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Assisted Living

State Medicaid agencies fail to report critical information about assisted living services

State Medicaid agencies covering assisted living services are failing to report some critical information about beneficiaries’ health and welfare, according to the United States Government Accountability Office (GAO), which released a report in January. According to the GAO:

  • Twenty-six state Medicaid agencies could not report to GAO the number of critical incidents that occurred in assisted living facilities, citing reasons including the inability to track incidents by provider type (nine states), lack of a system to collect critical incidents (nine states), and lack of a system that could identify Medicaid beneficiaries (five states).
  • State Medicaid agencies varied in what types of critical incidents they monitored. All states identified physical, emotional, or sexual abuse as a critical incident. A number of states failed to identify other incidents that may indicate potential harm or neglect, such as medication errors (seven states) and unexplained death (three states).
  • State Medicaid agencies varied in whether they made information on critical incidents and other key information available to the public. Thirty-four states made critical incident information available to the public by phone, website, or in person, while another 14 states did not have such information available at all.

GAO recommended that the Centers for Medicare & Medicaid Services clarify state requirements for reporting program deficiencies and require annual reporting of critical incidents. HHS said it would consider annual reporting requirements for critical incidents after completing an ongoing review.

State Medicaid agencies in 48 states that covered assisted living services reported spending more than $10 billion (federal and state) on such services in 2014, according to the GAO. These 48 states reported covering these services for more than 330,000 beneficiaries through more than 130 different programs.

Editor’s note: The GAO report – Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare Is Needed – is online at

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