaid entitlement for assisted living. The Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act (S. 4479 and H.R. 8662) amends the Social Security Act to require state Medicaid programs to cover assisted living services the same as nursing facility services for any individuals who meet nursing facility–level care criteria. While they support expanding access to assisted living, they believe this proposal would strain communities, limit innovation, and ultimately reduce access to care for seniors. Argentum is working with the bill sponsors, U.S. Senator Roger Marshall (R-KS) and U.S. Representative Max Miller (R-OH), to relay their concerns and to promote changes that preserve state flexibility, strengthen Medicaid waiver programs, and address reimbursement adequacy so providers can serve more seniors in high-quality, home-like settings.
Argentum continues to proactively work to educate policymakers and staff about the value of assisted living, the effectiveness of the state regulatory model, and the growing need for policies that support the availability of assisted living as America’s population ages. They are committed to shaping these conversation constructively, and will remain at the forefront to ensure that decisions affecting the sector are grounded in evidence, recognize the realities of assisted living operations, and preserve the ability of seniors to access the care and support they need in a place they can truly call home. As more Americans seek alternatives to institutional care, Argentum believes that policymakers should focus on expanding access, strengthening affordability, and supporting workforce development rather than creating duplicative regulatory structures.
In addition to their advocacy efforts, Argentum’s I Love Senior Living movement was launched this year, inviting residents, families, caregivers, team members, operators, and industry partners to share authentic stories that showcase connection, purpose, joy, service, innovation, and belonging across senior living. It is designed to reshape how lawmakers and the public see senior living by highlighting what residents, families, and professionals experience every day: communities where older adults form meaningful friendships, continue pursuing passions, receive support that improves quality of life, and remain connected to the people and activities that bring them purpose.
They anticipate that the GAO will issue another report on assisted living, likely within the next year, following a similar request made in March 2025 by Democratic members of the Aging Committee, who asked GAO to revisit questions related to assisted living oversight, Medicaid programs, critical incident reporting, and the role of federal involvement in the sector. As these reports are published, Argentum believes that some lawmakers will cite them as evidence for enacting sweeping federal regulations. They are closely monitoring these efforts, particularly if there is a shift in power in Congress following the November elections.
Thank you for your continued engagement and advocacy. If you have any questions, please don’t hesitate to reach out to President James R. Balda or Maggie Elehwany ([email protected]).
