Long-term services and supports, value-based care and regulatory scrutiny are among the key issues facing senior living providers one week after President Biden’s inauguration.

Policy experts discussed those and other issues affecting the industry Wednesday during a policy outlook webinar from the National Investment Center for Seniors Housing & Care.

Increased scrutiny

After its significant lobbying and education of lawmakers about senior living, said Anne Tumlinson, founder and CEO of ATI Advisory, the industry should watch for increased scrutiny and a “crackdown” on assisted living. Expect congressional hearings and pushes from lawmakers for different degrees of federal regulation in the near term, she said.

“An enormous amount of Medicaid money is going into assisted living right now. There’s a hook,” Tumlinson said. “ ‘Never again pandemic’ is now going to be part of healthcare policy going forward.”

More than 16% of assisted living residents rely on Medicaid for daily services, according to the National Center for Assisted Living.

Tumlinson said the long-term care industry, especially assisted living, has to be clear and strategic in articulating its value to federal policymakers in terms of what operators are contributing to the larger healthcare ecosystem.

“This is an administration that cares deeply about healthcare,” said Dan Mendelson, founder of Avalere Health. “Healthcare is going to be front and center.”

People investing or operating in the long-term care arena “should strap on their seatbelts because there’s going to be a lot of activity that is coming out,” he added. 


As early as today, Mendelson said, expect a series of executive orders with a goal of expanding coverage through existing programs, including health exchanges and Medicaid. Analysts, he added, concluded that one of the ways to erase disparities in healthcare is by expanding coverage through these existing channels.

Tumlinson said that she anticipates continued rapid enrollment and value driven to consumers through Medicare Advantage plans, which she said are attractive to low-income racial minorities and people who have chronic conditions. She also anticipates expansion in Medicaid managed long-term services and supports.

Depending on what happens in the next year, Tumlinson also said she anticipates an increase in federal contributions for home- and community-based services. Senior living, and particularly assisted living, she said, receives much of those Medicaid HCBS dollars.

Much of the Medicaid HCBS in assisted living is supported via Section 1915(c) waivers. Expenditures for HCBS for all Medicaid-eligible older adults and disabled individuals through those waivers topped $6.6 billion in 2018, representing 7.1% of overall spending for long-term services and supports in 2018, according to the Centers for Medicare & Medicaid Services.

Bob Kramer, NIC co-founder and strategic adviser, as well as president of Nexus Insights, co-moderated the webinar with Lynne Katzmann, Ph.D., president and CEO of Juniper Communities, which led the formation of a Medicare Advantage Plan called Perennial Advantage Plan and whose Connect4Life care coordination model is finding its way into senior living communities across the country under the terms of a five-year licensing agreement between Juniper and Medicare Advantage plan developer and administrator AllyAlign Health.

Kramer said that Medicare Advantage membership has experienced explosive growth, with 36% of eligible beneficiaries enrolled. Some estimates show those numbers increasing to 50% as soon as 2025, he added.

But Mendelson cautioned that the Biden administration will not just give “blank checks” to Medicare Advantage plans. Assisted living and skilled nursing providers, as well as investors in the sector, he said, should expect more scrutiny related to the beneficiary experience, quality and marketing practices. 

Proving value

“Learning to navigate in this context — having outstanding data, proving your value, having relationships with the people doing capitation work in our area — will become even more important as we move forward,” Mendelson said.

Assisted living needs to become more involved in these discussions, he added.

“If you want to shape the future of Medicare Advantage policy, you have to have a positive vision for what that means in your buildings,” Mendelson said.

“Assisted living was put on the map as part of the healthcare continuum as a result of lobbying for healthcare relief dollars to go to the sector,” Kramer said. “Now there are great opportunities for the assisted living sector with regard to how it can show how it can deliver using these programs, but at the same time, it had better be ready, because others will be eager to take those dollars if assisted living isn’t.”

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