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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, allow enrollment to take effect any day of the month and ease limits on provider applications and expansion. Its chances of enactment by the end of 2026 are uncertain.
Reps. Debbie Dingell, a Michigan Democrat, and John Moolenaar, a Michigan Republican, introduced the PACE Access Improvement Act on Sept. 24, proposing to make the Program of All-inclusive Care for the Elderly a mandatory Medicaid service in every state. The bill would also let enrollment take effect any day of the month and ease limits on organizations seeking to offer or expand PACE, a model that provides nursing home-level care to older adults in their homes.
Under current federal policy, PACE enrollment generally takes effect on the first day of the month after a provider receives the enrollment agreement. The bill would allow coverage to begin at any time during the month. The source report describes this as a change intended to ease enrollment, though it does not specify how providers would implement the revised timing.
The legislation would shift PACE from an optional Medicaid program to a mandatory one across all states. States that already have at least one PACE provider would have 180 days after enactment to comply; states without a PACE provider would have three years. The bill would also repeal certain marketing restrictions and numerical limits on PACE program agreements, as well as remove limitations on applications to become a PACE organization.
The National PACE Association reports that 33 states and the District of Columbia currently offer PACE, with 204 locations. The source report does not give a projected number of additional states, organizations or locations that would result from the bill. Supporters include the National PACE Association, the Alzheimer’s Association, the Alzheimer’s Impact Movement and the American Association on Health and Disability.
How the Bill Could Expand PACE
If enacted, the proposal would change both where PACE is available and how quickly coverage can begin after enrollment. Requiring the program in every state would create a federal obligation for states that do not currently offer it, while changing the enrollment date could shorten the wait tied to the existing first-of-the-following-month rule. Those provisions could affect access for older adults who need the services, though the source material does not quantify the potential effect.
The proposal also targets rules that supporters say constrain provider growth. Removing numerical limits on program agreements and restrictions on applications could give organizations more room to seek approval or expand. That is the bill’s stated policy direction; no specific growth estimate or implementation plan is provided in the source report.
PACE combines medical and social services under Medicare and Medicaid for older adults who can receive nursing home-level care at home. The model’s reach matters to families and people seeking home- and community-based services. Dingell said that too many Americans remain on waiting lists for those services, but the report does not provide a count of people waiting specifically for PACE.
PACE Availability Under Current Rules
PACE is a program under both Medicare and Medicaid. It is designed to let older adults receive nursing home-level care while living at home. Its availability currently depends on states opting into the program; according to the National PACE Association figures cited by Home Health Care News, 33 states and the District of Columbia have done so.
The bill is also intended to change how providers can enter and operate in the program. It would remove certain application limitations and numerical limits on PACE program agreements, and repeal some marketing restrictions. The source report does not detail each restriction or explain how the proposed changes would be administered, so the scope of those changes cannot be assessed from the available information.
One provider supporting the proposal is Seen Health, a Los Angeles-based PACE organization serving older adults of Asian and Pacific Islander heritages in Southern California. Its CEO, Xing Su, told Home Health Care News that more flexibility could help providers reach communities that need the model. Seen Health’s support is a provider’s position on the bill, rather than evidence of how many new centers or enrollees it would produce.
“PACE keeps frail older adults healthy and living at home, and families trust it. 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
Enactment is not assured. LeadingAge, an advocacy association that supports the bill, said it is unlikely to pass by the end of 2026. The report says a companion bill is expected in the Senate by year-end, but it does not identify a sponsor or a specific introduction date.
The source material does not state the bill’s committee assignments, hearing schedule, legislative text details beyond the provisions described, or whether lawmakers have secured enough support for passage. It also offers no estimate of how many states would need to establish PACE, how many providers might apply, or how enrollment changes would affect participants in practice.
Senate Companion and State Deadlines
The next stated legislative milestone is introduction of a Senate companion bill expected by the end of 2026. The proposal would then need to advance through the legislative process; the available report does not provide a schedule for committee consideration or votes.
If the bill becomes law, states with existing PACE providers would have 180 days from enactment to comply, while states without providers would have three years. Those deadlines are proposed terms, not current requirements. Until enactment, the existing optional-state framework and enrollment timing remain in place.
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 remove certain limits on provider applications, program agreements and marketing.
When would the bill’s requirements take effect for states?
Under the proposal, states that already have a PACE provider would have 180 days after enactment to comply. States without a PACE provider would have three years.
Has the bill become law?
No. The source report says the act was introduced on Sept. 24, 2026. It also reports that a Senate companion is expected by the end of the year and that LeadingAge considers passage by then unlikely.
How many states currently offer PACE?
The National PACE Association figures cited in the report list 33 states and the District of Columbia, with 204 PACE locations.
Source: rss
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