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To provide assisted living assistance through Medicaid and the low- income housing tax credit.
Summary
The ACCESS Act would expand Medicaid coverage to include services provided in assisted living residences for individuals who would otherwise require hospital or nursing facility care. Medicaid beneficiaries would be eligible if they meet state income and resource requirements and the estimated annual per-person cost in an assisted living residence does not exceed what would have been spent for hospital or nursing facility care. The bill also amends the Low-Income Housing Tax Credit program to add a new selection criterion favoring housing projects that reduce Medicaid costs for elderly long-term services and supports by providing such services in non-institutional settings like assisted living. These changes would take effect on January 1, 2027, with provision for states to delay implementation if state legislation is required.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
- Sen. Marshall, Roger [R-KS] (R-KS)
Money behind the sponsor
Top reported contributors to Roger Marshall’s campaign committee (2024 cycle) — who funds the bill’s sponsor, not a claim about this bill. Data from FEC.
- NULL $46,314
- PYRAMID SOUND $19,800
- GROWITZ EQUITY $13,200
- SPECCHEM $13,200
- ONYX EQUITY PARTNERS $13,200
Organizations whose employees gave the most — itemized individual contributions grouped by the donor’s reported employer (FEC Schedule A). Full finance for Roger Marshall → · Outside spending →
Actions (2)
- Apr 30, 2026 Read twice and referred to the Committee on Finance. · senate
- Apr 30, 2026 Introduced in Senate
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Full text
IN THE SENATE OF THE UNITED STATES
April 30, 2026
Mr. Marshall introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To provide assisted living assistance through Medicaid and the low- income housing tax credit.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act” or the “ACCESS Act”.
SEC. 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.
SEC. 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. <all>
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