The Government Accountability Office should have its study of Medicaid in assisted living completed in early 2017, an agency representative told McKnight’s Senior Living.
“We’ll be looking at what is known about the number of Medicaid enrollees in assisted living facilities and the amount of Medicaid spending for related care; what is known about state Medicaid coverage for assisted living, payment levels and eligibility requirements; and how the federal government and states, particularly state Medicaid programs, oversee the care provided to individuals in assisted living facilities, and how, if at all, that differs from oversight of care provided to Medicaid-covered individuals in nursing facilities,” said Chuck Young, the GAO’s managing director of public affairs.
The federal agency began its investigation after four senators requested it last July. “Given the growth in federal Medicaid spending for long-term care services and expected program growth caused by the aging and expansion of the population and program, information to understand federal and state spending and oversight of care provided in these settings is needed,” Sens. Susan Collins (R-ME), chairwoman of the Senate Special Committee on Aging; Claire McCaskill (D-MO), ranking member of the aging committee; Orrin Hatch (R-UT), chairman of the Senate Finance Committee; and Elizabeth Warren (D-MA) wrote in a letter to the GAO at the time.
Representatives of several organizations working on behalf of providers told McKnight’s Senior Living that they have met with the agency, have offered to be a resource as the study continues, and look forward to the final report.
Stephen Maag, director of residential communities for LeadingAge, said he hopes the effort will highlight “a major weakness in the use of Medicaid funds in assisted living,” which is that the home- and community-based services waiver program used by many states to cover assisted living care and services does not cover room and board.
“If you think about it, a Medicaid resident is someone who, by definition, doesn’t have much in the way of assets, and so to have them be responsible for the room and board component of the overall assisted living rate is a significant impediment to many people being able to utilize that program,” he said.
Whether drawing attention to the issue will result in any changes remains to be seen, however, Maag said.
He is confident, however, that the GAO will find that current state oversight of assisted living is sufficient. “From our perspective, the vast majority of assisted living providers, both our members in the not-for-profit sector and the for-profit sector, do a great job and provide a high level of quality care to residents,” Maag said. “Now, there are always situations that arise where things aren’t being done as well as they should, and we continue to try to respond to that, but I think what the GAO will find, and what we expect them to find, is that the states do a very good job of oversight for the vast majority of cases, and it’s really the exceptions that get the publicity and create the concern.”
Maribeth Bersani, chief operating officer and senior vice president for public policy at Argentum, said that her organization shared two main points with the GAO in its discussions with the agency.
“We did want them to know that that waiver is used for younger, disabled people as well as seniors, and … there are differences in how some of those populations train their staffs,” she said. “All we asked was, if they just looked at the waiver, if they could try to make a distinction between serving just seniors or serving younger, disabled people.”
Argentum also pointed out to the GAO that many assisted living providers serve older adults who pay with private funds as well as older adults who are Medicaid beneficiaries, whereas some communities that serve younger, disabled or developmentally disabled people rely completely on Medicaid for payment, Bersani said. “If you’re only getting $37 reimbursement a day, it’s pretty darn hard to provide quality care,” she said. “And maybe that will come out in the study, and that will be absolutely a positive thing.”
Rachel Reeves, director of communications for the National Center for Assisted Living, said NCAL has offered to serve as a resource for the GAO. “We welcome the opportunity to help the senators and the agency better understand the profession, and we’ll continue to monitor the progress of this report,” she said.
Maag and Bersani are members of the board of directors of the Center for Excellence in Assisted Living, which also has met with the GAO. Lindsay Schwartz, senior director of workforce and quality improvement programs for NCAL, is CEAL’s chairwoman.