Program of All-Inclusive Care for the Elderly (PACE): Medicaid’s Best Kept Secret

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Last Updated: May 06, 2024
PACE EssentialsEligibility RequirementsLocationsBenefitsCosts


The Program of All-Inclusive Care for the Elderly (PACE) is designed to provide families and health care providers with the flexibility to help aging loved ones live at home, in assisted living facilities or other settings in the community. PACE will cover nursing home stays when necessary, but 95% of program participants live in the community, according to the National PACE Association.

In some regions of the country, PACE is called Living Independence for the Elderly (LIFE).

PACE can be a welcome nursing home alternative for seniors and their families. This article will provide an overview of the program, including its benefits, eligibility requirements and locations. For an in-depth consultation of how PACE might impact a family, contact our team.


Understanding the PACE Essentials

PACE coordinates medical, social service and long-term care coverage and benefits for people age 55 and older who require a Nursing Facility Level of Care (NFLOC) but want to live in the community. This can be in their own home, the home of a loved one or an assisted living facility, including memory care units for people with Alzheimer’s disease or other dementias. The National PACE Association estimates that nearly half of the program’s participants have been diagnosed with some form of dementia.

An interdisciplinary team of health care professionals from PACE will work with elderly individuals and their families to develop a comprehensive and coordinated care plan. The benefits and coverage are detailed below, but the plan will include healthcare (like doctor’s visits and medications) and long-term care benefits (such as in-home nursing services and durable medical equipment). The plan will also coordinate Medicaid benefits and Medicare Part A, B and D benefits for seniors who are dual-eligible, although being enrolled in Medicaid or Medicare is not an eligibility requirement for PACE.

Once the plan is in place, PACE will schedule appointments, arrange transportation and coordinate care so providers are in communication with one another and benefits and services don’t overlap or conflict. The interdisciplinary team from PACE that created the plan will provide much of the care directly, so they can closely monitor the senior’s health and make changes as needed.

PACE program members can also make regular visits to their local PACE adult day health center. These centers offer a long list of services and benefits, which are also detailed below, but can include nursing care, physical therapy, meals and social activities. PACE will also provide transportation to and from the center.


PACE / LIFE Eligibility Requirements

To qualify for PACE, individuals must meet these four requirements:

• They are age 55 or older.
• They live in a service area of a PACE organization.
• They meet their state’s definition of Nursing Facility Level of Care (NFLOC).
• The benefits they receive from PACE will make it safe for them to live in the community.

As a reminder, how NFLOC is defined and measured can vary by state. In some states, needing assistance with two of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) might be the definition of a NFLOC, while it might be needing assistance with three of them in another state. Some states will also place greater emphasis on cognitive or behavioral issues than other states when it comes to measuring a NFLOC.


PACE / LIFE Program Locations

PACE’s roots go back to the early 1970s and On Lok Senior Health Services, which started in San Francisco’s Chinatown. The On Lok model was eventually replicated in a few other parts of the country in the 1980s. The National PACE Association (NPA) was formed in 1994 with 11 organizations in nine states, and today there are 163 PACE/LIFE organizations in 32 states and the District of Columbia.

The states that do not have a PACE/LIFE program as of April 2024 are: Alaska, Arizona, Connecticut, Georgia, Hawaii, Idaho, Illinois, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia and Wyoming. However, PACE services are scheduled to be available in Illinois as of June 2024.

Many states have more than one PACE organization. California tops the list with 25, but the number of PACE programs doesn’t necessarily correlate with population. Michigan has 14, while New York has nine and Ohio just one. This NPA tool and map can locate PACE/LIFE organizations by zip code, county or state.


Benefits of PACE/LIFE

As mentioned above, PACE coordinates all Medicaid and Medicare Part A, B and D benefits. It also covers any other care that is deemed medically necessary to maintain or improve the health of the program member. PACE will cover benefits and services in the home, at its adult day centers, in hospitals, in nursing homes and in other locations in the community.

Each PACE plan includes regular care from a primary care provider with an office that is on call 24 hours per day, seven days a week. It also covers all prescription medication, and over-the-counter supplements that are deemed medically necessary. Care from audiologists, optometrists, dentists and podiatrists is also covered, as are other special needs like cardiology, rheumatology and women’s services.

Outpatient services such as lab work, x-rays and radiology are covered, and if PACE program participants need inpatient services like hospitalizations, inpatient specialists or skilled rehab, PACE covers that, too. If the PACE member is dealing with dementia, grief, loss or other cognitive or behavioral issues, the program will cover assessments and psychiatric care.

In-home PACE benefits include meal delivery, chore services, physical and occupational therapy and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). PACE also covers rehabilitation equipment and durable medical equipment like wheelchairs, walkers, oxygen, hospital beds and diabetic testing supplies. All of these benefits can be provided in a private home or an assisted living facility.

Not all PACE adult day health centers offer the same benefits, but many of them do offer the following:
• Physician care
• Nursing services
• Physical therapy
• Occupational therapy
• Recreational therapy
• Social activities
• Exercise programs
• Nutritional counseling
• Lunch/snacks
• Social services
• Audiology
• Dentistry
• Optometry
• Podiatry

PACE provides door-to-door transportation to and from its adult day health centers, and to other healthcare appointments.


Paying for PACE/LIFE

Medicaid beneficiaries do not have to pay a premium for PACE. However, successfully applying for Medicaid can be complicated. The financial requirements can change depending on the applicant’s state of residence, marital status and financial situation. For seniors and their families who would like to begin the process, they can connect with our team.

Seniors who are not covered by Medicaid must pay a small premium for PACE. Once enrolled, PACE program participants never have to pay a deductible or co-payment for any medication, care or service provided by the PACE interdisciplinary team.

To apply for PACE, families should contact their local PACE office.