A new federal watchdog report requested by Senator Kirsten Gillibrand and other Senate Aging Committee Democrats says Medicare and Medicaid spent at least $12 billion in 2024 on services provided in assisted living facilities, while federal tracking and oversight remain limited.
The Government Accountability Office report found that the spending figure is likely an undercount because assisted living facilities are not uniformly defined in federal claims data, making it difficult to track services and costs.
What the report found
GAO identified at least $3.5 billion in federal Medicaid spending and $8.7 billion in federal Medicare spending for services provided in assisted living facilities in 2024.
Medicare generally does not cover assisted living services or room and board, but it may cover health care services such as hospice in assisted living facilities. Medicaid programs may cover assisted living services, including help with daily activities and other support services, as well as physical therapy or other covered care.
The report said 44 state Medicaid programs covered assisted living services for older adults or people with disabilities as of March 2025. Forty of those states covered the services through Medicaid home- and community-based services authorities.
Gillibrand said the report shows assisted living facilities receive billions in federal funding while facing little federal oversight to guarantee resident safety.
She said seniors and families deserve protection and peace of mind when seeking care in assisted living facilities, and pledged to keep pushing for stronger regulation and access to quality, affordable care.
Why the data is incomplete
GAO said spending estimates are limited because there is no single federal provider type that consistently identifies assisted living facilities across Medicare and Medicaid claims.
The report also said other federal agencies, including the Department of Housing and Urban Development and the Department of Veterans Affairs, pay for room, board or other costs in assisted living settings.
Demand is expected to grow
Assisted living facilities, including memory care centers, are state-regulated residences that provide housing, meals and support services to help people live independently.
The report said demand for assisted living services is likely to grow as the population ages, increasing pressure on federal and state programs to better understand spending, quality and oversight in those settings.
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