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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 in every state, change when enrollment can take effect and remove some limits on provider expansion. It has support from aging-services organizations, but passage by the end of 2026 is considered unlikely.
Reps. Debbie Dingell, a Democrat, and John Moolenaar, a Republican, both of Michigan, introduced the PACE Access Improvement Act on Sept. 24. The bill would make the Program of All-inclusive Care for the Elderly a mandatory Medicaid service in every state and change enrollment and operating rules that sponsors say could help more older adults receive care at home.
The proposal would let PACE enrollment take effect any day of the month. Under current federal policy, coverage generally starts on the first day of the month after a provider receives the enrollment agreement. The bill would also repeal certain marketing restrictions and numerical limits on PACE program agreements, while addressing constraints on organizations seeking to expand or open programs.
PACE combines medical and social services for older adults who qualify for nursing home-level care, allowing them to receive services at home. It operates under both Medicare and Medicaid. According to the National PACE Association, 33 states and the District of Columbia currently offer the program, with 204 locations.
If enacted, states that already have at least one PACE provider would have 180 days to comply with the new requirements. States without a PACE program would have three years. These deadlines are proposed terms in the bill; they would not take effect unless the legislation becomes law.
A Nationwide Medicaid Requirement
Making PACE mandatory would change the program from an option states can choose to offer into a required Medicaid service nationwide. That could extend access to people in states that do not currently offer PACE and create a clearer path for providers seeking to establish programs in new areas. The bill also addresses the point at which coverage begins, potentially reducing the wait tied to the current monthly start-date rule.
The sponsors and supporters frame the changes as a response to unmet demand for home and community-based care. Dingell said people remain on waitlists for those services. The source report does not provide a count of people waiting specifically for PACE or estimate how many additional participants the bill might serve, so the scale of any access change is not yet quantified.
For providers, removing some limits on agreements and easing expansion constraints could create room to add programs. That is a potential effect of the proposal, rather than a confirmed result: growth would depend on enactment, state implementation and provider decisions.
How PACE Rules Work Today
PACE is designed for older adults who meet criteria for nursing home-level care but can live in the community with coordinated support. The program brings together health care and social services, with the aim of supporting participants at home. Its coverage through both Medicare and Medicaid makes state Medicaid policy central to how widely the model is available.
Under current policy, PACE is optional for states, and availability remains uneven: the National PACE Association reports programs in 33 states and Washington, D.C. Enrollment generally takes effect on the first day of the month after the provider receives the agreement. The bill would alter both the state-by-state availability framework and that enrollment timing.
The proposal has backing from the National PACE Association, the Alzheimer’s Association, the Alzheimer’s Impact Movement and the American Association on Health and Disability. Seen Health, a Los Angeles-based provider serving older adults of Asian and Pacific Islander heritage in Southern California, also supports it. LeadingAge, an association representing nonprofit aging-services providers, supports the bill but said it is unlikely to pass by the end of 2026.
“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, Seen Health co-founder and CEO, to Home Health Care News
Passage and Reach Remain Uncertain
The bill has been introduced, but it has not been enacted. LeadingAge assessed that passage by the end of 2026 is unlikely. The source report gives no committee schedule, vote count or estimate of when the House might consider the measure.
A Senate companion bill is expected by the end of 2026, but its text and sponsors have not been identified in the report. It is also unclear how many states would need to establish PACE programs, how quickly providers could open new locations, or how many people might gain access if the proposal becomes law. The legislation’s possible effects on provider capacity and waitlists have not been quantified.
Senate Companion Expected This Year
The next stated legislative milestone is introduction of a companion bill in the Senate by the end of 2026. After that, the proposal’s path would depend on congressional consideration and whether lawmakers advance legislation that could be enacted. No House or Senate vote date is provided in the source report.
If the measure becomes law, states with existing PACE providers would face the proposed 180-day compliance period, while states without a program would have three years. Until lawmakers take further action, the enrollment, marketing and expansion changes remain proposed policy.
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 program agreements.
Is PACE currently available nationwide?
No. The National PACE Association reports that 33 states and the District of Columbia offer PACE, with 204 locations.
When would the proposed rules take effect?
The bill proposes 180 days for states that already have a PACE provider to comply after enactment, and three years for states without PACE. Those timelines apply only if the bill becomes law.
Has the bill passed?
No. The PACE Access Improvement Act was introduced on Sept. 24, 2026. LeadingAge supports it but considers passage by the end of 2026 unlikely.
What is the next expected step?
A Senate companion bill is expected to be introduced by the end of 2026. The source report does not give a date for congressional votes.
Source: rss
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