The Programs of All-Inclusive Care for the Elderly, known as PACE, delivers a comprehensive suite of medical and social services specifically designed for older adults who are frail and living within their communities. Many individuals enrolled in PACE are eligible for both Medicare and Medicaid. A key feature of PACE is its interdisciplinary team of healthcare professionals who work together to provide coordinated care for each participant. This integrated approach allows the majority of PACE participants to continue living at home and in their communities, avoiding the need for nursing home placement. The funding model for PACE is unique; it’s based on a capped budget, which empowers providers to offer all necessary services rather than being restricted to those services traditionally reimbursed under Medicare and Medicaid’s fee-for-service structures. PACE is officially recognized as a Medicare program, and states have the option to extend PACE services to Medicaid beneficiaries as part of their state Medicaid benefits. For those enrolled in PACE, the program becomes their single source for both Medicare and Medicaid benefits.
PACE: Comprehensive Care and Capped Financing
The capped financing model of the PACE program is a significant advantage. It allows PACE providers the flexibility to deliver the full spectrum of services that participants require. This contrasts sharply with traditional Medicare and Medicaid fee-for-service plans, which may limit service provision based on reimbursement structures. The PACE model is a recognized provider within Medicare, and it offers states a valuable option to provide these comprehensive services to Medicaid beneficiaries at the state level.
PACE Program Eligibility Requirements
To be eligible for PACE, individuals must meet specific criteria:
- Age Requirement: Applicants must be 55 years of age or older.
- Location: Individuals must reside within the defined service area of a PACE organization.
- Nursing Home Eligibility: Applicants must be certified as eligible for nursing home level of care by the relevant state authority.
- Community Safety: It must be determined that the individual can live safely in the community with the support of PACE services at the time of enrollment.
Once enrolled in PACE, the program becomes the exclusive source for all Medicare and Medicaid covered services. It’s 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.
