ACCESS Act
- Sponsor
- Sen. Marshall, Roger [R-KS]
- Committees
- Finance Committee (primary)
- Last action
- Apr 30, 2026
Bottom line
The ACCESS Act aims to enhance access to affordable assisted living for low-income seniors and individuals with disabilities by integrating it into Medicaid as a mandatory benefit and incentivizing its development through tax credits, potentially shifting care from more expensive institutional settings.
What it actually does
This bill expands Medicaid coverage to include services provided in an assisted living residence for eligible individuals who would otherwise require hospital or nursing facility care, provided the estimated cost is not higher. It also amends the Low-Income Housing Tax Credit (LIHTC) program to add a new selection criterion, prioritizing projects that reduce medical assistance costs by offering long-term services in non-institutional settings.
Proponents argue
Proponents argue this bill would provide more affordable and community-based long-term care options, allowing individuals to age in place with dignity, reduce reliance on costly institutional care like nursing homes, and empower states to offer more flexible care models. It addresses a critical gap in long-term care financing and aligns housing and healthcare goals.
Opponents contend
Opponents might raise concerns about the potential for increased Medicaid expenditures if the cost-neutrality clause is not rigorously enforced, the administrative burden on states to implement the new benefit and conduct complex cost-effectiveness assessments, and whether the LIHTC incentive is sufficient or appropriately targeted to achieve the desired outcomes without unintended consequences for other affordable housing needs.
The bill is concise and relatively easy to read, allowing for a quick understanding of its core provisions and their intended effects.
Section 2(a)
Medicaid Coverage for Assisted Living Residence Services
This provision amends the Social Security Act to include services provided in an assisted living residence as 'medical assistance' under Medicaid. This coverage is specifically for individuals who would otherwise require hospital or nursing facility care, meet state income and resource requirements, and for whom the estimated annual average per capita Medicaid cost for assisted living would be no greater than the estimated cost of institutional care.
Supporters argue
Supporters argue this expands person-centered care, offers more choice in long-term care settings, and can be more cost-effective than traditional nursing home care, thereby improving the quality of life for beneficiaries while potentially managing state budgets.
Critics contend
Critics might express concern about the potential for states to struggle with accurately estimating and managing the 'no greater cost' requirement, which could lead to unforeseen budget pressures or limited access if states are overly cautious in their implementation.
Tradeoffs
This provision balances the desire for individual choice and community-based care with the critical need for fiscal responsibility and ensuring that assisted living provides appropriate and cost-effective levels of care compared to institutional settings.
Section 2(b)
Assisted Living Services as a Mandatory Medicaid Benefit
This section amends the Social Security Act to designate the newly defined assisted living residence services as a mandatory benefit under state Medicaid plans. This means states would be required to offer these services, rather than having the option to do so.
Section 3(a)
Low-Income Housing Tax Credit (LIHTC) Selection Criterion for Assisted Living
This provision amends the Internal Revenue Code to add a new criterion for Qualified Allocation Plans (QAPs) under the Low-Income Housing Tax Credit (LIHTC). State housing agencies are now required to consider projects that reduce the medical assistance costs of long-term services and supports for the elderly by providing such services in a non-institutional setting (i.e., assisted living) when allocating LIHTC.
Medicaid coverage for services in an assisted living residence is contingent on the estimated annual average per capita total Medicaid cost for individuals receiving these services being no greater than the estimated cost if those individuals received services in a hospital or nursing facility.
Section 1905(a)(32) of the Social Security Act, as added by Section 2(a)
Why it matters:This is standard legislative practice for defining parameters within a complex statutory framework, ensuring that the new benefit is fiscally responsible and does not lead to uncontrolled cost increases.
Case for: Supporters argue this ensures the expansion of assisted living services under Medicaid is budget-neutral or even cost-saving, addressing concerns about increased federal and state expenditures.
Case against: Critics might contend that accurately estimating and comparing per capita costs between different care settings is administratively challenging and could lead to states being overly conservative, thereby limiting access to assisted living for eligible individuals.
Estimated impact: This provision could significantly influence the number of individuals who can access assisted living through Medicaid and the financial burden on states, acting as a gatekeeper for the new benefit.
States that require state legislation (other than legislation appropriating funds) to implement the new Medicaid requirements are granted a delay in compliance. The delay extends until the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that ends after a one-year period from the bill's enactment.
Section 2(c)(2)
Why it matters:This is a common and necessary legislative practice to accommodate the diverse legislative calendars and processes of individual states, preventing immediate non-compliance and allowing for orderly implementation.
Case for: Proponents argue this flexibility is essential for practical and orderly implementation, allowing states adequate time to adjust their laws and administrative procedures without penalty, thereby ensuring a smoother transition.
Case against: No significant case against, as such provisions are generally seen as pragmatic. Some might argue it delays the benefits for citizens in certain states, creating an uneven rollout of services.
Estimated impact: Ensures a smoother transition for states by providing a grace period for legislative and administrative adjustments, but could result in a staggered rollout of new Medicaid benefits across the country.