A recently released Government Accountability Office (GAO) report examining federal spending associated with services delivered in assisted living settings is expected to intensify congressional discussions about the future of assisted living oversight. The report, requested by several Democratic members of the Senate Aging Committee in 2024, found that federal Medicaid and Medicare spending associated with services provided in assisted living settings totaled at least $12 billion in 2024.
The report’s release prompted calls from some policymakers for greater federal involvement in assisted living regulation. In a press release issued on Monday, U.S. Senator Kirstin Gillibrand (D-NY), the ranking member of the Aging Committee, said “[T]hey are subject to little federal oversight to guarantee resident safety. That’s unacceptable.” In the same press release, Senator Elizabeth Warren (D-MA) said, “This report identifies a huge federal oversight gap…there is no federal role in ensuring that they are providing high quality care.”
Argentum strongly disagrees with the premise of the report and the conclusion by these lawmakers. Assisted living is fundamentally a residential and social model—not a clinical health care setting—and most federal spending identified in the report flows through state Medicaid programs or federally regulated health care providers serving residents, rather than directly to assisted living communities. Argentum is developing a white paper to promote how assisted living is already subject to robust state oversight and that imposing a nursing home-style federal regulatory model would increase costs, reduce provider participation in Medicaid, and limit options for seniors.
Notably, the GAO report acknowledges that assisted living operates within a layered oversight system in which states license, inspect, and regulate communities, while Medicare- and Medicaid-certified providers remain subject to federal regulation. The report also recognizes assisted living as an important alternative to institutional care, allowing older adults to receive support in a more home-like setting. The findings highlight both the growing role of assisted living in the long-term care continuum and challenges facing the sector, including affordability, workforce shortages, and Medicaid reimbursement pressures.
Argentum is also working with lawmakers in response to the introduction of the ACCESS Act (S. 4479/H.R. 8662), which would create a new mandatory Medicaid entitlement for assisted living services. Argentum continues to advocate for policies that preserve state flexibility, strengthen existing waiver programs, and improve reimbursement adequacy.
As federal interest in the sector grows, Argentum will continue educating policymakers about the value of assisted living, the effectiveness of the state-based regulatory model, and advancing policies that expand access, strengthen affordability, and support workforce development—not through duplicative federal regulations.