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Reps. Debbie Dingell and John Moolenaar introduced the bipartisan 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 restrictions on PACE organizations. Its prospects for passage by the end of 2026 are uncertain.
Reps. Debbie Dingell, a Democrat, and John Moolenaar, a 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 change when coverage can begin and ease some limits on PACE enrollment and provider expansion, potentially affecting older adults who need nursing-home-level care at home.
Under the bill, PACE enrollment could take effect on any day of the month. Current federal policy generally starts coverage on the first day of the month after a provider receives the agreement. The proposal also would repeal certain marketing restrictions and numerical limits on PACE program agreements, while addressing constraints on organizations seeking to expand.
The bill would move PACE from an optional Medicaid program to a required service across all states. 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 program would have three years, according to the source report.
The National PACE Association says 33 states and the District of Columbia currently offer PACE, with 204 locations. Those figures describe the current footprint reported by the association; they do not establish how many new programs the legislation would produce. 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.
A Broader Path to PACE Care
PACE combines medical and social services for eligible older adults, allowing them to receive nursing-home-level care while living at home. Making Medicaid coverage mandatory could extend the program to states that have not adopted it, while changing enrollment timing could reduce the wait tied to the current monthly start schedule.
The proposal could also give providers more room to establish or expand programs, though the bill itself does not guarantee that new centers will open or that waitlists will shrink. Provider growth would depend on implementation and the ability of organizations to serve additional communities. The changes matter to older adults and families seeking long-term supports, as well as states and providers responsible for delivering them.
How PACE Coverage Works Today
PACE operates under both Medicare and Medicaid and serves older adults who meet program eligibility requirements. Its model brings together health care and social support, with the aim of helping participants remain in their homes rather than receive care in a nursing home.
Today, states decide whether to offer PACE through Medicaid. According to the National PACE Association figures cited by Home Health Care News, 33 states and the District of Columbia have opted in. The proposed act would change that state-by-state approach by requiring participation nationwide, subject to the timelines set out in the bill.
“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, speaking to Home Health Care News
Passage and Expansion Remain Uncertain
The legislation has been introduced, but its prospects for enactment remain unclear. LeadingAge, which supports the bill, said it is unlikely to pass by the end of 2026. The source report does not provide a legislative schedule or details on committee action.
The number of states or providers that would add programs if the bill becomes law is also unknown. The bill’s proposed changes may remove some barriers, but the available reporting does not quantify likely enrollment gains, new locations or effects on waitlists.
Senate Proposal Expected Later
A companion bill is expected in the Senate by the end of 2026, according to the source report. Its introduction would provide another step in the legislative process, but no passage date or final outcome has been confirmed.
If enacted, states with existing PACE providers would face a 180-day implementation period, while states without programs would have three years to comply. Until the legislation advances, the proposed nationwide requirement and operational changes remain subject to congressional action.
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 repeal certain marketing restrictions and numerical limits on program agreements.
What is PACE?
The Program of All-inclusive Care for the Elderly provides medical and social services through Medicare and Medicaid, enabling eligible older adults to receive nursing-home-level care while living at home.
How many states currently offer PACE?
The National PACE Association reports that 33 states and the District of Columbia offer the program, with 204 locations.
When would states have to comply?
Under the bill, states with at least one PACE provider would have 180 days after enactment to comply. States without PACE would have three years.
Has the bill passed?
No. It was introduced on Sept. 24, 2026. A Senate companion is expected by year’s end, and LeadingAge has said passage by the end of 2026 is unlikely.
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