​Two proposals released this past spring by the Centers for Medicare & Medicaid Services (CMS) threaten to exclude many assisted living providers, like those highlighted in this article, from participating in the Medicaid program.

If approved, the proposals could place providers in a state of limbo and threaten residents’ ability to live in their communities, assisted living advocates say.

At issue is a proposed rule that would exclude many communities from being considered a home- and community-based setting because of the following proposed definition: “a setting is not [a home- and community-based setting] if it is: (A) Located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment or custodial care; in a building on the grounds of, or immediately adjacent to, a public institution; or a housing complex designed expressly around an individual’s diagnosis or disability as determined by the Secretary; or (B) has qualities of an institutional setting, as determined by the Secretary.”

Letters from the National Center for Assisted Living, sent to CMS and to Congress, warn that if the proposed rules are not changed, they could force the majority of the 130,000 Medicaid beneficiaries currently living in assisted living communities to be transferred to a nursing facility setting.