S. 4479

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4479 Introduced in Senate (IS)]

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119th CONGRESS
2d Session
S. 4479

To provide assisted living assistance through Medicaid and the low-
income housing tax credit.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

April 30, 2026

Mr. Marshall introduced the following bill; which was read twice and 
referred to the Committee on Finance

_______________________________________________________________________

A BILL

To provide assisted living assistance through Medicaid and the low-
income housing tax credit.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Assisted Living Affordability, 
Choice, Community, Empowerment, Savings, and Support Act'' or the 
``ACCESS Act''.

SEC. 2. COVERAGE OF SERVICES IN AN ASSISTED LIVING RESIDENCE UNDER 
MEDICAID.

(a) Definition of Medical Assistance.--Section 1905(a) of the 
Social Security Act (42 U.S.C. 1396d(a)) is amended--
(1) in paragraph (31), by striking ``and'' after the 
semicolon;
(2) by redesignating paragraph (32) as paragraph (33); and
(3) by inserting after paragraph (31), the following new 
paragraph:
``(32) services provided in an assisted living residence 
consistent with State law permitting such services, including 
to individuals who would require the level of care provided in 
a hospital or nursing facility, the cost of which could be 
reimbursed under the State plan (or a waiver of such plan), and 
who meet the State's income and resources requirements adopted 
under section 1902(a)(10)(A)(i)(V) and for whom the estimated 
annual average per capita total Medicaid cost for all services 
for individuals receiving services in an assisted living 
residence would be no greater than the estimated annual average 
per capita total Medicaid cost for all services that would have 
been incurred had those individuals received services in a 
hospital or nursing facility; and''.
(b) Mandatory Benefit.--Section 1902(a)(10)(A) of such Act (42 
U.S.C. 1396a(a)(10)(A)) is amended in the matter preceding clause (i), 
by striking ``and (30)'' and inserting ``(30), and (32)''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the 
amendments made by this section shall take effect on January 1, 
2027.
(2) Delay permitted if state legislation required.--In the 
case of a State plan approved under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
Health and Human Services determines requires State legislation 
(other than legislation appropriating funds) in order for the 
plan to meet the additional requirements imposed by the 
amendments made by this section, the State plan shall not be 
regarded as failing to comply with the requirements of such 
title XIX solely on the basis of the failure of the plan to 
meet such additional requirements before the first day of the 
first calendar quarter beginning after the close of the first 
regular session of the State legislature that ends after the 1-
year period beginning with the date of the enactment of this 
section. For purposes of the preceding sentence, in the case of 
a State that has a 2-year legislative session, each year of the 
session is deemed to be a separate regular session of the State 
legislature.

SEC. 3. SELECTION CRITERIA FOR QUALIFIED ALLOCATION PLAN UNDER THE LOW-
INCOME HOUSING TAX CREDIT.

(a) In General.--Subparagraph (C) of section 42(m)(1) of the 
Internal Revenue Code of 1986 is amended by striking ``and'' at the end 
of clause (ix), by striking the period at the end of clause (x) and 
inserting ``, and'', and by adding at the end the following new clause:
``(xi) projects which reduce the medical 
assistance costs of long-term services and 
supports for the elderly by providing such 
services and supports in a non-institutional 
setting.''.
(b) Effective Date.--The amendments made by this section shall 
apply to allocations made after January 1, 2027.
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