The Programs of All-Inclusive Care for the Elderly (PACE) is dedicated to offering extensive medical and social services tailored for older adults who are considered frail yet still residing within their communities. A significant portion of PACE beneficiaries are dually eligible for both Medicare and Medicaid, highlighting the program’s role in supporting vulnerable populations. PACE distinguishes itself through its interdisciplinary team approach, where health professionals collaborate to deliver coordinated care to each participant. This comprehensive care model is crucial in enabling most participants to continue living in their homes and communities, effectively preventing or delaying the need for nursing home placement.
A key feature of PACE is its capped financing structure. This unique funding model empowers service providers to focus on delivering all necessary services to participants, rather than being restricted to services solely reimbursable under traditional Medicare and Medicaid fee-for-service arrangements. PACE operates under the umbrella of Medicare, and importantly, states have the option to extend PACE services to Medicaid beneficiaries as an additional Medicaid benefit. For those enrolled in PACE, the program becomes the single source for accessing their Medicare and Medicaid benefits, streamlining care and access.
Eligibility for PACE
To be eligible for the Pace Program For All Inclusive Care Of The Elderly, individuals must meet specific criteria designed to ensure the program serves those who can benefit most from its comprehensive services:
- Age Requirement: Applicants must be 55 years of age or older to qualify for PACE.
- Residency: Individuals must reside within the defined service area of a designated PACE organization to ensure they can access the program’s services effectively.
- Need for Nursing Home Level Care: A critical eligibility requirement is that individuals must be certified as needing nursing home level care. This criterion ensures that PACE targets those elderly individuals who are at a high risk of needing institutional care.
- Safe Community Living: Applicants must be assessed as being able to live safely in a community setting with the support of PACE services. This ensures that the program can effectively support individuals in their homes and communities.
It is important to note that for individuals enrolled in PACE, the program assumes responsibility for coordinating and providing all needed healthcare services. This means that enrollment in the pace program for all inclusive care of the elderly makes PACE the exclusive provider of Medicare and Medicaid benefits. Despite this comprehensive integration, individuals retain the flexibility to disenroll from the PACE program at any time, ensuring participant autonomy and choice in their care.
