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Proposed Medicaid Waiver Rules Could Greatly Reduce Choice Says Leading Senior Living Organization


ALEXANDRIA, Va. – June 15, 2011 – The Assisted Living Federation of America (ALFA) today expressed its concern in a letter to the U.S. Centers for Medicare & Medicaid about a revised proposed rule that will guide implementation of Medicaid Home and Community-based Service (HCBS) waivers. These waivers were intended to offer seniors of limited financial means more senior care options.

“Some components of the proposed rule could have a devastating effect of denying the opportunity for frail seniors to participate in the HCBS waiver program,” wrote Richard P. Grimes, president and CEO of ALFA. “A recurring theme in our comments is that the proposed rule focus on the specific needs of the individual, and not on the physical setting as the determination for a home and community-based environment.”

Grimes continued, “We strongly object to rules that define a home and community-based setting based on the size of the apartment or the number of people who may live in an assisted living community. Further, individuals must have the choice to live where they want to live. The core values of respect, dignity, privacy, independence, autonomy and choice are the foundation for person-centered planning. When operationalized, each individual is treated as a unique person with inherent value. Our belief is that this is the true measure of a home and community-based setting.”

In addition to commenting on the proposed rule, ALFA also addressed the background section of it that outlines eight specific conditions assisted living communities, and only assisted living communities, must meet to qualify for the waiver program.

“Given the numerous congregate care options available to seniors today, it is completely unfair in this case to single out assisted living or to treat it differently from all the other options. While we provided comments related to each of the eight conditions, a potential result of the conditions is less access to quality community-based options,” Grimes said.

The comments were provided to CMS as part of a request for comments on a proposed rule to 42 CFR Part 441 of the Federal Register and as it relates to implementation of Medicaid Home and Community Based Services waiver under section 1915(c) of the Social Security Act. The complete comments by ALFA are found online at

About the Assisted Living Federation of America
Assisted Living Federation of America (ALFA) is the largest national
association exclusively dedicated to professionally-managed,
resident-centered senior living communities and the seniors and families
they serve.  Since 1990, ALFA has advocated for choice, accessibility,
independence, dignity, and quality of life for all seniors.  ALFA’s
programs promote business and operational excellence through education,
research, publications, professional networking and online tools
designed to foster innovation and entrepreneurialism in the field of
senior living.  Visit ALFA’s Web site at