TL;DR
Get everyday helpers delivered free — and shop member deals
- Fast, free delivery on millions of items
- Access to Prime Big Deal Days deals on October 6–7
- Prime Video, Amazon Music and more included
Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.) introduced the PACE Access Improvement Act on Sept. 24, which would make PACE a mandatory Medicaid service nationwide and remove enrollment and expansion barriers. PACE currently operates in 33 states and D.C. with 204 locations, and a Senate companion bill is expected by the end of 2026.
A bipartisan pair of Michigan lawmakers introduced legislation on Sept. 24 that would make the Program of All-inclusive Care for the Elderly (PACE) a mandatory Medicaid service nationwide, easing enrollment barriers and loosening restrictions that currently limit how many organizations can operate PACE programs. The PACE Access Improvement Act, sponsored by Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.), is backed by provider groups who say it would let proven programs reach more frail older adults who want nursing home-level care at home.
The bill would shift PACE from an optional Medicaid benefit to a mandatory service in all 50 states. Currently, 33 states and the District of Columbia have opted into PACE, operating a combined 204 locations, according to the National PACE Association. States that already have at least one PACE provider would need to comply with new regulations 180 days after enactment; states without any PACE presence would have three years to comply.
The legislation would also change how enrollment timing works. PACE enrollment currently takes effect on the first day of the month after the provider receives the signed agreement; the bill would allow enrollment to take effect at any time of the month, a change supporters say would get care to eligible older adults faster. In addition, the bill would repeal certain PACE marketing restrictions, remove numerical limits on PACE program agreements, and eliminate limitations on applying to become a PACE organization.
The proposal has drawn support from provider and advocacy organizations including the National PACE Association, the Alzheimer’s Association, the Alzheimer’s Impact Movement, the American Association on Health and Disability, and LeadingAge, the Washington, D.C.-based association representing nonprofit aging-services providers. Tech-enabled PACE provider Seen Health, a Los Angeles-based company serving older adults of Asian and Pacific Islander heritages in Southern California, also supports the bill.
Stakes for Frail Seniors and Home Care Providers
The bill addresses a persistent gap in long-term care access. Because PACE is optional, roughly 17 states have never offered it, leaving eligible frail older adults in those states without access to a model designed to deliver nursing home-level care in their own homes. Making PACE mandatory could extend the program to tens of thousands of additional seniors who qualify for nursing home care but prefer to remain in their communities, and supporters argue it could reduce waitlists for home and community-based services that Dingell described as a barrier for too many Americans. For providers and investors, lifting the numerical caps on program agreements would open a growth path for both nonprofit and for-profit PACE organizations, a shift that could draw new entrants — including tech-enabled operators like Seen Health — into a market that has been constrained by federal limits. There are also fiscal implications worth watching: the mandate would impose new administrative and budgetary obligations on states that have so far declined to participate, and expanded enrollment would increase Medicaid spending in exchange for, as PACE’s proponents contend, potential offsetting savings from reduced nursing home placements and hospitalizations.
How PACE Works Now
PACE has existed as an optional Medicaid benefit for decades, leaving individual states to decide whether to offer it. The current federal policy also layers administrative constraints on the program: coverage generally begins on the first day of the month after the provider receives the enrollment agreement, and federal rules cap the number of PACE program agreements and restrict how organizations may market their services. The National PACE Association counts 204 PACE locations across 33 states and D.C. The bill introduced this week targets each of those constraints — the timing rule, the numerical caps, the marketing limits and the state-by-state opt-in structure — in a single package.
“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, co-founder and CEO of Seen Health
Legislative Odds and Open Questions
The bill’s path forward is uncertain. According to LeadingAge, a supporter of the legislation, the bill is unlikely to pass by the end of 2026. A Senate companion bill is expected to be introduced by the end of 2026, but that timing could slip. It is not yet clear how much the mandatory-service mandate would cost states without existing PACE programs, or how quickly the Centers for Medicare & Medicaid Services could process an expected wave of new PACE organization applications if the caps are lifted.
Watching the Senate and Committee Calendar
Advocates are waiting for a Senate companion bill, expected by the end of 2026, which would need to advance alongside the House version for the legislation to reach the president’s desk. In the House, the bill would need committee action and a floor vote; neither has been scheduled, according to the report. Provider organizations such as the National PACE Association and LeadingAge are expected to continue lobbying for the measure, while PACE organizations could begin preparing expansion plans if the numerical limits on program agreements are repealed.
Key Questions
What is PACE?
The Program of All-inclusive Care for the Elderly is a Medicare and Medicaid program that provides medical and social services, including nursing home-level care, to eligible older adults in their own homes rather than in institutions.
What would the PACE Access Improvement Act change?
It would make PACE a mandatory Medicaid service in all states, allow enrollment to take effect at any time of the month, remove numerical limits on PACE program agreements, repeal certain marketing restrictions, and remove limitations on applying to become a PACE organization.
How many states currently offer PACE?
According to the National PACE Association, 33 states and the District of Columbia have opted into PACE, with 204 locations in total.
How quickly would states have to comply if the bill passes?
States with at least one existing PACE provider would need to comply with the new requirements 180 days after enactment. States with no PACE presence would have three years.
Is the bill likely to become law soon?
Not immediately. LeadingAge, which supports the bill, said it is unlikely to pass by the end of 2026. A Senate companion bill is expected to be introduced by the end of 2026.
Source: rss
Fall Picks
fall essentials
As an affiliate, we earn on qualifying purchases.
