The Government Accountability Office (GAO) released a report on July 2, 2026, that profiles federal spending and Medicaid coverage of Assisted Living. The report was driven by a 2025 request from a group of Democratic Senators to update a 2018 GAO report on state and federal oversight of assisted living facilities that participate in Medicaid.

For the 2026 report, GAO analyzed Medicaid and traditional, fee-for-service Medicare claims, as well as documentation for other programs that may cover assisted living services through agencies such as the Department of Housing and Urban Development (HUD), Social Security, and the Veterans Administration (VA). GAO found that 44 states covered assisted living services through various Medicaid programs such as the Home- and Community-Based Services (HCBS) waiver, a Medicaid demonstration, or state plan. HCBS waivers were most commonly used. GAO found that federal spending on assisted living services through Medicaid was at least $3.5 billion in 2024; total federal spending on assisted living services from all programs was unable to be calculated due to data limitations and differences in assisted living categorization by state.

Federal-state Medicaid spending on services provided in assisted living averaged about $23,000 per beneficiary, but costs for services varied widely, both across states and within states, based on factors such as facility size, services, and location. Most Medicaid beneficiaries receiving services provided in an assisted living setting were dually-eligible for Medicare and Medicaid, with 24% of beneficiaries being between the ages of 65-74 years. Rates of beneficiaries aged 75-84 years, and 85 years and older were comparable.

Stakeholders interviewed by GAO cited five key barriers affecting access to federally funded assisted living services: lack of coverage outside of Medicaid, coverage limitations within Medicaid, provider participation challenges, and the changing landscape including an increased demand for assisted living services at the same time that Medicaid funding is being cut at the federal level. LeadingAge closely monitors federal involvement in assisted living oversight and understands this report may provide fodder for future proposals to expand federal assisted living requirements, which LeadingAge opposes.