From McKnight’s Senior Living – By Kimberly Bonvissuto –
Assisted living could become a covered benefit under Medicaid under proposed legislation, but senior living groups caution that one-size-fits-all policies risk unintended consequences.
Last week, Sen. Roger Marshall (R-KS) introduced the Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support, or ACCESS, Act to make assisted living a covered Medicaid benefit for older adults who meet nursing facility-level care criteria. The goal is to lower federal Medicaid spending while expanding access to community-based care.
Medicaid spending is projected to grow 63% in the next decade, placing increased pressure on federal and state budgets. Those state budgets already are under pressure to absorb $1 trillion in federal Medicaid cuts under HR 1, the budget resolution bill signed into law in summer 2025. Senior living groups have warned that substantial cuts to federal Medicaid spending could lead to reduced spending for home- and community-based services, because states are required to provide nursing home care to Medicaid beneficiaries deemed to need it, but providing HCBS to Medicaid beneficiaries generally is optional.
Supporters said the bill would realign incentives by allowing states to provide care in settings that better match someone’s needs without increasing overall program costs. But the move could bring additional federal scrutiny to the assisted living sector.
The National Center for Assisted Living told McKnight’s Senior Living that it appreciates efforts to expand access to assisted living for Medicaid beneficiaries paired with provider reimbursement. But NCAL Executive Director LaShuan Bethea said that it is “imperative to preserve state flexibility.” States and providers should be able to opt into a program to ensure that care delivery models can be designed and implemented to reflect the unique needs of residents and communities, she said.
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