Last week, U.S. Senator Roger Marshall (R-KS) and U.S. Representative Max Miller (R-OH) introduced the Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act, legislation to make assisted living a covered Medicaid benefit for seniors who meet nursing facility level-of-care criteria. Argentum is closely monitoring this legislation and is cautioning against potentially significant unintended consequences of the bill that could impact access to care for seniors.
The ACCESS Act would allow assisted living to become a mandatory Medicaid benefit for seniors who meet nursing facility–level care criteria, with the goal of expanding access to community-based care while controlling costs. Specifically, the bill would:
- Add assisted living to Medicaid’s definition of “medical assistance.” States would be required to cover services provided in licensed assisted living residences, consistent with state law.
- Apply only to individuals who meet nursing facility–level care criteria. Eligibility is limited to seniors who would otherwise qualify for hospital or nursing facility care under Medicaid rules.
- Require cost neutrality. Medicaid spending for individuals receiving assisted living services cannot exceed what Medicaid would have spent if those individuals received care in a hospital or nursing facility. The bill explicitly does not create a new eligibility population.
- Make assisted living a mandatory Medicaid benefit. The bill amends Section 1902 of the Social Security Act to require state Medicaid programs to cover assisted living services in the same way nursing facility services are currently mandatory.
- Align Medicaid policy with housing development incentives. The legislation references coordination with housing policy, including use of the Low‑Income Housing Tax Credit, to support development of additional assisted living supply.
A separate, but similar bill led by U.S. Representative Debbie Dingell (D-MI) was introduced last week, the Home and Community-Based Services (HCBS) Access Act. It seeks to eliminate HCBS waiting lists and the need for states to repeatedly apply for HCBS waivers, by: increasing Medicaid funding for home and community-based services; increasing the federal match for state funding to expand their capacity to meet the needs of people who prefer HCBS; addressing stability, availability, and quality of direct care providers; and provide resources, training and support. Representative Dingell similarly introduced the Long-Term Care Workforce Support Act to improve pay, working conditions, recruitment, and retention, while creating clearer pathways into caregiving jobs.
While Argentum appreciates that lawmakers are recognizing the value of assisted living, both for residents and for savings to public programs, we are deeply concerned about potential unintended consequences from federal mandates layered on top of existing state regulatory frameworks that could strain communities, limit innovation, and ultimately reduce access for seniors. We will be working with the bill sponsors and other lawmakers to ensure that legislation preserves state flexibility, strengthens Medicaid waiver programs, and addresses reimbursement adequacy so providers can serve more seniors in high-quality, home-like settings.