Washington, D.C. — A bipartisan bill introduced in Congress last week would require Medicaid to cover assisted living services for seniors who qualify for nursing facility-level care — a structural shift that could redirect thousands of residents away from traditional nurs and reshape how long-term care is funded in the United States.
The legislation, called the Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support Act — or the ACCESS Act — was introduced by Sen. Roger Marshall (R-KS) in the Senate and Rep. Max Miller (R-OH) in the House. Right now, Medicaid is required to cover nursing home care for eligible seniors, but assisted living is optional. The bill would change that, making assisted living a mandatory benefit for individuals who meet nursing facility criteria, as long as the cost doesn’t exceed what institutional care would run.
“The system is backwards,” Miller said in a statement. “We’re paying more for unnecessary care while more practical options remain out of reach.”
What the bill actually does
Under the ACCESS Act, states would be required to offer assisted living as a Medicaid benefit to seniors who qualify for nursing home care — but only if doing so doesn’t increase average Medicaid spending. The bill also includes a housing component, encouraging states to prioritize affordable housing developments that pair housing with supportive services for older residents. Those provisions would apply to tax credit allocations issued after January 1, 2027.
Supporters argue the bill would fix a long-standing misalignment in Medicaid’s incentive structure. Because nursing home care is mandatory and assisted living is not, states often end up paying for more intensive — and more expensive — care than a resident actually needs. Medicaid spending is projected to grow 63% over the next decade, and backers say this bill is one way to slow that trajectory without cutting benefits.
Industry groups: cautiously supportive, but wary
Senior living associations largely welcomed the bill’s intent while flagging concerns about federal overreach. The National Center for Assisted Living said it appreciates efforts to expand access, but stressed that states must retain flexibility to design programs that fit their own care delivery models. “One-size-fits-all policies risk unintended consequences,” NCAL Executive Director LaShuan Bethea said.
Argentum, which represents assisted living operatalled the bill a recognition of the value assisted living delivers — particularly as tens of thousands of seniors sit on Medicaid home- and community-based services waiting lists. But the group cautioned that unfunded federal mandates layered on top of existing state regulations could strain providers and limit innovation.
LeadingAge supported the concept but echoed the same concern: states should lead on quality oversight, not Washington.
What it means for nursing homes
For skilled nursing operators, the bill raises a real question about future census. If assisted living becomes a mandatory Medicaid benefit, some residents who currently end up in nursing homes — because that’s where Medicaid dollars flow — could instead be placed in lower-acuity settings. That’s a potential occupancy headwind, particularly for facilities that rely heavily on Medicaid.
It’s worth noting the bill still has a long road ahead. It’s been referred to the House Ways and Means and Energy and Commerce committees, and no floor vote is scheduled. But the conversation it’s starting — about whether Medicaid’s institutional bias is costing the system money — isn’t going away. As industry reports have noted, the financial pressures facing long-term care providers are already severe, and any shift in where Medicaid dollars flow will be felt across the sector.
If passed, the changes would take effect January 1, 2027.
