Goodsurance

Policy & oversight

GAO: Medicare and Medicaid Together Spent About 12 Billion Dollars on Assisted Living Services in 2024, but Neither Covers the Cost of a Room

A federal watchdog report maps what government programs pay for inside assisted living facilities and what they do not, finding that the legal bar on using Medicaid funds for room and board is the main reason eligible seniors cannot access care they qualify for on paper.

By the Goodsurance editorial teamJuly 31, 2026

A Government Accountability Office report released in July 2026 found that Medicare and Medicaid together spent approximately 12 billion dollars on services delivered to residents of assisted living facilities in 2024. Federal Medicaid funds accounted for at least 3.5 billion dollars of that total, covering personal care and home and community-based services for income-eligible residents. Federal Medicare payments for health services provided to assisted living residents, such as skilled nursing visits, physical therapy, and hospice, made up about 8.7 billion dollars.

Both programs pay for health services delivered while a person lives in an assisted living facility, but neither program covers the room and board costs that typically represent the largest share of an assisted living bill. Medicare does not cover custodial or residential care in assisted living at any income level. Medicaid programs in 44 states cover a range of personal care services for eligible residents, but federal Medicaid statute prohibits those funds from being used for room and board in assisted living settings.

Medicare and Medicaid spent 12 billion dollars on assisted living services in 2024, but neither covers the room. A GAO report explains the gap.

The GAO found this restriction has practical consequences beyond a legal technicality. State and national organizations told researchers that Medicaid's inability to cover room and board is the primary barrier preventing more low-income older adults from using federal dollars to remain in assisted living rather than entering a nursing facility. The result, in the GAO's framing, is that Medicaid coverage of assisted living services can exist on paper without being financially realistic for many applicants.

For Medicare-eligible seniors weighing long-term care options, the report reinforces a persistent coverage boundary: Medicare covers limited post-acute skilled care, not long-term residential care, and neither federal program closes the gap between what the government pays and what assisted living actually costs.

In plain words

A government report looked at how much Medicare and Medicaid pay for care inside assisted living facilities. Together they paid about 12 billion dollars in 2024 for health services delivered there.

But neither program pays for the room itself or for meals. That part, called room and board, is almost always a private cost. Medicare does not cover long-term assisted living at all. Medicaid can pay for some personal care services in most states, but by law it cannot pay for the room.

This means many seniors who qualify for Medicaid help still cannot afford assisted living. The government covers some of their health care but not their housing. The report says this is the main reason many eligible people cannot access the care they legally qualify for.

Source: GAO
Read at the source →

More news

Other stories on what is moving in Medicare.

Policy & oversight

CMS Barred a Puerto Rico Medicare Advantage Plan From Accepting New Members for 2027

The Centers for Medicare and Medicaid Services issued an enrollment suspension notice on September 3 prohibiting MMM Healthcare LLC from enrolling new Medicare Advantage beneficiaries under contract H7522 for contract year 2027. Existing members are not affected.

September 23, 2026

Policy & oversight

Missouri Receives More Than 45 Million Dollars in Federal Rural Health Grants for Hospitals, Behavioral Care, and EMS Training

Today's announcement directs funds to facility upgrades at 20 rural hospitals, psychiatric consultation access for children and families, and training for hundreds of emergency medical workers.

September 22, 2026

Policy & oversight

OIG Found About 2.3 Million Dollars in Medicare Telehealth Billing Violations That CMS Safeguards Did Not Catch

A federal audit found that Medicare paid for virtual check-ins and e-visits that violated billing timing rules because CMS and its contractors lacked automated detection tools.

September 21, 2026

Policy & oversight

New Mexico Receives 74 Million Dollars in Federal Rural Health Funds to Expand Specialty Care Across Frontier and Tribal Communities

Six Regional Hub Organizations will use the five-year grant to bring telehealth, e-consults, chronic disease management, and workforce support closer to rural, frontier, and Tribal residents statewide.

September 21, 2026

Policy & oversight

Traditional Medicare Required Prior Authorization for Certain Services in Six States for the First Time Starting January 2026, KFF Finds

A KFF examination of the WISeR Model, active in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, found it targets services whose spending grew about 400 percent between 2019 and 2024.

September 21, 2026

Policy & oversight

CMS Releases Final Mandatory Participant List for New Medicare Specialist Payment Model Starting January 2027

Cardiologists and certain pain, orthopedic, and neurosurgery specialists treating Medicare patients for heart failure or low back pain in selected areas are now on notice that a mandatory payment model ties their Part B reimbursement to outcomes beginning January 1.

September 20, 2026