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119-s-4479119th CongressWALLET

ACCESS Act

Sponsored By: Senator Marshall, Roger [R-KS]

Introduced

Summary

Expands Medicaid coverage for services provided in assisted living residences. It would make those services a mandatory Medicaid benefit and push tax credit rules to favor housing that supports non-institutional long-term care for older adults.

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  • Seniors and families: People who need the level of care normally provided in a hospital or nursing facility could receive those services in an assisted living residence if state law allows it. Medicaid coverage would apply only when the expected annual per-person Medicaid cost for assisted living is no greater than the cost of care in a hospital or nursing facility.
  • States and eligibility: States would be required to include this new category as a mandatory Medicaid benefit, with a start date of January 1, 2027 and limited extra time if state law changes are needed to implement the rules.
  • Housing and developers: The Low-Income Housing Tax Credit Qualified Allocation Plan would be revised to prioritize projects that reduce Medicaid long-term care costs by offering non-institutional services and supports for elderly residents.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Medicaid help for assisted living

If enacted, Medicaid would cover certain services provided in assisted living residences. You would qualify only if you meet your State Medicaid income and resource rules and would otherwise need nursing-facility or hospital-level care. The services must be allowed under State law and be the type the State could pay for under its Medicaid plan or a waiver. The bill would require that the average Medicaid cost per person in assisted living not exceed the average cost in a nursing home. The rule would take effect January 1, 2027, but States that need new laws could get a delay.

Tax credit priority for senior housing

If enacted, state housing agencies would be directed to give priority in Low-Income Housing Tax Credit awards to projects that reduce Medicaid long-term care costs by delivering services in non-institutional settings. This change would apply to LIHTC allocations made after January 1, 2027. The change would make community-based housing projects that support non-institutional care more likely to receive tax credits. It would not directly change your individual tax bill right away.

Sponsors & CoSponsors

Sponsor

Marshall, Roger [R-KS]

KS • R

Cosponsors

  • Sen. Daines, Steve [R-MT]

    MT • R

    Sponsored 9/23/2026

  • Sen. Sheehy, Tim [R-MT]

    MT • R

    Sponsored 9/23/2026

Roll Call Votes

No roll call votes available for this bill.

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