ACCESS Act
- Bill Number
- S. 4479
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-04-30: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-05-21T19:55:33Z
AI-Generated Summary
Bill Summary: Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act (ACCESS Act, S. 4479)
Purpose
The legislation aims to make assisted living more affordable and accessible for low-income individuals who need long-term care, by expanding Medicaid coverage for services in assisted living residences and prioritizing such projects in the low-income housing tax credit (LIHTC) program. It promotes community-based care over more expensive institutional options like nursing homes.
Key Provisions
- Medicaid Expansion:
- Adds services in state-approved assisted living residences as a new mandatory Medicaid benefit (under Section 1905(a)(32) of the Social Security Act).
- Covers individuals who:
- Require care equivalent to a hospital or nursing facility.
- Meet state income and resource limits for Medicaid long-term care.
- Have projected annual Medicaid costs in assisted living no higher than in institutional settings.
- Effective January 1, 2027; states get a delay (up to one year after their legislative session) if they need new laws to comply.
- LIHTC Adjustments:
- Requires state housing agencies to prioritize LIHTC allocations for projects that provide long-term services and supports (like assisted living) to elderly individuals in non-institutional (community) settings, reducing Medicaid costs (amends Section 42(m)(1)(C)(xi) of the Internal Revenue Code).
- Applies to tax credit allocations made after January 1, 2027.
Significant Changes to Existing Law
- Medicaid: Converts assisted living services from optional to mandatory under Medicaid, previously limited to institutional care; introduces cost-neutrality requirement to ensure savings or equivalence.
- LIHTC: Adds a new mandatory selection criterion for state "qualified allocation plans," shifting priorities toward projects that lower long-term Medicaid spending on elderly care.
Potential Impacts
- Citizens: Increases access to affordable assisted living for low-income elderly or disabled people needing nursing-home-level care, encouraging living in community settings rather than institutions.
- Government Agencies: States must update Medicaid plans and may see net cost savings if assisted living proves cheaper; federal government influences housing development via tax credits. No direct impact on international relations.
- Housing and Providers: Boosts development of assisted living units eligible for tax credits, potentially expanding supply.
Main Stakeholders Affected
- Low-income elderly and disabled individuals eligible for Medicaid long-term services.
- State Medicaid agencies (must implement coverage and ensure compliance).
- Assisted living providers (gain Medicaid reimbursements and tax credit opportunities).
- Housing developers using LIHTC (face new allocation priorities).
- Federal agencies like HHS (oversees Medicaid) and IRS (administers tax credits).
Notable Legal, Constitutional, or Political Implications
- Federalism Considerations: Mandates state Medicaid changes but includes flexibility for legislative delays, respecting state processes.
- Cost Control: Emphasizes budget neutrality to avoid increasing federal Medicaid spending.
- Policy Shift: Advances "rebalancing" long-term care toward community options, aligning with existing federal goals but making it more enforceable; no clear constitutional challenges noted.
- Politically, it bridges health and housing policy to address aging population needs without new funding.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2026-04-30: Read twice and referred to the Committee on Finance.
- 2026-04-30: Introduced in Senate
Bill Versions
- Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act — issued 2026-04-30 — PDF (4 pages)