Medicaid expands to cover assisted living; housing credits redirected to integrated care.
S. 4479 — ACCESS Act · Filed by Roger Marshall (R-KS) · Introduced Apr 30, 2026 · Referred to committee
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What it does
This bill expands Medicaid to cover assisted living services as an alternative to nursing homes or hospitals, and modifies the low-income housing tax credit to prioritize projects that provide long-term care services in non-institutional settings. States must offer assisted living under Medicaid if the per-capita cost does not exceed what would be spent on institutional care; the housing tax credit will favor developments that integrate affordable housing with long-term services for elderly residents.
Why we flagged it
The bill's core mechanism is a dual expansion: it mandates Medicaid coverage of assisted living services (a new benefit category) and redirects low-income housing tax credits toward projects that bundle affordable housing with long-term care services. Both are policy choices, not commemorative or vanity provisions.
What the text implies
- States retain discretion over what 'assisted living residence' means under state law, creating potential variation in coverage scope and quality standards across jurisdictions.
- The cost-neutrality requirement (assisted living cost ≤ institutional care cost) may incentivize states to shift higher-acuity patients into assisted living to reduce per-capita spending, potentially affecting care quality or patient outcomes.
The full analysis lists 4 implications of this text.
Who stands to gain
assisted living facility operators; real estate developers (housing tax credit recipients); property management companies