GAO $12 – A new Government Accountability Office report finds Medicare and Medicaid spent more than $12 billion on assisted-living facilities in 2024, while federal oversight remains limited. Senators Elizabeth Warren and Kirsten Gillibrand say the figures expose a huge
For many families, the decision to move an older loved one into long-term care is supposed to feel like a step toward stability. But a federal watchdog report released July 2 suggests the system underneath that choice is far less clear than it should be.
The Government Accountability Office found that federal health programs Medicare and Medicaid spent more than $12 billion on assisted-living facilities for older adults and people with disabilities. The spending level is rising at the same time that oversight responsibilities are fragmented—assisted-living facilities are typically regulated by states. while nursing homes face a more direct federal inspection and rules structure.
The result has landed in the middle of a fresh push by Democrats in the Senate for tougher federal oversight.
The spending numbers are now spelled out in detail. The GAO report said Medicare spent $8.5 billion in 2024 on behalf of nearly 830,000 people at assisted-living facilities. Most of that spending was for hospice care. but residents also received “home health” services including nursing as well as physical. occupational and speech therapy. Medicare also paid for home visits to assess people, along with nail care and psychotherapy.
In parallel, the GAO identified $3.5 billion in federal Medicaid spending in 2024 for services provided in assisted-living facilities. The report did not tally how much states paid to assisted-living facilities.
The headline figure—more than $12 billion—comes with important caveats. The GAO report said that amount did not include spending from other federal agencies such as Housing and Urban Development and Veterans Affairs. which also pay for room and board and other costs at assisted-living facilities. It also did not include spending by private insurance companies that administer Medicare Advantage plans.
That is part of why the debate over oversight has sharpened.
The senator who framed it as a protection problem, not a paperwork problem, was Elizabeth Warren. In an email, Warren said the report identified a “huge oversight gap.”
“Assisted living facilities receive billions in federal dollars. but there is no federal role in ensuring that they are providing high-quality care. ” Warren said. “Residents of these facilities deserve better. and that starts by making sure that assisted living facilities are making good use of taxpayer dollars and are not leaving our seniors out to dry.”.
Warren’s push is rooted in earlier warnings. She has sought more oversight of assisted-living centers for nearly a decade. Along with other senators. she requested a 2018 GAO report that documented safety issues including medication errors and deaths at assisted-living facilities in 22 states. During President Joe Biden’s administration, Warren also called for federal reporting standards for problems at assisted-living facilities.
Kirsten Gillibrand, the top Democrat on the Senate Aging Committee, echoed that urgency. Gillibrand vowed to bolster regulation and oversight, saying in an email that seniors and their families “deserve protection and peace of mind when seeking care in assisted living facilities.”
“Though these facilities receive at least $12 billion a year in taxpayer funding, they are subject to little federal oversight to guarantee resident safety. That’s unacceptable,” Gillibrand said.
Part of what makes the dispute so difficult is that assisted living and nursing homes are not the same type of care. Assisted-living facilities house and provide care to seniors and some people with disabilities. and residents typically live independently while receiving help with daily activities such as bathing. eating and using the restroom.
Nursing homes, by contrast, are often staffed by nursing assistants and higher-skilled positions such as licensed practical nurses or registered nurses. Nursing home residents generally have access to around-the-clock nursing or rehabilitation services.
Where oversight fits into that divide is where Democrats see a mismatch.
Assisted-living facilities are typically regulated by states, while nursing homes are regulated by the federal Centers for Medicare & Medicaid Services and subject to routine inspections.
LaShuan Bethea, executive director of the National Center for Assisted Living, pushed back against the direction of that argument. Bethea said assisted living is a high-quality option for more than 1 million Americans. and argued that the GAO report reinforces the idea that a range of assisted-living models—paired with state regulation through Medicaid waivers—is the best approach.
“A one-size-fits-all approach does not fit our assisted-living residents who each have unique needs,” Bethea said. “States are best equipped to manage their Medicaid programs and oversee assisted-living communities.”
The spending figures arrive as families also grapple with affordability.
A CareScout Cost of Care Survey in 2025 found that assisted-living facilities are typically less expensive than nursing homes for seniors seeking long-term care. Families, according to the survey, spend on average $74,400 a year for care at an assisted-living center. For nursing home care. the average annual cost was nearly $115. 000 for a semi-private room. and slightly more for a private room.
Still, money doesn’t go far when care needs are growing.
A March report from AARP said that home care and assisted-living costs for older adults and people with disabilities have surged over the past five years. AARP reported that the cost of the most common type of long-term services—home care and assisted-living services—rose nearly 50% from 2019 through 2024. far outpacing median income growth of 22% for senior households.
That’s the tension families face as assisted living becomes a bigger part of the long-term care picture: rising federal funding and growing demand on one hand, and—according to Warren and Gillibrand—limited federal involvement on the other.
The sequence of facts is now hard to ignore. Medicare and Medicaid spend billions at assisted-living facilities. state oversight is the norm. and federal inspections—so central to nursing homes—do not operate the same way for assisted living. With the GAO report laying out $12 billion in spending in 2024 and lawmakers calling the gap unacceptable. the next question is no longer whether taxpayer dollars flow to these facilities. but what protections come with them.
GAO assisted living Medicare Medicaid elder care Senate Aging Committee Elizabeth Warren Kirsten Gillibrand LaShuan Bethea long-term care costs
So basically nobody’s watching the assisted living stuff? Cool.
Medicare paid $12 billion and the feds are “limited”?? That sounds like a loophole for sure. I thought nursing homes were the only ones with problems, but I guess assisted living is just… not as regulated.
Wait I’m confused, isn’t assisted living like just apartments? If it’s “assisted” then why wouldn’t it have the same checks as nursing homes? Also $12 billion in 2024 sounds fake, like how they even track that number. My cousin says her place was fine though so idk.
Warren and Gillibrand want more oversight, sure, but every time the gov steps in it turns into red tape and higher costs. States already regulate, so maybe it’s just that people don’t report violations or something. The headline says gap in oversight but then it’s about Medicare/Medicaid spending, so are they saying fraud or just lack of inspections? Either way it’s upsetting, especially for families getting jerked around.