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Impact of Medicaid Assisted-Living Policies: New Issue Brief Series

A significant number of frail elders with Medicaid coverage choose to live in an assisted-living facility as an alternative to a nursing home. Yet, low-income older adults who are dually eligible for Medicare and Medicaid (known as dual eligibles) face many challenges in obtaining Medicaid coverage for high-quality assisted living services.

In addition, though Medicaid has been paying for assisted living services for over 20 years, either through Home and Community-Based Services (HCBS) waivers, demonstration waivers, or state-plan services, to this day there exist no federally established standards for assisted living facilities. This lack of federally established standards leaves some residents in danger of discriminatory practices. As the program grows it becomes more important to address how Medicaid funding for assisted living operates in practice in order to identify the appropriate consumer protections required to rectify existing problems.

With support from The Commonwealth Fund, the National Senior Citizens Law Center undertook an extensive study of federal and state Medicaid policies for assisted living coverage, with a special focus on how such policies affect the lives of dual eligibles. The research included a survey of respondents in the 37 states that pay for assisted living services through a federal Medicaid Home and Community-Based Services waiver, as well as more in-depth research of policies and practices in five of those states: Arkansas, New Jersey, Oregon, Texas, and Washington. The research was conducted in cooperation with the University of California at San Francisco.

Policy briefs and white papers from this study, the “Medicaid Payment for Assisted Living Policy Issue Brief Series,” are published as a resource for advocates, policymakers, state Medicaid officials, assisted living facility operators, and others on

The publications include:

  • Transfer of Assets: Making Assisted Living Residents Ineligible Forever. Focuses on policies in some states that impose a permanent ineligibility as a transfer-of-assets penalty for people seeking Medicaid coverage for assisted living services.
  • Refusing to Admit Eligible Applicants. Looks at facilities that deny admission to applicants with greater care needs or that reject Medicaid-eligible applicants to save space for residents with private insurance.
  • Using Medically Needy Eligibility to Prevent Resident Evictions. Addresses the need for more states to offer medically needy eligibility, which extends coverage to those whose income is over the income limit but still insufficient to cover health care expenses. 
  • Requiring Families to Supplement Medicaid Payment. Examines assisted living facilities that attempt to obtain payment above and beyond that authorized by Medicaid and/or SSI from residents’ family and friends.

To read these publications, visit, a National Senior Citizens Law Center Web site.

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