A newly introduced Senate Bill S.4479, titled the Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act, proposes expanding Medicaid to cover assisted living services, offering seniors an alternative to more costly skilled nursing care. The bill aims to lower federal Medicaid spending while expanding access to care for more seniors.
Medicaid expenditures are projected to grow more than 60% over the next decade, straining federal and state budgets. At the same time, many providers are scaling back or discontinuing their skilled nursing programs due to increased staffing costs, regulatory requirements and inadequate reimbursement rates. In some cases, facilities have closed entirely – contributing to a growing gap in care for an aging population.
“Medicaid spending is on an unsustainable path, and too many seniors are being pushed into higher-cost care they don’t actually need,” said Senator Roger Marshall, sponsor of the Senate Bill, in a statement. “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.”
In Pennsylvania, a provider assessment (commonly referred to as the “bed tax”) places an even greater burden on nursing facilities. As a result, many providers have downsized the number of licensed nursing beds while increasing their capacity to offer assisted living, home care and other alternatives for seniors. However, these alternatives generally are not eligible for Medicaid reimbursement. Assisted living services remain largely ‘private pay’ in most states, often placing services out of reach for families unable to afford the monthly costs.
“Right now, the system is backwards. [The government is] paying more for unnecessary care while more practical options remain out of reach. This legislation fixes that. It’s about common sense – giving seniors better choices and making sure Medicaid dollars are spent wisely,” stated Congressman Max Miller, sponsor of this legislation in the House of Representatives.
Critics of the proposal have raised concerns about whether the legislation could limit states’ flexibility in administering their Medicaid programs. In addition, anticipated reductions in federal Medicaid spending under H.R. 1 may place further pressure on states in allocating Medicaid funds. Still, many stakeholders agree that the long-term care industry faces growing strain, and that practical – if not innovative – policy solutions are needed. Senate Bill S. 4479 may serve as an early step in that broader conversation.
Takeaway: Long-term care providers should closely monitor this legislation, as it could significantly reshape reimbursement structures and accelerate the shift toward assisted living and community-based care models.
If you have any questions about how this proposed legislation may impact your services, please contact partner Christopher J. Churchill or any member of Barley Snyder’s Senior Living Industry Group.
