New Managed Care Findings from Brown University Outlined (Medicaid Mechanisms and State Licensure: Pathways to Payment in Assisted Living): Managed Care

2025 NOV 18 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Data detailed on Managed Care have been presented. According to news reporting originating from Providence, Rhode Island, by NewsRx correspondents, research stated, “To document and highlight the variation in the types of assisted living (AL) licensed settings eligible for Medicaid home and community-based services (HCBS) payment. Observational descriptive study. We examined 32,991 licensed AL communities across all 50 states and the District of Columbia, representing 215 unique license combinations operating in 2019.”

Our news editors obtained a quote from the research from Brown University, “We analyzed 6 Medicaid mechanisms: 1915(b), 1915©, and 1115 waivers, and 1905(a), 1915(i), and 1915(k) state plan amendments. We empirically reviewed the waivers and state plans active in 2019 providing Medicaid-paid care and documented any eligible AL licenses. We compared the characteristics of eligible and ineligible AL licenses, including geography, number of AL communities represented, and AL capacity. Overall, 89% of AL communities operated under a license type that is eligible for Medicaid payment through a waiver, state plan amendment, or other contracting mechanism. Forty-five states and DC employed a mechanism to reimburse care in AL with Medicaid payments, most having a 1915© waiver; 13 states that authorized Medicaid-reimbursed care in AL limited this benefit to a subset of licenses. AL communities operating under a license type that granted Medicaid contract eligibility had a smaller average capacity than those operating under licenses that did not allow for Medicaid payment. This paper builds on previous research that found associations between the percentage and concentration of dually enrolled residents in AL and state-level Medicaid payment mechanisms. We found that although most AL communities are eligible to accept Medicaid payment, the proportion of eligible ALs differs across states.”

According to the news editors, the research concluded: “Our research suggests that Medicaid policy may affect the accessibility of AL not only at the state level but also based on the type of license, which determines the type of care and services an AL can provide.”

This research has been peer-reviewed.

For more information on this research see: Medicaid Mechanisms and State Licensure: Pathways to Payment in Assisted Living. Journal of the American Medical Directors Association, 2025:105961. Journal of the American Medical Directors Association can be contacted at: Elsevier Science Inc, Ste 800, 230 Park Ave, New York, NY 10169, USA. (Elsevier - www.elsevier.com; Journal of the American Medical Directors Association - http://www.journals.elsevier.com/journal-of-the-american-medical-directors-association/)

The news editors report that additional information may be obtained by contacting Rachel Gunderson, Dept. of Economics, Brown University, Providence, RI, United States. Additional authors for this research include Lindsey Smith, Portia Y. Cornell, Paula Carder and Kali Thomas.

Publisher contact information for the Journal of the American Medical Directors Association is: Elsevier Science Inc, Ste 800, 230 Park Ave, New York, NY 10169, USA.

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