The Programs of All-Inclusive Care for the Elderly (PACE) is designed to provide a comprehensive suite of medical and social services for certain elderly individuals who are frail and still living within their communities. Many of these individuals are dually eligible for both Medicare and Medicaid, highlighting the program’s role in supporting a vulnerable population. PACE utilizes an interdisciplinary team of healthcare professionals to ensure participants receive well-coordinated care. A key benefit for most participants is the ability to continue living in their own homes and communities, avoiding the need for nursing home care.
The financial structure of PACE is capped, which is a significant advantage. This capped financing model empowers providers to offer all necessary services to participants, rather than being restricted to services solely reimbursed under traditional Medicare and Medicaid fee-for-service arrangements. PACE operates under Medicare, and state governments have the option to extend PACE services to Medicaid beneficiaries as an optional Medicaid benefit. For those enrolled in PACE, the program effectively becomes the single source for both their Medicaid and Medicare benefits, streamlining their care and coverage.
PACE Eligibility Criteria
To be eligible for enrollment in PACE, individuals must meet specific criteria:
- Age Requirement: Applicants must be 55 years of age or older.
- Residency: Individuals must reside within the defined service area of a PACE organization.
- Nursing Home Level of Care: Applicants must be certified as eligible for nursing home care by the relevant state authority. This signifies the level of care needed, even if the goal is to avoid nursing home placement.
- Community Safety: It must be determined that the individual can live safely in a community setting with the support of PACE services. This ensures that remaining at home is a viable and safe option for the participant.
Once enrolled in PACE, the program becomes the exclusive provider of services covered by Medicare and Medicaid. It’s important to note that enrollment in PACE is voluntary, and individuals retain the right to disenroll from the program at any time should their needs or preferences change.
Further Information
For more detailed information about specific PACE programs, eligibility requirements in your state, or to find a PACE organization near you, it is recommended to consult the official Medicare and Medicaid websites or contact your local Area Agency on Aging. These resources can provide tailored guidance and support for accessing the Program for All-Inclusive Care for the Elderly.
