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Reps. Debbie Dingell and John Moolenaar introduced the bipartisan PACE Access Improvement Act on Sept. 24. It would make PACE a mandatory Medicaid service, change when coverage can begin and remove some restrictions on provider expansion; its prospects for passage this year are uncertain.
Reps. Debbie Dingell, a Democrat, and John Moolenaar, a Republican, both of Michigan, introduced the PACE Access Improvement Act on Sept. 24, proposing to make the Program of All-inclusive Care for the Elderly a mandatory Medicaid service in every state. The bill would also change enrollment timing and remove some restrictions on PACE organizations, potentially widening access to a model that provides nursing home-level care in community settings.
Under the proposal, a person’s PACE enrollment could take effect at any time during the month. Current federal policy generally starts coverage on the first day of the month after the provider receives the enrollment agreement. The bill would also repeal certain marketing restrictions and numerical limits on PACE program agreements, according to the report by Home Health Care News.
The legislation would require states to offer PACE through Medicaid, shifting it from an optional program. States that already have at least one PACE provider would have 180 days after enactment to comply with the new requirements. States without a PACE provider would have three years, the source report says. Those timelines would apply only if the bill becomes law.
PACE combines medical and social services for eligible older adults, allowing them to receive nursing home-level care while living at home. The National PACE Association counts programs in 33 states and the District of Columbia, with 204 locations. The bill’s sponsors say it would address barriers to enrollment and expansion; those expected effects are the legislation’s stated aims, not outcomes established by its introduction.
How the Bill Could Change PACE Access
If enacted, the bill would establish PACE as a nationwide Medicaid service requirement, rather than leaving states to decide whether to offer it. That could matter to people who need extensive support to remain in their homes, as well as families seeking alternatives to institutional care. The proposal’s shorter, more flexible enrollment timing could also reduce the wait between an enrollment agreement and the start of coverage.
Provider growth is another part of the proposal. Repealing numerical limits on program agreements and easing restrictions on applying to become a PACE organization could make it easier for providers to seek expansion, according to the source report. More locations could extend the model’s reach, though the bill alone would not establish how many organizations would open or where. States would also need time and capacity to meet any new requirements.
Supporters point to unmet demand for home and community-based services. Dingell said Americans with disabilities and older adults remain on waitlists for such services. The report does not provide a count of those waiting specifically for PACE, so the scale of demand for this program cannot be determined from the available material.
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PACE Programs Across the States
PACE operates under both Medicare and Medicaid and provides a combination of health care and social services. The model is intended for older adults who need nursing home-level care but can live safely in the community with coordinated support. The proposed legislation focuses on federal and state program rules, including enrollment, marketing and provider agreements.
The bill has support from the National PACE Association, the Alzheimer’s Association, the Alzheimer’s Impact Movement and the American Association on Health and Disability, according to Home Health Care News. Seen Health, a Los Angeles-based provider serving older adults of Asian and Pacific Islander heritages in Southern California, also supports the proposal. LeadingAge, an advocacy association representing nonprofit aging-services providers, supports the bill but considers passage by the end of 2026 unlikely.
““Giving programs more flexibility to enroll people when they need care and making it easier for proven programs to open new centers would let providers like Seen Health reach more of the communities that need this model most.””
— Xing Su, co-founder and CEO of Seen Health, to Home Health Care News
Passage and Expansion Remain Uncertain
The bill has been introduced, but the source report does not say that either chamber of Congress has voted on it or provide a legislative schedule. LeadingAge considers passage by the end of 2026 unlikely. The report also says a companion measure is expected in the Senate by year’s end; it does not identify a Senate sponsor or confirm that the companion bill has been introduced.
It remains unclear how many states would need to establish PACE programs if the proposal became law, what resources they would need, or how quickly providers might expand. The available source gives the current number of participating states and locations but does not estimate future enrollment, new centers or costs. The proposed changes therefore describe possible policy effects, not guaranteed increases in access.
Senate Companion Expected This Year
The next reported step is introduction of a companion bill in the Senate, which is expected by the end of 2026. Congress would then need to consider the legislation before any proposed requirements or timelines could take effect. The source report does not provide a committee hearing date, vote schedule or estimate of when a decision might be reached.
If enacted, the compliance periods would begin from the law’s enactment: 180 days for states already operating PACE and three years for states without a program. Until then, the bill’s proposed enrollment and provider changes remain pending.
Key Questions
What would the PACE Access Improvement Act do?
It would make PACE a mandatory Medicaid service, allow enrollment to take effect at any time during a month and repeal certain marketing restrictions and numerical limits on program agreements.
Is PACE currently available in every state?
No. The National PACE Association count cited by Home Health Care News lists programs in 33 states and the District of Columbia, with 204 locations.
When would states have to comply?
If the bill became law, states with at least one PACE provider would have 180 days after enactment. States without a provider would have three years.
Has Congress passed the bill?
The source reports that Dingell and Moolenaar introduced it on Sept. 24. It does not report passage. LeadingAge considers enactment by the end of 2026 unlikely.
What is expected next?
A Senate companion bill is expected to be introduced by the end of 2026, according to the source report. No Senate sponsor or legislative schedule is provided.
Source: rss
