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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 some limits on provider growth. Its passage is uncertain, and a Senate companion is expected by the end of 2026.
Reps. Debbie Dingell, a Democrat, and John Moolenaar, a Republican, introduced the PACE Access Improvement Act on Sept. 24, proposing that Medicaid make the Program of All-inclusive Care for the Elderly (PACE) mandatory and changing rules that affect enrollment and provider expansion. The proposal could widen access to a model that combines medical and social services for eligible older adults, but it has not become law.
The bill would shift PACE from an optional Medicaid service to a mandatory one across states. According to the source report, 33 states and the District of Columbia currently offer PACE, with 204 locations listed by the National PACE Association. States that already have at least one PACE provider would have 180 days after enactment to comply with the new rules. States without a PACE provider would have three years.
The proposal would also allow a participant’s enrollment to take effect on any day of the month. Under current federal policy described in the report, coverage generally begins on the first day of the month after a provider receives the agreement. That timing change could reduce the wait between enrollment and coverage, although the bill’s practical effect would depend on its final terms and implementation.
Other provisions would repeal certain marketing restrictions and numerical limits on PACE program agreements, as well as remove limitations on applications to become a PACE organization and address constraints on expansion. The source report does not specify every restriction affected or how each change would work in practice. The legislation is intended to make it easier for programs to open or grow, but it does not itself establish new centers or guarantee that providers will expand.
Potential Reach of Medicaid PACE Coverage
Making PACE mandatory could change the program’s status in states that do not currently offer it. PACE serves eligible older adults who need a level of care comparable to nursing-home care while receiving services at home and in the community. A nationwide Medicaid requirement would create a new obligation for states, with the bill setting different compliance periods depending on whether a state already has a PACE provider.
The proposed enrollment timing change addresses a practical gap between signing an agreement and the start of coverage. If enacted as described, it could let participants begin receiving covered services sooner than waiting for the first day of the next month. The report does not provide estimates of how many people might benefit, how many new providers might enter the field, or what the federal and state costs would be.
Provider organizations and advocates say the changes could help address unmet demand. The report says some people remain on waitlists for home and community-based services, but it gives no waitlist total or estimate of the number who could qualify for PACE. Any expansion would also depend on states’ implementation and providers’ ability to establish and operate programs.
Seen Health, a technology-enabled PACE provider based in Los Angeles, supports the legislation. The company provides culturally informed services to older adults of Asian and Pacific Islander heritages in Southern California. Its support reflects one provider’s view of the proposed flexibility; it does not establish how broadly providers would expand if the bill passes.
How PACE Coverage Works Today
PACE is a medical and social services program operating under both Medicare and Medicaid. It is designed for eligible older adults who need nursing-home-level care, with services coordinated so they can live at home rather than in a nursing home. The proposed legislation concerns Medicaid’s role and rules for PACE organizations; the source report does not describe changes to Medicare coverage.
At present, states may choose whether to offer PACE. The National PACE Association figures cited in the report show that the program is available in 33 states and the District of Columbia, across 204 locations. Those figures describe the current footprint, not a projection of what the bill would produce. The legislation would require states to provide PACE, while setting a longer implementation period for states that do not already have a provider.
The bill has support from the National PACE Association, the Alzheimer’s Association, the Alzheimer’s Impact Movement and the American Association on Health and Disability, according to Home Health Care News. LeadingAge, an advocacy association representing nonprofit aging-services providers, also supports it. That backing does not resolve the legislative outlook: LeadingAge said the measure is unlikely to pass by the end of 2026.
““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
Passage, Costs and State Rollout
The bill’s legislative prospects remain uncertain. LeadingAge said it is unlikely to pass by the end of 2026, and the source report does not identify a committee schedule, hearing date or vote. A companion measure is expected in the Senate by year-end, but its sponsor and text are not specified.
The available account does not provide fiscal estimates, explain how states would fund implementation, or quantify how many additional people could enroll. It also does not detail which marketing restrictions or numerical agreement limits would be repealed. The proposal’s effects on provider participation, program locations and waitlists therefore cannot yet be measured from the information provided.
Eligibility rules and operational requirements would continue to matter to people seeking care. The report does not say whether the legislation would change those rules, how enrollment on a non-first day would be administered, or what federal guidance states and providers would receive. Those details would depend on the final legislation and any later implementation instructions.
Senate Proposal and Congressional Review
A Senate companion bill is expected by the end of 2026. Congress would then need to consider the House and Senate proposals, and any enacted version would determine the final requirements and timelines. The source report gives no date for Senate introduction or subsequent hearings.
If the measure were enacted, states with at least one PACE provider would have 180 days to comply, while states without a provider would have three years. Those periods would begin after enactment, not after the bill’s introduction. Until lawmakers act, PACE remains optional for states under the current arrangement described in the report.
Further developments to watch include the Senate bill’s provisions, congressional action on both measures and any official estimates of costs or expected enrollment. The current report does not establish whether the proposal will advance or how many new PACE organizations might open.
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.
Is PACE mandatory under Medicaid now?
No. The source report says states currently choose whether to offer PACE. It reports that 33 states and the District of Columbia have the program.
When would states have to comply?
Under the bill as described, states with at least one PACE provider would have 180 days after enactment. States without a provider would have three years.
Has the bill passed?
No. Dingell and Moolenaar introduced it on Sept. 24, 2026. LeadingAge said passage by the end of 2026 is unlikely, and a Senate companion is expected by year-end.
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