The Program of All-Inclusive Care for the Elderly (PACE) is designed to provide a comprehensive suite of medical and social services to support frail, older adults who are still living in their communities. Many individuals enrolled in PACE are eligible for both Medicare and Medicaid. PACE utilizes an interdisciplinary team of healthcare professionals to deliver coordinated care, aiming to help participants remain in their homes and communities instead of requiring nursing home placement.
PACE operates under a capped financing model. This unique funding structure allows PACE providers the flexibility to offer all necessary services to participants, rather than being restricted to only those services traditionally reimbursed under standard Medicare and Medicaid fee-for-service arrangements. PACE is officially recognized as a provider within the Medicare system. Furthermore, states have the option to incorporate PACE services as part of their Medicaid benefits. For those enrolled in PACE, the program becomes their single source for both Medicare and Medicaid benefits.
Key Aspects of the PACE Program
The core goal of PACE is to keep older adults, who require nursing home level care, living safely and comfortably within their own communities for as long as possible. This is achieved through a holistic approach that addresses not just medical needs but also social and emotional well-being. The interdisciplinary team within PACE is central to this model, bringing together doctors, nurses, social workers, therapists, and other professionals to create a personalized care plan for each participant. This team works collaboratively to ensure all aspects of a participant’s health and daily living needs are met in a coordinated and proactive manner.
PACE Eligibility Requirements
To be eligible for PACE, individuals must meet specific criteria. These include:
- Being 55 years of age or older.
- Residing within the designated service area of a PACE organization.
- Meeting their state’s criteria for nursing home level of care.
- Being able to live safely in a community setting with the support of PACE services at the time of enrollment.
Once enrolled in PACE, the program becomes the participant’s exclusive source for Medicare and Medicaid covered care. However, individuals retain the right to disenroll from PACE at any time should they choose to do so.
