I wonder if the older adult you are caring for qualifies for this federal and state funded program?
PACE enables certain home-dwelling elderly individuals to remain in the community rather than receive care in a nursing home.
PACE stands for Program of All-Inclusive Care for the Elderly. It’s a partnership between a state’s social services and federally-funded Medicaid or Medicare. There are 272 PACE centers in 30 states, serving approximately 55,000 participants. PACE organizations provide care and services in the home, the community, and the PACE center. Medicare and Medicaid funds are used to cover all medically-necessary care and services provided by PACE. While each PACE program follows specified guidelines, each center is independently run so services may vary.
If your older adult qualifies for this program, it could be a game changer! Here’s a fast-track checklist to determine if PACE is an option for the older adult in your life.
Does the older adult meet the following criteria?
✅ Is 55 years old or older
✅ Is a full-time resident in the service area of a PACE organization (This includes these states: Alabama, Arkansas, California, Colorado, Delaware, Florida, Indiana, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Ohio, Oklahoma, Oregon, Nebraska, New Mexico, New York, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin, Wyoming.)
✅ Lives within the geographic area covered by a PACE center in their state. This map shows the specific PACE locations in each state. Also, because new programs are being added, check the map to see the most current national coverage information.
✅ Can be certified by the state in which they live as meeting the need for nursing home level care
✅ Is able to live safely in the community with the help of PACE services
✅ Qualifies for Medicaid. PACE centers may be able to help you fill out Medicaid paperwork and check to see if you qualify. (You can access PACE by paying privately. The private pay amount is usually on par with the cost of a nursing home, but the participant would still have the cost of their own living situation so paying privately for PACE doesn’t really make financial sense, that’s why 90-95% of PACE participants qualify for Medicaid.)
If an older adult qualifies based on the criteria above, PACE can provide:
- Adult day primary care (including doctor and recreational therapy nursing services)
- Emergency services
- Home care
- Hospital care
- Laboratory/x-ray services
- Medical specialty services
- Nursing home care
- Nutritional counseling
- Occupational Therapy
- Physical therapy
- Prescription drugs
- Preventive care
- Social services, including caregiver training, support groups, and respite care
- Social work counseling
- Transportation to the PACE center for activities or medical appointments, if medically necessary. You may also be able to get transportation to some medical appointments in the community.
This brief video gives a glimpse of life at a PACE program.
Pay special attention to these other key points about the PACE program:
- When enrolled in PACE, participants must receive Medicare and Medicaid benefits solely through the PACE organization. This means that you may have to change doctors and use the providers at your PACE center.
- PACE assumes total financial risk and pays for ALL health care services. This means that if the participant is hospitalized or needs surgery and rehab, all that cost is covered when arranged by PACE.
- The interdisciplinary care team at PACE works with the participants and their caregivers to create a plan of care, meaning the participant and caregiver have a voice in the care plan. Also, because providers usually care for a small number of people, they get to know their patients and care is less fragmented.
- Financing for the program is capped, which allows providers to deliver all services participants need rather than only those reimbursable under Medicare and Medicaid fee-for-service plans. For example, Medicare will only pay for a certain amount of physical therapy, but PACE doesn’t have that limitation.
- PACE organizations are required to provide enrollees with all medically necessary services, including drugs, without any limitation or condition as to the amount, duration, or scope.
- Medical equipment can be requested and provided through PACE.
- PACE provides all the care and services covered by Medicare and Medicaid when/if authorized by the PACE health care team. If the health care team decides you need care and services that Medicare and Medicaid doesn’t cover, PACE may still cover them.
- If you need help completing a Medicaid application to enroll in PACE, your local PACE center can help you with that process.
- Participants can disenroll at any time and resume their Medicaid and Medicare programs.
If an older adult meets the criteria for PACE and has access to one in their area, it could allow an older adult to age in their own home. That’s a dream come true for many! If you are ready to dive even deeper into PACE, we can evaluate it and other paying for care options with our stress-free Paying for Care service.
May you find joy in loving one another well.
Elizabeth Dameron-Drew is the Co-founder and President of Ways & Wane. She walked closely with her own father through his years of waning. She lives near Seattle with her two teenage sons, husband and two rescue dogs.