S. 4479

119 S4479 IS: Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act
 U.S. Senate
 2026-04-30
 text/xml
 EN
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 II  119th CONGRESS  2d Session  S. 4479  IN THE SENATE OF THE UNITED STATES   April 30, 2026   Mr. Marshall  introduced the following bill; which was read twice and referred to the  Committee on Finance    A BILL
To provide assisted living assistance through Medicaid and the low-income housing
 tax credit.
1.
Short title
This Act may be cited as the   Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act   or the   ACCESS Act  .
2.
Coverage of services in an assisted living residence under Medicaid
(a)
Definition of medical assistance
Section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ) is amended—
(1)
in paragraph (31), by striking  and  after the semicolon;
(2)
by redesignating paragraph (32) as paragraph (33); and
(3)
by inserting after paragraph (31), the following new paragraph:
(32)
services provided in an assisted living residence consistent with State law permitting such services, including to individuals who would require the level of care provided in a hospital or nursing facility, the cost of which could be reimbursed under the State plan (or a waiver of such plan), and who meet the State's income and resources requirements adopted under section 1902(a)(10)(A)(i)(V) and for whom the estimated annual average per capita total Medicaid cost for all services for individuals receiving services in an assisted living residence would be no greater than the estimated annual average per capita total Medicaid cost for all services that would have been incurred had those individuals received services in a hospital or nursing facility; and
 .
(b)
Mandatory benefit
Section 1902(a)(10)(A) of such Act ( 42 U.S.C. 1396a(a)(10)(A) ) is amended in the matter preceding clause (i), by striking  and (30)  and inserting  (30), and (32) .
(c)
Effective date
(1)
In general
Except as provided in paragraph (2), the amendments made by this section shall take effect on January 1, 2027.
(2)
Delay permitted if state legislation required
In the case of a State plan approved under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title XIX solely on the basis of the failure of the plan to meet such additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that ends after the 1-year period beginning with the date of the enactment of this section. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of the session is deemed to be a separate regular session of the State legislature.
3.
Selection criteria for qualified allocation plan under the low-income housing tax credit
(a)
In general
Subparagraph (C) of  section 42(m)(1)  of the Internal Revenue Code of 1986 is amended by striking  and  at the end of clause (ix), by striking the period at the end of clause (x) and inserting  , and , and by adding at the end the following new clause:
(xi)
projects which reduce the medical assistance costs of long-term services and supports for the elderly by providing such services and supports in a non-institutional setting.
 .
(b)
Effective date
The amendments made by this section shall apply to allocations made after January 1, 2027.