Assisted Living News 2026June19

Kierstin Reed • June 18, 2026

New Section 1115 Guidance Released

On June 11, CMS released a state Medicaid director's letter on budget neutrality and section 1115 waivers. One-third of Medicaid spending runs through section 1115 waivers. HR 1 required that the CMS Chief Actuary certifies that Medicaid section1115 waivers are budget neutral compared to the cost of running a Medicaid program absent the waiver. CMS says in the letter: "Overall, CMS’s intended approach to implementing section 1115(g) is tied to CMS’s current policy goals: ideally, section 1115 demonstrations should deliver better outcomes and operate as, or more, efficiently than the existing Medicaid program. This includes an approach to budget neutrality that is expected to reduce overall expenditures in section 1115 demonstrations, thereby reducing federal outlays." This appears to deviate from the existing approach of budget neutrality with a greater focus on achieving cost savings, but CMS notes there will be additional guidance, details and technical assistance prior to their change in approach which starts Jan 1, 2027. LeadingAge is reviewing the letter in more detail and will provide more analysis as needed.

Don’t miss our next Assisted Living Survey Session

LeadingAge Nebraska will be hosting Survey Readiness 365: Staying Ahead of Assisted Living Deficiencies on June 30th. This session is free for members and we will be discussing common areas of deficiency in Assisted Living surveys. This session will provide tips and resources to make your next survey the best one possible! Registration is open now. 


Updates from DHHS Survey Department

As a recap of our provider/surveyor call on Wednesday, here are your highlights. 

Life Plan Community Weekly Recap. Here is your weekly LPC Weekly Recap.

