The Programs of All-Inclusive Care for the Elderly, known as PACE, are designed to deliver extensive medical and social services to specific groups of older adults who are frail and still living in their communities. A significant portion of PACE participants are eligible for both Medicare and Medicaid. These programs utilize an interdisciplinary team of healthcare professionals to ensure participants receive well-coordinated care. For the majority of individuals involved, PACE offers a comprehensive support system that enables them to continue living within their communities, avoiding the need for nursing home placement.
PACE operates under a capped financing model. This unique funding structure allows service providers the flexibility to offer all necessary services to participants, rather than being restricted to services solely covered under the traditional Medicare and Medicaid fee-for-service systems. Established as a Medicare provider model, PACE also allows states to elect to offer PACE services as an optional benefit for Medicaid beneficiaries. For those enrolled in PACE, the program becomes the single source for their Medicare and Medicaid benefits.
Understanding PACE Eligibility
To be eligible for PACE, individuals must meet specific criteria:
- Must be 55 years of age or older.
- Reside within the service area of a PACE organization.
- Qualify for nursing home level of care as certified by the state.
- Be able to live safely in the community with the support of PACE services at the time of enrollment.
Once enrolled in PACE, the program serves as the participant’s exclusive source for all Medicare and Medicaid covered care. It’s 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.
