ACCESS Act

ACCESS Act (S. 4479, 118th Congress) — Summary

This bill, titled the Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act (ACCESS Act), seeks to expand Medicaid coverage for assisted living services and to influence housing tax credit allocations to promote non-institutional long-term care options.

1) Main purpose and intent

• Expand access to assisted living services via Medicaid.
• Encourage the use of assisted living and non-institutional settings to reduce Medicaid costs and support aging in place.
• Use the Low-Income Housing Tax Credit (LIHTC) program to prioritize projects that reduce medical assistance costs by providing long-term services and supports in non-institutional settings.

2) Key provisions and changes

A. Medicaid coverage for assisted living in an assisted living residence

• Amends Section 1905(a) of the Social Security Act to add new services under Medicaid:
  • Defines “medical assistance” to cover services provided in an assisted living residence, as allowed by state law.
  • Coverage includes individuals who would otherwise require hospital or nursing facility care but meet state income and resources requirements.
  • Requires that the estimated annual average per capita Medicaid cost for individuals receiving these services in an assisted living residence would be no greater than the cost if they received hospital or nursing facility services.
• Creates a mandatory Medicaid benefit for these assisted living services:
  • Adds the new coverage (paragraph 32) to the list of mandatory benefits under §1902(a)(10)(A).

B. Effective date and state flexibility

• General effective date: January 1, 2027.
• Possible delay if a state requires state legislation for plan changes:
  • If a state plan approved under Medicaid requires state legislation (other than funding), the state can delay compliance until after the first regular session end following the first calendar quarter after enactment.
  • For states with 2-year legislative sessions, each year counts as a separate regular session.

C. Incentives via the Low-Income Housing Tax Credit (LIHTC)

• Tax Credit selection criteria: Amends 42(m)(1) to include a new criterion:
  • Projects that reduce medical assistance costs of long-term services and supports for the elderly by providing those services in a non-institutional setting are eligible for LIHTC consideration.
• Effective date for LIHTC changes: Applies to allocations made after January 1, 2027.

3) Who or what would be affected

• Medicaid programs and beneficiaries:
  • Individuals who would otherwise need hospital or nursing facility care and who meet state income/resources limits could receive assisted living services covered by Medicaid.
• States and state plans:
  • States would need to adjust Medicaid state plans to incorporate the new assisted living services as mandatory benefits, subject to the effective dates and any legislative delays.
• Assisted living providers and residents:
  • Non-institutional long-term care providers would be positioned to serve more residents under Medicaid.
• LIHTC applicants:
  • Housing projects proposing senior or elderly housing with integrated assisted living/long-term services could gain a competitive edge for LIHTC allocations if they demonstrate cost-reductions in Medicaid expenditures.

4) Procedural and timeline aspects

• Introduction and referral:
  • Introduced April 30, 2026; referred to the Senate Committee on Finance.
• Enactment timeline:
  • General effective date of January 1, 2027.
  • State plan adjustments may be delayed if state legislation is required, following the timeline rules described above.
• LIHTC timing:
  • New LIHTC criteria take effect for allocations made after January 1, 2027.

5) Potential implications

• Economic:
  • Potential Medicaid cost savings if per-capita costs in assisted living are lower than hospital/nursing facility care.
  • Increased demand for funded assisted living services and related non-institutional care infrastructure.
• Access and choice:
  • Expanded options for seniors and individuals needing long-term services, enabling more people to receive care in community/assisted living settings.
• Policy alignment:
  • Aligns Medicaid policy with non-institutional care models and leverages housing policy (LIHTC) to incentivize suitable projects.

Note: As with any bill, the final enacted text and any amendments could modify the scope, implementation, or timing detailed above.