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Reps. Debbie Dingell and John Moolenaar introduced the bipartisan PACE Access Improvement Act on Sept. 24, 2026. It would require every state to offer PACE, make coverage effective when enrollment paperwork is signed and ease barriers to opening or expanding centers; the bill’s passage and implementation details remain uncertain.
U.S. Reps. Debbie Dingell and John Moolenaar introduced the bipartisan PACE Access Improvement Act on Sept. 24, proposing to require every state to offer the Program of All-Inclusive Care for the Elderly and to make coverage effective when an eligible person signs enrollment paperwork. The bill could widen access to coordinated, home-based care for older adults, but it has not yet become law.
PACE is a joint Medicare and Medicaid program that coordinates medical and support services for eligible older adults who need nursing-home-level care but can live safely in the community with help. Under current eligibility rules, a person must be at least 55, live in a PACE organization’s service area and receive state certification that nursing-home-level care is needed.
Currently, participants may submit enrollment paperwork at any time during the month, but coverage generally starts on the first day of the following month after the PACE organization receives the signed agreement. The bill would instead start coverage on the day the provider signs the paperwork, bringing the start of benefits forward for eligible enrollees.
The proposal would also make PACE a mandatory Medicaid offering in every state and seek to ease barriers to opening or expanding centers. The source report says 33 states currently offer PACE. It does not provide a full account of the proposed center-approval changes or their implementation requirements.
Earlier Access and More State Programs
If enacted, the measure could affect both when eligible older adults receive coverage and where PACE is available. Starting coverage on the paperwork-signing date could reduce the wait built into the current monthly effective-date rule. Requiring every state to offer PACE could also create a path for service expansion in places without programs today.
Supporters say these changes may help providers reach more people with complex medical and social needs. InnovAge CEO Patrick Blair told Home Health Care News that PACE serves only a small fraction of older adults who could benefit. That is an industry leader’s assessment, not a quantified estimate in the report. The bill’s real effect would depend on enactment, state implementation, local capacity and whether eligible people can access a center in their community.
Expansion could involve more than adding a program on paper: providers need centers, staff and transportation to deliver coordinated services. The legislation may therefore matter to home-based care organizations as well as older adults and their families, though the source does not quantify likely growth in enrollment, provider numbers or spending.
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How PACE Enrollment Works Today
PACE combines Medicare and Medicaid funding to organize care for older adults who meet program requirements. Participants must live within a provider’s service area and be able to remain safely in the community with PACE support. Those conditions mean a nationwide state requirement would not, by itself, make every older adult eligible or guarantee that a provider serves every locality.
The current enrollment timing is a central target of the bill: signing up during a month does not generally mean coverage begins that day. The proposal would replace the next-month start with a same-day effective date tied to provider signature. It also addresses state availability and provider expansion, linking individual enrollment rules with the broader reach of the program.
For local providers, outreach before a center opens is another issue raised in the report. Stephanie Winslow, executive director of the PACE Association of Michigan, said providers may have staff and transportation ready but face limits on marketing services before opening. Earlier outreach, she said, could give prospective participants time to learn about PACE and consider enrollment.
“Allowing seniors to enroll when they need care, rather than waiting until the beginning of the following month, removing unnecessary barriers to opening and expanding centers and making PACE available in every state would meaningfully improve access.”
— Patrick Blair, CEO of InnovAge, speaking to Home Health Care News
Passage and Rollout Remain Unsettled
The source report describes a bill introduced by two representatives, not an enacted policy. It does not report committee action, a vote schedule or the legislation’s prospects in Congress. A Senate companion was expected in November, according to the National PACE Association, but the report does not confirm that it was introduced.
Details about how states would meet a nationwide PACE requirement, how quickly new programs could open, and what standards or timelines would apply are not specified in the source material. It is also unclear how many additional centers might be created, how providers would finance expansion, or how many older adults would enroll. The proposed earlier effective date would not remove the program’s age, care-needs or service-area eligibility requirements.
Senate Proposal and Legislative Action
The next reported milestone was a Senate companion bill expected in November 2026, according to the National PACE Association. Whether it is introduced, and how its provisions compare with the House measure, remains to be confirmed.
Readers should watch for congressional action on the bill and for details about any amendments, implementation rules or state requirements. Until Congress passes legislation and it takes effect, current PACE eligibility and coverage-start rules remain in place.
Key Questions
What would the PACE Access Improvement Act change?
It would require every state to offer PACE, make coverage effective on the day the provider signs enrollment paperwork and ease barriers to opening or expanding centers, according to the source report.
When does PACE coverage generally start under current rules?
Although people can enroll at any time during the month, coverage generally begins on the first day of the following month after the PACE organization receives the signed enrollment agreement.
Who can qualify for PACE?
Under the eligibility criteria described in the report, applicants must be at least 55, live in a PACE organization’s service area, be certified by the state as needing nursing-home-level care and be able to live safely in the community with PACE services.
Does every state currently offer PACE?
No. The source report says 33 states currently offer PACE. The bill would require all states to offer the program if enacted.
Has the bill become law?
No enactment is reported. Representatives Debbie Dingell and John Moolenaar introduced the bill on Sept. 24, 2026. A Senate companion was expected in November, but the report does not confirm its introduction.
Source: homehealthcarenews.com