By Kierstin Reed September 17, 2026
HUD Report Highlights BABA Implementation, Monitoring Issues. On September 10, the Department of Housing and Urban Development (HUD) published a report by its own oversight entity, the Office of the Inspector General (OIG), evaluating the agency’s implementation of Build America, Buy America (BABA) requirements throughout HUD programs. The Buy America Preference within BABA requires federal agencies to limit federal infrastructure spending unless the iron, steel, manufactured, and construction products used were domestically sourced in the U.S., which has proven infeasible for LeadingAge members developing new affordable housing units. The report, titled “HUD Needs to Improve its Monitoring of the Buy America Preference of the Build America, Buy America Act,” called out HUD’s lack of compliance monitoring for BABA; OIG recommends that HUD designate an official responsible for overseeing BABA implementation and consistency across HUD program offices. BABA is applicable to four HUD program offices, including the Office of Multifamily Housing Programs, which administers the Section 202 Supportive Housing for the Elderly program, as well as the Green and Resilient Retrofit Program (GRRP), both of which are subject to BABA requirements. LeadingAge continues to urge HUD and Congress to fully exempt affordable housing developments from the Buy America requirements because they are too difficult to execute and the original statute did not intend to BABA requirements to affordable housing. HUD Publishes LeadingAge-Driven Flexibilities on Emergency Call Systems. On September 10, the Department of Housing and Urban Development (HUD) published new guidance, driven by concerns shared by LeadingAge, to create more flexibility within emergency notifications system requirements for affordable senior housing providers. Previously, the agency required owners of certain HUD-assisted senior housing communities to operate emergency call systems in independent living units, which could be used by residents to call for aid in the case of an emergency, like a fall or a medical event. However, LeadingAge members consistently reported issues with the call systems, including residents misusing the systems and property insurance providers limiting whole-building coverage because of the perceived liability risk associated with the medical nature of the emergency notification devices and systems. Further, many residents reported to housing providers that they prefer to utilize personally-worn emergency devices and view the property call system as overreach by housing providers. In its new guidance, HUD makes the systems optional and encourages owners to conduct wellness checks instead, which many LeadingAge affordable housing providers already do. LeadingAge confirmed with HUD that the removal of the now optional emergency notification systems is a project-eligible expense. We applaud HUD for addressing the concerns of senior housing communities, and we will work with our membership to ensure the highest quality of housing for HUD-assisted residents. Here is your weekly Affordable Housing Weekly Recap.
By Kierstin Reed September 17, 2026
CMS' Technical Error in Final FY27 Hospice Wage Index
By Kierstin Reed September 17, 2026
LeadingAge Nebraska Testifies at LR481
By Kierstin Reed September 17, 2026
Coalition Partners to Host Webinar on El Salvador TPS. As many LeadingAge members know firsthand, the future of Temporary Protected Status (TPS) is creating significant uncertainty for employees, employers, and communities across the country. Two LeadingAge coalition partners – WorkPermits.US and the American Business Immigration Coalition (ABIC) – will host a virtual webinar on Thursday, September 17 at 3p ET that will provide U.S. employers with critical updates regarding the status of work authorization for Salvadoran employees with TPS. As of September 9th, El Salvador TPS is still in place , pending the government's decision on whether to extend the program. Nonetheless, for employers, changes to TPS can have real consequences for workforce stability, employee retention, recruitment, and business operations. It is important for employers to understand what these changes mean, what responsibilities they have, and how they can support their employees with TPS. During the virtual webinar, expert panelists will cover compliance responsibilities, employer legal obligations, and actionable advocacy steps to protect essential workers. Register here if interested in this topic, and as always, reach out to Associate Director for Immigration Advancement Shane Myers if you have questions or concerns. Here is your weekly Workforce Weekly Recap
By Kierstin Reed September 17, 2026
CDC Releases Updated Return-to-Work Guidance
By Kierstin Reed September 17, 2026
Here is the link to the recording of last week’s Joint Provider-Surveyor Training: https://vimeo.com/1226926568/a6ed3394ec?fl=tl&fe=ec&share=copy LeadingAge Nebraska Testifies at LR481 Senator Bostar held a hearing on Wednesday this week regarding LR481 with a purpose of examining the fiscal and operational issues related to the addition of long-term care services and supports to the Medicaid managed care program. LeadingAge Nebraska provided testimony that would caution the state against this implementation and would encourage them to proceed with thoughtful planning and collaboration prior to implementation. In his closing comments, Senator Bostar asked an important question, “Is it necessary?” He pointed out that the state has held off on implementing this for the long term care sector for a reason. Nebraska should examine the reason they want to implement this and the complications that could result from the implementation. LeadingAge Nebraska and our members continue to meet with MCO’s regarding this on a quarterly basis and we encourage members to participate in those meetings. Here is your Life Plan Community Weekly Recap .
By Kierstin Reed September 17, 2026
