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Reps. Debbie Dingell and John Moolenaar introduced the PACE Access Improvement Act on Sept. 24. It would make PACE a mandatory Medicaid service, allow enrollment to take effect any day of the month and ease certain limits on provider growth. The bill’s prospects and implementation details remain uncertain.
Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.) introduced legislation 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 let enrollment take effect any day of the month and ease some restrictions on provider expansion, changes that supporters say could widen access to care for older adults and people with disabilities.
Under the bill, PACE enrollment could take effect at any time during the month. Current federal policy generally starts coverage on the first day of the month after a provider receives the enrollment agreement. The proposal would also shift PACE from an optional Medicaid program to a mandatory one, requiring states to offer it.
The legislation would repeal certain marketing restrictions and numerical limits on PACE program agreements, and address constraints on expanding PACE organizations. States already operating at least one PACE provider would have 180 days after enactment to comply. States without a PACE provider would have three years, according to the report by Home Health Care News.
The bill 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 technology-enabled PACE provider based in Los Angeles, also supports it. The company provides culturally informed services to older adults of Asian and Pacific Islander heritages in Southern California.
A Wider Route to PACE Services
Making PACE mandatory would change the program’s status from a state option to a Medicaid requirement, potentially extending its availability to places that do not currently offer it. Faster enrollment start dates could also reduce the wait between completing an agreement and beginning coverage, though the bill’s practical effect would depend on how states and providers implement the changes.
Supporters point to unmet demand for home and community-based services. Dingell said too many people remain on waitlists, while Seen Health CEO Xing Su argued that enrollment flexibility and easier expansion could help providers reach more communities. Those are supporters’ assessments; the source material does not quantify how many people might gain access or how quickly new centers could open.
How PACE Works Today
PACE combines medical and social services for eligible older adults, allowing them to receive nursing-home-level care while living at home, according to the source report. It operates under both Medicare and Medicaid. Participation by states is currently optional.
The National PACE Association counted 33 states and the District of Columbia with PACE, operating 204 locations. The bill would also remove limits on applying to become a PACE organization and address constraints on expansion. The proposed deadlines distinguish between states that already have a provider and those that do not.
“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
The Bill’s Path and Reach
Passage is not assured. LeadingAge, an advocacy association that supports the bill, said it is unlikely to pass by the end of 2026. The source report says a Senate companion is expected by year-end, but does not identify its sponsors or provide a timetable for consideration.
The source material does not specify how the bill would be funded, how states would meet the new requirement, or how many additional providers and participants the changes could produce. Those outcomes would depend on the bill’s final terms and implementation.
Senate Companion Expected
A companion measure is expected to be introduced in the Senate by the end of 2026. Congress would then need to consider and pass legislation before the proposed state deadlines could begin; the source report gives no enactment date. The bill’s progress and any changes made during consideration will determine whether its enrollment and provider-growth provisions take effect.
Key Questions
What would the PACE Access Improvement Act change?
It would make PACE a mandatory Medicaid service, allow enrollment to take effect any day of the month and repeal certain marketing restrictions and numerical limits on program agreements.
Would every state have to offer PACE?
Under the bill, yes. States with an existing PACE provider would have 180 days after enactment to comply; states without one would have three years.
How many states currently offer PACE?
The National PACE Association count cited by Home Health Care News lists 33 states and the District of Columbia, with 204 locations.
Has the bill passed?
No passage is reported. LeadingAge said it is unlikely to pass by the end of 2026, and a Senate companion is expected by that year’s end.
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