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Reps. Debbie Dingell and John Moolenaar introduced the bipartisan PACE Access Improvement Act on Sept. 24. The bill would make PACE a required Medicaid service in every state, change when enrollment begins and ease certain limits on provider expansion, but it is unlikely to pass by the end of 2026, according to LeadingAge.
Reps. Debbie Dingell, a Michigan Democrat, and John Moolenaar, a Michigan Republican, introduced a bill on Sept. 24 that would make the Program of All-inclusive Care for the Elderly (PACE) a mandatory Medicaid service in every state. The PACE Access Improvement Act would also change enrollment timing and remove certain limits on providers, potentially expanding access to a model that delivers nursing home-level care in people’s homes.
The bill 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 proposal would also repeal some marketing restrictions and numerical limits on PACE program agreements, and address constraints on expanding PACE organizations.
States would have different timelines to comply if the bill became law. States that already have at least one PACE provider would need to meet the new requirements within 180 days of enactment. States without a PACE program would have three years. The National PACE Association reports that PACE is currently available in 33 states and the District of Columbia, with 204 locations.
Seen Health, a technology-enabled PACE provider based in Los Angeles, supports the proposal. The company provides culturally informed services to older adults of Asian and Pacific Islander heritages in Southern California. Its co-founder and CEO, Xing Su, told Home Health Care News that the bill could give providers more flexibility to enroll people and open new centers.
More States Could Offer PACE
Making PACE mandatory under Medicaid would change the program’s status from a state option to a requirement, if Congress passes the bill. That could extend the model to states that do not currently offer it and create a defined timetable for implementation. The proposal’s enrollment change could also shorten the wait for coverage to begin after an agreement is received, though the practical effect would depend on how the rules are implemented.
The provider provisions address the ability to expand and the number of agreements available. Supporters argue that easing these restrictions could help organizations reach more older adults and people with disabilities who need long-term support. The bill itself does not establish how many new providers would open, how many people would enroll or how much access would grow.
That distinction matters for people waiting for home and community-based services. The National PACE Association’s figures describe the program’s current footprint, while Dingell cited waitlists for such services as a reason to broaden access. The proposed changes could affect how states and providers plan services, but their impact would depend on enactment, state implementation and provider capacity.
How PACE Works Today
PACE combines medical and social services for older adults who meet program eligibility requirements. It is delivered through both Medicare and Medicaid and is designed to let participants receive nursing home-level care while living at home. The bill concerns the program’s Medicaid status and the rules governing enrollment and provider expansion.
At present, states can choose whether to offer PACE. The National PACE Association reports programs in 33 states and the District of Columbia, operating at 204 locations. The proposed federal requirement would therefore affect states with existing programs as well as those without one, although the bill gives those groups different compliance periods.
The legislation has support from the National PACE Association, Alzheimer’s Association, Alzheimer’s Impact Movement and American Association on Health and Disability, in addition to Seen Health. LeadingAge, an advocacy association for nonprofit aging-services providers, also supports the bill. Its assessment, as reported by Home Health Care News, is that the measure is unlikely to pass by the end of 2026.
““PACE keeps frail older adults healthy and living at home, and families trust it.””
— Xing Su, Seen Health co-founder and CEO
The Bill’s Reach Remains Unknown
The bill has been introduced, but it has not become law. Its prospects are uncertain, and LeadingAge told Home Health Care News that passage by the end of 2026 is unlikely. The source report does not specify a committee schedule, vote date or other near-term action in the House.
The legislation’s eventual effect on enrollment, waitlists and provider growth is also unknown. Its provisions would set requirements and remove certain restrictions, but the source material does not give estimates for new locations, additional participants, costs or state implementation plans. Those details would depend on the final law and subsequent decisions by federal and state officials.
Senate Companion Expected
A companion measure is expected to be introduced in the Senate by the end of 2026, according to the source report. That would be a next legislative step, not a guarantee of passage. The House bill’s path, the contents of a Senate version and whether the chambers would advance matching legislation remain open questions.
If Congress enacted the proposal, states with existing PACE providers would face a 180-day compliance period, while states without a program would have three years. Until then, PACE remains optional for states under current policy, and enrollment generally takes effect on the first day of the month after the provider receives the agreement.
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 and repeal certain marketing restrictions and numerical limits on program agreements.
When would the proposed requirements take effect?
If enacted, states with at least one PACE provider would have 180 days to comply. States without a PACE program would have three years.
How widely is PACE available now?
The National PACE Association reports PACE programs in 33 states and the District of Columbia, with 204 locations.
Is the bill expected to pass in 2026?
That is uncertain. LeadingAge, a supporter of the bill, told Home Health Care News that passage by the end of 2026 is unlikely.
What is the next expected legislative step?
A Senate companion bill is expected to be introduced by the end of 2026. Its text and prospects for action have not been reported.
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