Improving access to assisted living is the goal behind bills proposed in Massachusetts and recently passed in Colorado.
In Massachusetts, lawmakers are considering several bills that could affect access to assisted living and highlight it as a distinct setting for older adults.
The state’s senior living advocacy organizations testified recently before the state’s Joint Committee on Aging and Independence on SB 474 / HB 791, which would expand access to assisted living through the Medicaid Frail Elder Waiver, and HB 770, which would clarify how assisted living is classified.
The Frail Elder Waiver allows eligible older adults to receive long-term care services in home settings or skilled nursing facilities. Current law does not allow the waiver to be used in assisted living communities, something that differs from most other states.
State senior living associations told lawmakers that assisted living is a community-based care model that fills a gap between home care and nursing homes but that many older adults cannot afford assisted living without Medicaid coverage.
“The urgency to pass this legislation has heightened in recent years, as multiple assisted living residences with residents on reimbursement programs have had to close since those programs are not designed specifically for assisted living and are not keeping up with the cost of providing assisted living services,” Brian Doherty, the Massachusetts Assisted Living Association’s president and CEO, told lawmakers. “Expanding the Frail Elder Waiver to include assisted living is a cost-effective way to provide independence and quality of life for more older adults.”
That change to the waiver, Doherty said, would bring Massachusetts in line with “the majority of the country” and ensure that families can choose the care setting that best meets their needs.
The Massachusetts Senior Care Association said that although it supports the intent of the legislation, its position is that existing MassHealth-covered long-term services and supports must be fully funded before Medicaid services can be expanded into another setting — namely, assisted living. According to MSCA, existing LTSS programs across the state are underfunded, costing nursing facilities $305 million annually. That funding gap contributes to 5,000 direct care positions going unfilled.
“These unfilled positions cause staffing disruptions, reliance on costly temporary nursing pools, talent burnout and compromised quality of care,” MSCA stated in submitted testimony. “Based on this data, we have grave concerns about expanding Medicaid services until all of our LTSS programs are on solid financial footing, able to maintain and scale the quality of care that Massachusetts prides itself on.”
MSCA recommended that the state’s Joint Committee on Aging and Independence amend SB 474 to study the proposal and prepare an analysis showing the cost of expanding Medicaid coverage to assisted living.
The other legislation, HB 770, targets legal confusion over how landlord-tenant law applies to assisted living communities. Recent court decisions, according to Mass-ALA, have blurred distinctions between assisted living and traditional rental housing, jeopardizing the services and protections of the setting.
The bill aims to reaffirm the original intent of state regulations that treat assisted living as a hybrid model that combines housing with care, which is distinct from both nursing homes and standard rental apartments. It would exempt assisted living from a broad application of landlord/tenant statutes while maintaining essential protections, including balancing autonomy, safety and care. Assisted living providers faced challenges in implementing health measures during the COvID-19 pandemic due to restrictions tied to landlord/tenant law.
“Assisted living is not akin to an apartment complex. It’s a unique setting where older adults receive the support they need to thrive,” Doherty said. “Clarifying the law will protect the integrity of these communities and ensure that regulations reflect their specialized role in our continuum of care.”
Mass-ALA also voiced support for another bill, SB 469, which would give the organization — and LeadingAge Massachusetts — a seat on the Assisted Living Advisory Council.
Bill easing AL regulation awaits CO governor’s signature
Meanwhile, in Colorado, lawmakers have passed a bill meant to address assisted living workforce challenges and a state regulatory environment viewed by the industry as “cumbersome.”
HB25-1213 introduces several changes aimed at altering the regulation of assisted living communities, healthcare billing processes and Medicaid services.
Senior living organizations in the state generally have praised the bill, saying that as the state’s older adult population continues to grow at a fast pace, the easing of assisted living regulations will give communities the flexibility to adapt their space for more residents.
The bill, which was sent to Gov. Jared Polis (D) earlier this month for his signature, recommends increasing the hourly minimum wage for direct care workers from $17 to $25 over the next two years, and it would roll back some regulations on senior living communities. The most significant provision exempts an assisted living community from state board of health facility compliance standards if the community has fewer than 19 beds and has not undergone renovation or begun new construction.
Between November 2024 and April 2025, the number of assisted living beds in the state dropped by 270, including 205 Medicaid beds. Communities that accepted residents whose care was financed through Medicaid waivers have reported waiting lists of more than two years, according to the Colorado Assisted Living Association.
Nicole Zamparelli, RN, owner/administrator of A Wildflower Assisted Living and Care Home and a former president of the CALA, said the bill will help Medicaid providers open more beds “without unnecessary bureaucratic red tape that has nothing to do with safety.”
Although LeadingAge Colorado supported passage of HB25-1213, the organization said it was disappointed that a portion about home- and community-based services was removed.
“The initial version of the bill included a section that ensured those relying on home- and community-based services — which includes those using Medicaid to access assisted living in Colorado — continue to access them if their condition has not changed in the last three years,” LeadingAge Colorado Director of Government Affairs Joseph Dubroff told McKnight’s Senior Living. “We are disappointed that this portion was removed from the bill, as it would lessen the administrative burden on providers.”
Source: McKnights Seniorliving