119 S4479 IS: Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act U.S. Senate 2026-04-30 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II119th CONGRESS2d SessionS. 4479IN THE SENATE OF THE UNITED STATESApril 30, 2026Mr. Marshall introduced the following bill; which was read twice and referred to the Committee on FinanceA BILLTo provide assisted living assistance through Medicaid and the low-income housing tax credit.

1.

Short title

This Act may be cited as the Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act or the ACCESS Act.

2.

Coverage of services in an assisted living residence under Medicaid

(a)

Definition of medical assistance

Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—(1)in paragraph (31), by striking and after the semicolon;(2)by redesignating paragraph (32) as paragraph (33); and(3)by inserting after paragraph (31), the following new paragraph:(32)services provided in an assisted living residence consistent with State law permitting such services, including to individuals who would require the level of care provided in a hospital or nursing facility, the cost of which could be reimbursed under the State plan (or a waiver of such plan), and who meet the State's income and resources requirements adopted under section 1902(a)(10)(A)(i)(V) and for whom the estimated annual average per capita total Medicaid cost for all services for individuals receiving services in an assisted living residence would be no greater than the estimated annual average per capita total Medicaid cost for all services that would have been incurred had those individuals received services in a hospital or nursing facility; and.(b)

Mandatory benefit

Section 1902(a)(10)(A) of such Act (42 U.S.C. 1396a(a)(10)(A)) is amended in the matter preceding clause (i), by striking and (30) and inserting (30), and (32).(c)

Effective date

(1)

In general

Except as provided in paragraph (2), the amendments made by this section shall take effect on January 1, 2027.(2)

Delay permitted if state legislation required

In the case of a State plan approved under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title XIX solely on the basis of the failure of the plan to meet such additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that ends after the 1-year period beginning with the date of the enactment of this section. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of the session is deemed to be a separate regular session of the State legislature.

3.

Selection criteria for qualified allocation plan under the low-income housing tax credit

(a)

In general

Subparagraph (C) of section 42(m)(1) of the Internal Revenue Code of 1986 is amended by striking and at the end of clause (ix), by striking the period at the end of clause (x) and inserting , and, and by adding at the end the following new clause:(xi)projects which reduce the medical assistance costs of long-term services and supports for the elderly by providing such services and supports in a non-institutional setting..(b)

Effective date

The amendments made by this section shall apply to allocations made after January 1, 2027.