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Reps. Debbie Dingell and John Moolenaar introduced the PACE Access Improvement Act on Sept. 24. The bill would make PACE a mandatory Medicaid service, change when enrollment takes effect and remove some restrictions on provider expansion. Its prospects and timing remain uncertain; LeadingAge says passage by the end of 2026 is unlikely.
Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.) 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 let enrollment take effect at any time of the month and loosen limits on PACE organizations, changes supporters say could help more older adults access care at home.
PACE combines medical and social services for eligible older adults who need a level of care comparable to nursing home care. The program is jointly associated with Medicare and Medicaid and is designed to let participants receive services while living in their communities. Under current federal policy described in the bill’s coverage, enrollment generally takes effect on the first day of the month after a provider receives the agreement. The proposal would allow it to begin any day of the month.
The legislation would change PACE from an optional Medicaid program to a required one. The National PACE Association reports that 33 states and the District of Columbia currently offer PACE, with 204 locations. Under the bill, states that already have a PACE provider would have 180 days after enactment to comply with new requirements. States without a program would have three years.
The bill would also repeal certain marketing restrictions and numerical limits on PACE program agreements, and address constraints on expansion. Los Angeles-based Seen Health, which provides culturally informed PACE services to older adults of Asian and Pacific Islander heritage in Southern California, supports the measure. Its co-founder and CEO, Xing Su, told Home Health Care News that added flexibility could help providers serve more communities.
How State Coverage Could Change
Making PACE mandatory would establish a federal requirement for states to offer the program, replacing the current state-by-state choice. That could change where eligible older adults can access this model of community-based, nursing home-level care, though the bill does not itself specify how many new centers would open or how many people would enroll.
Changing enrollment dates could also affect how soon a person’s coverage begins after joining. Providers and supporters argue that removing limits on agreements and easing expansion constraints could make it easier to grow programs. Those are intended effects of the proposal; the source material does not provide estimates of likely enrollment growth, costs or provider capacity.
PACE’s Current State-by-State Reach
PACE serves older adults who meet criteria for a nursing home level of care but can live safely in the community with support. Its services combine health care with social supports, coordinated through a local program. The model is relevant to debates over access to long-term services and supports, including home- and community-based care.
The measure has support from the National PACE Association, Alzheimer’s Association, Alzheimer’s Impact Movement and American Association on Health and Disability, as well as LeadingAge, an advocacy association for nonprofit aging-services providers. Support does not establish that the bill will pass. LeadingAge said passage by the end of 2026 is unlikely, according to Home Health Care News.
““PACE keeps frail older adults healthy and living at home, and families trust it.””
— Xing Su, Seen Health co-founder and CEO, speaking to Home Health Care News
Passage and Expansion Remain Uncertain
The bill’s path through Congress is not settled. LeadingAge expects passage by the end of 2026 to be unlikely, and the source report does not describe committee action, a vote schedule or a cost estimate. A Senate companion is expected by year-end, but its text and timing have not been provided.
It is also unclear how many states would add PACE, how quickly providers could establish new locations, or what the changes would mean for enrollment and waitlists. The 204-location figure is a current count reported by the National PACE Association; the source provides no baseline or forecast for future growth.
Senate Companion Expected This Year
A companion bill is expected to be introduced in the Senate by the end of 2026. Congress would then need to consider and pass legislation before the proposed requirements could take effect. If enacted, states with existing PACE providers would have 180 days to comply, while states without PACE would have three years.
Further developments to watch include the Senate bill’s text, any congressional hearings or votes, and whether lawmakers amend the proposed enrollment, marketing or expansion provisions.
Key Questions
What would the PACE Access Improvement Act change?
It would make PACE a mandatory Medicaid service in every state, allow enrollment to take effect any day of the month, repeal certain marketing restrictions and remove numerical limits on PACE program agreements.
How many states currently offer PACE?
The National PACE Association reports that 33 states and the District of Columbia offer the program, with 204 locations.
When would states have to comply?
Under the proposal, states with at least one PACE provider would have 180 days after enactment. States without a PACE program would have three years.
Has the bill passed?
No passage is reported in the source material. LeadingAge said passage by the end of 2026 is unlikely. A Senate companion is expected to be introduced by the end of that year.
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