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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, allow mid-month enrollment and lift limits on new PACE programs. A Senate companion bill is expected by the end of 2026, though LeadingAge says passage this year is unlikely.
Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.) introduced bipartisan legislation on Sept. 24 that would make the Program of All-inclusive Care for the Elderly (PACE) a mandatory Medicaid service in every state and remove several barriers that currently limit enrollment and the growth of PACE providers. The bill, called the PACE Access Improvement Act, is backed by provider groups including the National PACE Association and LeadingAge, though advocates acknowledge it is unlikely to pass before the end of 2026.
The legislation would shift PACE from an optional Medicaid program to a mandatory one in all 50 states. Currently, 33 states and the District of Columbia have opted into PACE, operating 204 PACE locations, according to the National PACE Association. States that already have at least one PACE provider would need to comply with the new requirements within 180 days of enactment, while states without any PACE presence would have three years to comply.
The bill would also change how enrollment timing works. Under current federal policy, PACE coverage generally begins on the first day of the month after the provider receives the signed agreement. The legislation would instead allow enrollment to take effect at any time of the month, which supporters say would let frail older adults begin receiving care sooner.
Additional provisions would remove numerical limits on PACE program agreements, repeal certain PACE marketing restrictions, and eliminate limitations on applying to become a PACE organization — steps supporters describe as fostering the growth of PACE and its programs. PACE is a medical and social services program operating under both Medicare and Medicaid that allows older adults to receive nursing home-level care in their own homes.
What the Bill Means for Older Adults and Providers
For older adults, the bill addresses a persistent gap in access to home- and community-based care. PACE currently reaches only a fraction of the eligible population, concentrated in the 33 states plus D.C. that have opted in. Making the program mandatory nationwide would extend the model to the 17 states with no PACE presence, and easing enrollment timing could shorten the wait between a care crisis and the start of services.
For providers, the removal of numerical caps on program agreements and application limitations would open a clearer path to expansion. Tech-enabled PACE provider Seen Health, which provides culturally informed PACE services for older adults of Asian and Pacific Islander heritages in Southern California, supports the bill. Xing Su, the Los Angeles-based company’s co-founder and CEO, told Home Health Care News that greater flexibility would let providers “reach more of the communities that need this model most.” The bill’s supporters also include the Alzheimer’s Association, the Alzheimer’s Impact Movement and the American Association on Health and Disability.
How PACE Works Today
PACE has operated as an optional Medicaid benefit for decades, which is why its footprint varies so widely by state. The program bundles medical care, social services and long-term supports for frail older adults who qualify for nursing home-level care, with the goal of allowing them to remain in their own homes rather than enter institutions.
The legislative effort comes amid sustained demand for home-based alternatives to nursing homes, and Dingell framed the bill around the gap between demand and access. The Michigan Democrat said in a statement that the bill’s purpose is to put long-term supports “in reach for those who need them the most.”
“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
What’s Unclear About the Bill’s Path
The bill’s prospects in Congress are uncertain. LeadingAge, the Washington, D.C.-based advocacy association for nonprofit aging-services providers that supports the legislation, said the bill is unlikely to pass by the end of 2026. It is not yet clear when the House might take up the measure or what opposition, if any, it could face from states concerned about new Medicaid costs.
A companion bill is expected in the Senate by the end of 2026, according to the report, but it has not yet been introduced, and its sponsors have not been named. The fiscal impact of making PACE mandatory — for states that would need to stand up new programs or for the federal government — has not been detailed in the available material.
Next Steps for the Legislation
Watch for a Senate companion bill expected by the end of 2026, which would identify Senate sponsors and signal broader bipartisan momentum. In the House, the PACE Access Improvement Act would need to move through committee before reaching a floor vote.
If enacted, the compliance clock would start immediately: states with existing PACE providers would face a 180-day deadline to meet the new requirements, while the 17 states without PACE would have three years to establish programs. Provider organizations such as the National PACE Association and LeadingAge are expected to continue advocacy around the bill, and home care companies positioned to open PACE programs would be watching the expansion rules closely.
Key Questions
What is PACE?
The Program of All-inclusive Care for the Elderly (PACE) is a medical and social services program operating under both Medicare and Medicaid that allows older adults who need nursing home-level care to receive that care in their own homes instead of in an institution.
What would the PACE Access Improvement Act change?
The bill would make PACE a mandatory Medicaid service in all states, allow enrollment to take effect at any time of the month rather than the first of the following month, remove numerical limits on PACE program agreements, repeal certain marketing restrictions and ease the process of becoming 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 PACE locations operating nationwide.
When would states have to comply if the bill passes?
States that already have at least one PACE provider would need to comply with the new regulations within 180 days of enactment. States with no PACE presence would have three years to comply.
Is the bill likely to become law soon?
LeadingAge, which supports the bill, said it is unlikely to pass by the end of 2026. A companion bill is expected to be introduced in the Senate by the end of 2026.
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