Sponsor
Roger Wayne Marshall
Senator · R-KS
Senator · R-KS
The bill expands options for community‑based assisted living and supportive affordable housing—potentially improving quality of life and reducing institutional care—while relying on cost controls and state implementation choices that could limit access, reduce service quality, delay benefits, or shift costs to states and taxpayers.
Medicaid beneficiaries (seniors and people with disabilities) can receive nursing‑facility or hospital‑level care in assisted living settings, increasing access to home‑like, community‑based care and reducing some institutional stays.
States must cover assisted‑living services as a mandatory Medicaid benefit, which could standardize access across states rather than leaving coverage optional.
A cost‑neutrality test limits Medicaid expansion of assisted‑living coverage to situations where costs do not exceed institutional care, helping constrain Medicaid spending growth.
States retain discretion through income/resource rules and the cost test, so many eligible Medicaid beneficiaries—particularly low‑income people—may still be denied assisted‑living coverage.
The cost‑neutrality requirement may incentivize states to limit covered services or underpay providers to meet the test, reducing quality or availability of assisted‑living care.
States that require implementing legislation can delay access to the new benefit until after their next legislative session, postponing benefits well beyond Jan 1, 2027 for some people.
Based on analysis of 3 sections of legislative text.
Adds assisted living services as a mandatory Medicaid benefit (with a cost‑parity test) and requires LIHTC plans to prefer projects that reduce Medicaid long‑term care costs in non‑institutional settings.
Official title: Provide assisted living assistance through Medicaid and the low-income housing tax credit.
Introduced April 30, 2026 by Roger Wayne Marshall · Last progress April 30, 2026
Creates a new mandatory Medicaid benefit category allowing states to cover assisted living residence services for people who otherwise need hospital or nursing facility care, provided the average per‑person Medicaid cost for assisted living does not exceed institutional care; coverage option becomes effective January 1, 2027, with a delayed state-implementation window if state law changes are needed. Also adds a criterion to the Low-Income Housing Tax Credit (LIHTC) qualified allocation plan to prioritize projects that reduce Medicaid long‑term services and supports costs by delivering care in non‑institutional settings, effective for allocations after January 1, 2027.