The Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act (S. 4479), introduced on April 30, 2026, by Senator Roger Marshall, M.D. (R-KS), would make assisted living a covered Medicaid benefit for older adults who meet service need thresholds akin to someone needing nursing home or hospital care.

The bill would also add a new emphasis required to how states prioritize their allocations of federal Low Income Housing Tax Credits (LIHTC). The new selection criteria would require states to consider how much an affordable housing development vying for some of the state’s LIHTCs would “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.”

“Medicaid spending is on an unsustainable path, and too many seniors are being pushed into higher-cost care they don’t actually need,” Senator Marshall said in a statement about the bill. “As a physician, I’ve seen the consequences of that firsthand. This bill is about giving states the ability to provide the right care in the right setting, while protecting the long-term future of Medicaid.”

Rep. Max Miller (R-OH) is introducing a House version of the bill, according to Senator Marshall’s press release: “Right now, the system is backwards. We’re paying more for unnecessary care while more practical options remain out of reach. This legislation fixes that,” says Rep. Miller. “It’s about common sense—giving seniors better choices and making sure Medicaid dollars are spent wisely.”

LeadingAge supports the bill while emphasizing that states must retain assisted living oversight authority.

“Making assisted living a covered Medicaid benefit for older adults brings affordability to a needed but often financially out of reach service and helps to reduce overall Medicaid spending for those whose needs can be met outside of more expensive nursing home settings. The Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act recognizes that while there is a nationwide opportunity to expand access to assisted living, there is no need for a one size fits all approach to circumvent existing state oversight of assisted living. As they steadfastly have, states must continue to lead the way on ensuring assisted living quality through their own guidelines that meet their unique needs. The bill does not just open up the benefits of assisted living to more older adults through the Medicaid program; it also expands the supply of affordable assisted living by improving the Low Income Housing Tax Credit program, the nation’s largest affordable housing development program, and better pairing it with long‑term services and supports so older adults can more affordably age in the community. LeadingAge is grateful for Senator Marshall and Representative Miller’s leadership on this legislation in the Senate and House, respectively,” LeadingAge SVP Linda Couch told McKnight’s Senior Living.

Together with last week’s introduction of the Home and Community-Based Services (HCBS) Access Act by Representatives Dingell and Schakowsky, LeadingAge is pleased to see Congress firmly step out and champion meaningful proposals under the umbrella of long-term care affordability.