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By Aliss Higham
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A newly proposed measure in the House of Representatives seeks to broaden Medicaid to cover certain services provided in assisted living settings for some low-income older adults, potentially enabling more seniors to receive care outside traditional nursing homes.
Introduced by Republican Representative Max Miller of Ohio, the bill would require state Medicaid programs to cover assisted living services for eligible individuals, provided the cost does not exceed that of care in a hospital or nursing facility. Medicaid is a federal and state program that helps with medical costs for people with limited income.
The effort comes amid mounting pressure on state and federal policymakers from an aging population, increasing nursing home costs and persistent criticism that Medicaid tends to favor institutional care over less restrictive options.
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What To Know
The legislation would expand Medicaid’s definition of “medical assistance” to clearly encompass services provided in assisted living facilities, provided they are permitted under state law.
Coverage would extend to seniors who meet Medicaid’s financial eligibility criteria and who would otherwise qualify for hospital-level or nursing home care. States would need to demonstrate that delivering care in assisted living environments does not lead to higher average Medicaid spending than institutional alternatives.
The proposal would also make assisted living services a mandatory Medicaid benefit, meaning states would generally have to provide coverage once the policy takes effect.
The legislation also includes a provision related to the federal Low-Income Housing Tax Credit (LIHTC), a tool used to finance affordable housing.
State housing agencies would be encouraged to prioritize developments that reduce long-term Medicaid costs by providing housing paired with supportive services for older residents in community-based settings. This would apply to tax credit allocations issued after January 1, 2027.
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Who Could Be Affected
According to the Centers for Disease Control and Prevention (CDC), as of 2022, roughly 1 million people in the United States live in assisted living or similar residential care settings. Approximately 17 percent are Medicaid beneficiaries.
More widely, the measure could impact low-income seniors who currently pay out of pocket for assisted living until their savings run out, after which many must transition to nursing homes to remain eligible for Medicaid.
What Happens Next
The bill has been sent to the House Ways and Means Committee and the Energy and Commerce Committee for consideration ahead of any potential floor vote.
If approved by Congress, the changes would take effect on January 1, 2027. States requiring additional legislation to comply could receive extra time aligned with their legislative schedules.
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