NASL Article Details



General Announcement

GAO Reports on Medicaid Funding in Assisted Living

NASL, 2/28/2018


On February 5, 2018, the Government Accountability Office (GAO) released a report entitled, Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health & Welfare Is Needed. The report responds to a 2015 request from Senators Susan Collins (R-ME), Claire McCaskill (D-MO), Elizabeth Warren (D-MA) and Orrin Hatch (R-UT), who asked for a review of Medicaid spending and federal and state oversight of care provided to Medicaid beneficiaries in assisted living. 

The report focuses on the health and safety of Medicaid beneficiaries living in assisted living. The GAO study identified some areas of weakness in defining critical incidents, reporting of this information to Medicaid agencies and making this information available to the public. Specifically, the report noted the following:

  • The report focuses primarily on the lack of information that the state Medicaid agencies had regarding a number of incidences involving Medicaid beneficiaries in assisted living facilities. The GAO found 26 Medicaid state agencies could not report to GAO the number of critical incidences for this population.
  • The report also highlights the lack of criteria defining “critical incidents.” While all Medicaid agencies included elder abuse in that definition, not all included medication errors or unexplained deaths.
  • The report also looks at whether information on critical incidents was made available to the public, finding 34 states did make this information available online, or by phone, and 14 states did not have information available. 
  • The Centers for Medicare & Medicaid Services' (CMS') oversight of home-and-community-based (HCBS) programs requires that states provide annual reports to CMS and identify program deficiencies. The GAO found that CMS instructions for completing the HCBS annual report are not specific enough with regard to what should be reported as a deficiency, and what steps should be taken to ensure deficiency will not recur. In addition, the GAO identified 28 states that had not provided CMS with the required annual reports.


GAO Recommendations
The GAO surveyed all state Medicaid agencies and interviewed officials in three states: Georgia, Nebraska and Wisconsin. The GAO also reviewed regulations and interviewed CMS officials in advance of making the following three recommendations to CMS:

1. The CMS Administrator should provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states (state Medicaid agencies) using HCBS waivers are required to report on their HCBS annual reports.

2. The CMS Administrator should establish standard Medicaid reporting requirements for all states (state Medicaid agencies) to annually report key information on critical incidents, considering at a minimum, the type of critical incidents involving Medicaid beneficiaries, and the type of residential facilities (including assisted living) where critical incidents occur. 

3. The CMS Administrator should ensure that all states (state Medicaid agencies) submit annual reports for HCBS waivers on time as required.


Read the full GAO report here. Review highlights from the GAO report here