The Programs of All-Inclusive Care for the Elderly (PACE) are designed to offer extensive medical and social services to specific groups of older adults who are frail and still living within their communities. Many of these individuals are dually eligible for both Medicare and Medicaid benefits. A core feature of PACE is the interdisciplinary team of healthcare professionals who work together to provide coordinated care for each participant. For the majority involved in PACE, this comprehensive suite of services makes it possible to continue living in their own homes and communities, rather than needing to move into a nursing home facility. The funding structure of the PACE program is designed with a capped budget. This unique financial model empowers service providers to ensure that participants receive all the necessary services, instead of being restricted to only those services that are traditionally reimbursable under standard Medicare and Medicaid fee-for-service arrangements. PACE operates as a Medicare program, and individual states have the option to extend PACE services as part of their Medicaid benefits for eligible beneficiaries. For those enrolled in PACE, the program effectively becomes their single source for accessing both Medicaid and Medicare benefits.
This capped financing structure is a key differentiator, enabling PACE providers to focus on delivering holistic care tailored to each participant’s needs. This contrasts sharply with systems that might limit care to only what’s covered under typical fee-for-service models. The PACE model is officially recognized as a provider within the Medicare framework. Furthermore, it allows states to integrate PACE into their Medicaid offerings, providing a valuable state option for elderly care services.
PACE Eligibility Criteria
To be eligible for enrollment in a Programs of All-Inclusive Care for the Elderly (PACE) program, individuals must meet several specific requirements:
- Age Requirement: Applicants must be 55 years of age or older.
- Location: Individuals must reside within the defined service area of a designated PACE organization.
- Need for Nursing Home Level Care: Applicants must be certified as being eligible for nursing home level of care by the relevant state authority. This doesn’t mean they must reside in a nursing home, but rather demonstrate a level of need that would otherwise necessitate such care.
- Community Living Safety: It must be determined that the individual can live safely in a community setting with the support of PACE services.
Once enrolled in the PACE program, it becomes the exclusive source for all Medicare and Medicaid benefits for eligible participants. It is also important to note that enrollment in PACE is voluntary, and individuals have the option to disenroll from the program at any time should they choose to do so.