Bipartisan Bill Seeks to Stop Medicare Advantage Payment Clawbacks Reps. Greg Landsman (D-OH) and Bob Onder (R-MO) introduced the bipartisan Protecting Approved Care Act, legislation aimed at preventing Medicare Advantage (MA) plans from retroactively denying or reducing payment for care that has already been approved and delivered. The bill would apply protections to prior authorizations, pre-service and concurrent determinations, and authorizations for transfers from hospitals to post-acute care settings. LeadingAge appreciates the bill’s focus on practices our nonprofit and mission-driven members increasingly encounter, including plans denying or making only partial payment for previously approved services and seeking lower payments than CMS-required assessments indicate. Providers should be able to rely on an MA plan’s approval when they furnish care in good faith rather than face burdensome appeals or legal action after services have already been delivered. LeadingAge is reviewing the legislation and its implications for members and will continue engaging with Congress on policies that ensure MA plans appropriately cover and pay for needed care. Here is the link to the recording of last week’s Joint Provider-Surveyor Training: https://vimeo.com/1226926568/a6ed3394ec?fl=tl&fe=ec&share=copy LeadingAge Nebraska Testifies at LR481 Senator Bostar held a hearing on Wednesday this week regarding LR481 with a purpose of examining the fiscal and operational issues related to the addition of long-term care services and supports to the Medicaid managed care program. LeadingAge Nebraska provided testimony that would caution the state against this implementation and would encourage them to proceed with thoughtful planning and collaboration prior to implementation. In his closing comments, Senator Bostar asked an important question, “Is it necessary?” He pointed out that the state has held off on implementing this for the long term care sector for a reason. Nebraska should examine the reason they want to implement this and the complications that could result from the implementation. LeadingAge Nebraska and our members continue to meet with MCO’s regarding this on a quarterly basis and we encourage members to participate in those meetings.
By Kierstin Reed September 17, 2026
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By Kierstin Reed September 10, 2026
HUD Publishes, Then Withdraws, Controversial Reorganization Notice. In a notice scheduled to be published on September 8 but quickly withdrawn, the Department of Housing and Urban Development (HUD) outlined reorganization plans involving headquarters and the field staff and offices throughout the agency. According to HUD, the changes “are designed to better enable HUD to address crucial workplace and mission needs by eliminating redundancies, streamlining and increasing flexibility in work processes, and consolidating administrative functions, thus allowing the Department to more efficiently deliver on its mission utilizing current resources.” Notably, the notice did not propose any office closure or staff relocations. LeadingAge’s analysis of the notice shows an effort by the agency to come to terms with the drastic staff reductions and policy priority shifts that occurred throughout calendar year 2025; for example, HUD’s notice describes the collapse of the separate office that handled the Green and Resilient Retrofit Program (GRRP), which awarded preservation funding to climate-vulnerable multifamily housing projects, including LeadingAge communities. However, the GRRP office had already been absorbed by the broader Office of Recapitalization last year, which has reassigned staff to continue carrying out the GRRP work. Therefore, in the case of GRRP, the impacts of the consolidation announcement in the notice are minimal, and no other changes are listed for HUD’s Multifamily Housing program offices, which administer the project-based Section 8 and Section 202 Supportive Housing for the Elderly programs, among others. However, for other offices and programs within HUD, the impacts may be greater. For example, the notice describes consolidations and changes to reporting structures within the Office of the General Council, which in part reviews closing documents for HUD awards and loans, as well as legal interpretations of statutes and regulations impacting affordable senior housing. The notice also addresses changes to the Real Estate Assessment Center (REAC), which handles oversight and inspections for properties participating in HUD programs, the Office of Fair Housing and Equal Opportunity (FHEO), which oversees fair housing protections, and the Office of Public and Indian Housing (PIH), which handles Housing Choice Vouchers and Public Housing. LeadingAge will continue to analyze the impacts of the reorganization notice and advocate to ensure both streamlining and continuity for critical senior housing programs. HUD Posts HOTMA MAT Guide for Comment; Implementation Delay Notice Still Forthcoming. The Department of Housing and Urban Development (HUD) has posted for public comment a crucial material needed for implementation of the Housing Opportunity Through Modernization Act (HOTMA), which is a major rule change for affordable housing communities. While HOTMA implementation will be delayed past its current date of January 1, 2027, HUD is proceeding with public comment on new proposed changes to the Monthly Activity Transmission (MAT) Guide for the agency's rental assistance platform, which needed updates for HOTMA compliance. According to HUD , the MAT Guide revisions are available for review and comment until October 2. HUD's communication to stakeholders states that HOTMA cannot be implemented until the rental assistance platform is fully updated and additional HUD forms are released. In the absence of final HOTMA materials from HUD, housing providers have already begun the tenant certification work that is effective January 1, 2027, under pre-HOTMA rules. Meanwhile, LeadingAge is frustrated by HUD’s delay in issuing an expected notice officially delaying HOTMA implementation. While the MAT Guide does need updating before HOTMA is implemented, housing providers deserve official direction as soon as possible that HOTMA’s overall implementation will again be delayed. More information on the new MAT Guide is available under the "draft" section of the website. UPDATE: Proposed Rule Rolling Back Community Reinvestment Act Obligations Published. As we reported last week, a multi-agency proposed rule seeks to roll back the Community Reinvestment Act and could weaken investment in affordable housing and community development. This proposed rule has now been published in the Federal Register on August 12 kicking off a 60-day comment period that will end on October 13, 2026. The full article can be read here . Here is your weekly Affordable Housing Weekly Recap.
By Kierstin Reed September 10, 2026
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