S4479

1) What happened: On April 30, 2026, Senator Roger Marshall (R-KS) introduced S.4479, the Assisted Living Affordability, Choice, Community, Empowerment, Savings, and Support Act (ACCESS Act). The bill was read twice and referred to the Senate Committee on Finance. It is in an early legislative stage with two cosponsors (Sens. Daines and Sheehy, both R-MT). A companion bill, HR8662, has been introduced in the House and referred to the Ways and Means and Energy and Commerce committees. 2) The money trail: The ACCESS Act does not authorize or appropriate specific funding. Instead, it amends the Social Security Act to make assisted living services a mandatory benefit under Medicaid (Section 1905(a)(32)). This means states must cover these services to receive federal Medicaid matching funds. The cost to the federal government would be the federal share of Medicaid spending on assisted living services for eligible individuals. The Congressional Budget Office would estimate the cost, but it is likely significant given the large number of Medicaid-eligible seniors. The effective date is January 1, 2027, with a delay for states requiring legislative changes. 3) The convergence: No related signals or procurement were provided. The bill is currently isolated, but its companion bill in the House (HR8662) increases its legislative momentum. The bipartisan sponsorship (all Republican) and referral to the Finance Committee (which has jurisdiction over Medicaid) suggest a serious legislative effort. 4) Structural winners and losers: Winners: Healthcare REITs with assisted living exposure ($WELL, $OHI, $SBRA, ) will see increased demand and occupancy as Medicaid covers more residents. Medicaid managed care insurers ($UNH, $HUM, $CVS) will benefit from increased enrollment and premium revenue. Losers: Skilled nursing facility operators may face competition from assisted living facilities as a lower-cost alternative. The bill requires that the cost of assisted living services be no greater than the cost of nursing facility services, which could shift Medicaid spending away from skilled nursing. 5) Timeline: The bill is in early stage. It must pass the Senate Finance Committee, then the full Senate, then the House (where HR8662 is pending), and be signed by the President. Given the 2027 effective date, the legislative path is tight but achievable if there is bipartisan support. The 119th Congress runs through 2027, so there is time.