White Nelson Diehl Evans is dedicated to providing high quality, client focused tax, financial accounting and advisory services to assist our many customers in the aging services sector:

  • Continuing Care Retirement Communities (CCRCs)
  • Senior Housing
  • Assisting Living
  • Skilled Nursing
  • In Home Care Providers
How Obamacare (ACA) Affects Assisted Living Facilities

The Affordable Care Act (ACA) more commonly referred to as “Obamacare” does notspecifically address assisted living facilities in the law, but several of the Medicaid long-term care regulations will likely impact the ability of states to expand Medicaid coverage for assisted living. A primary objective of Obamacare is to help states rebalance their long-term care systems to spend less on traditional institutional care and more on home or community-based care facilities, like assisted living.

The provisions incorporated into the ACA that give states the ability to expand Medicaid coverage are currently optional provisions, meaning the states have to elect to implement them.To date, only 31 states plus the District of Columbia have expanded Medicaid and California is one of those states. In California, the Assisted Living Waiver allows the use of Medi-Cal funds to pay for persons who require nursing home level care, but request to live in a Residential Care facility. However, the Assisted Living Waiver program is limited to specific counties within the state.

Assisted living facilities need to make sure that they are enrolled in the program, and coordinate with the Care Coordination Agency for referrals made by Medi-Cal. The full impact of Obamacare is yet to flow as many of the provisions are yet to be implemented into the law. The ACA is long and complicated.

Changing Medicare Regulations/Reimbursements and Your Bottom Line

Most reimbursements for the medical costs of seniors over the age of 65 fall under the Center for Medicare and Medicaid Services (CMS). Service providers that accept Medicare/Medicaid are subject to the Inpatient Prospective Payment System, or IPPS, wherein members agree to pre-determined rates in order to receive Medicare payments. In 2015, IPPS issued its final rule which increased hospital inpatient rates by 1.4%, long-term care payments by 1.1%, and skilled nursing facility payments by 2%.

Medicare continues to play a significant role in various reforms under Obamacare, and the rules that providers must learn and abide by in order to receive reimbursement from Medicare can be extremely onerous. In a study of Medicare Audits, the Senate Special Committee on Aging found that CMS and contractor’s post payment review methods are inefficient and increase
provider burden. The CMS prepayment reviews and audits do not consistently target problem areas and can have a limited ability to affect improper payments. The CMS has not effectively educated providers sufficiently to avoid payment errors. In fact, the industry overall has a high rate of non-payment, under-payments or disputed payments which transfers a significant cost to service providers and their billing system effectiveness.

Once the above issues are resolved, it is essential to have automation, expertise and established benchmarks for tracking and measuring reimbursement performance - whether from Medicare/Medicaid or insurance companies. White Nelson Diehl Evans leverages our broad range of capabilities in the nursing home and assisted living facility sectors to help insure that our clients successfully achieve their bottom line goals.


2020 Cybersecurity Guidelines for C-Suite Executives


THE BRAVE NEW WORLD OF CYBER-ATTACKS Cyber-attacks arguably pose the single biggest modern threat to businesses. The number of cyber-attacks, their level of sophistication, and the financial...


How Business Owners Can Improve Cash Flow By Thinking Profit First


Entrepreneurs don't necessarily need to be numbers people in order to succeed: You need drive, passion, the ability and will to follow things through, and the hustler's spirit that enables you to...


Using Big Data on a Small Budget to Improve Real-Time Decision-Making


For years, companies looked to data tracked by their finance and accounting departments primarily as a way to understand past performance. But quantum leaps in computing power and other technology...

Contact Us
Tax Planning Guide

At White Nelson Diehl Evans, we know how difficult it is to stay ahead of the complex and dynamic tax laws. From new standards changing revenue recognition rules to the impact of the Affordable Care Act, our goal is to help our clients stay in front of tax issues that impact your bottom line. To help in this effort, we have put together a comprehensive tax-planning guide and it’s available to download for free.

Partner Testimonial

“With a dedicated aging services practice group, we understand the many businesses and services that make up the sector, and recognize that this field will continue to grow in both size and complexity as the population ages. At WNDE, we strive to deliver audit, tax and advisory services that help our aging services clients meet compliance requirements and improve bottom-line results.”

Dave Vediner Audit Partner