This bill expands Medicaid coverage to include services in assisted living facilities for individuals who currently require hospital or nursing home care, provided they meet state income and resource limits. It also modifies the Low-Income Housing Tax Credit to give priority funding to projects that help reduce long-term medical costs for the elderly by offering care in non-institutional settings. Both changes are scheduled to take effect on January 1, 2027, allowing states time to update their laws and plans to comply with the new requirements.
The ACCESS Act expands Medicaid coverage to include services in assisted living facilities for individuals who currently require nursing home-level care, provided they meet state income and resource limits. This change aims to lower costs by ensuring that the average expense for these residents does not exceed the cost of their care in a hospital or nursing facility. Additionally, the bill allows the Low-Income Housing Tax Credit to be used for projects that reduce long-term medical costs for the elderly by offering care in non-institutional settings. These provisions are scheduled to take effect on January 1, 2027, with a grace period for states needing to update their legislation to comply.
HR 3000, the Caring for Seniors Act, establishes a Senior Care Cost Reduction Program to help low-income seniors aged 70+ live in assisted living facilities instead of more expensive nursing homes. The program provides states with funds to offer eligible seniors a monthly cost reduction of $1,000 (adjusted annually for inflation), covering part of their assisted living fees. To qualify, seniors must reside in an approved facility, meet Medicaid or chronic illness criteria, have net income below 60% of their state’s median income, and possess assets under $19,000 (single) or $25,000 (married). The program is funded by redirected pandemic relief funds and aims to reduce reliance on costly institutional care while expanding access to lower-cost assisted living services.
The WISH Act would create a federal long-term care insurance program to help seniors cover costs of long-term care services. It would provide monthly benefits to seniors who have a serious disability lasting at least a year, have met coverage requirements (6 quarters of coverage in the base period starting in 2026), and have not exhausted their savings. Benefits would be calculated based on the median cost of personal assistance care and the individual's work history. The program would be funded through an initial $12 million appropriation for each of fiscal years 2026-2028, plus $50 million for public education. This would help seniors avoid exhausting their savings or becoming dependent on Medicaid for long-term care costs.
This bill temporarily allows doctors to prescribe and dispense certain Medicare-covered medications directly to seniors in their offices from 2026 to 2030, under specific conditions. It requires prior in-person visits, limits dispensing to group practices, and mandates billing through the physician’s practice. The bill also directs the GAO to study whether physician-owned pharmacies are becoming common and how such arrangements might affect prescribing. It directly affects seniors receiving Medicare Part D drugs and physician practices participating in these arrangements. The exception expires in 2030, with no changes to Medicare Part D program rules.
HRES 694 is a non-binding House resolution calling on the Centers for Medicare & Medicaid Services (CMS) to halt a pilot program using artificial intelligence to decide Medicare coverage for medical services. It directly affects seniors who rely on Medicare, as the resolution argues AI-driven coverage decisions could jeopardize their access to critical healthcare. The resolution expresses the House's "sense" that CMS should not proceed with this AI evaluation method, referencing CMS's June 2025 announcement of the pilot. As a resolution, it does not create new law but urges CMS to pause the program.
This bill would add dental, vision, and hearing services to Medicare coverage for beneficiaries. It defines specific services including routine dental cleanings, eye exams, and hearing assessments, with coverage gradually increasing from 0% to 80% over eight years. The bill also establishes frequency limits, such as two dental cleanings per year and one eye exam annually. Medicaid would see increased federal funding (90% FMAP) for these services starting six months after enactment. This legislation directly affects Medicare beneficiaries, particularly seniors and people with disabilities, by expanding access to previously uncovered preventive health services.
