The Program of All-Inclusive Care for the Elderly, widely known as PACE, is designed to provide comprehensive medical and social services to specific groups of senior individuals who are considered frail and are currently living within their communities. A significant portion of PACE program participants are eligible for both Medicare and Medicaid benefits, often referred to as being dually eligible. Care coordination is central to PACE, delivered through an interdisciplinary team of healthcare professionals who work together to meet participant needs.
For a vast majority of enrollees, the all-encompassing service package offered by PACE enables them to continue living in their own homes and communities, effectively preventing the need for relocation to a nursing home facility. The financial structure of the PACE program is based on a capped payment system. This unique funding model empowers service providers to ensure that participants receive all necessary services, rather than being restricted to only those services that are traditionally reimbursed under standard Medicare and Medicaid fee-for-service arrangements.
PACE operates as a recognized provider within the Medicare framework. Furthermore, state governments have the option to incorporate PACE services into their Medicaid offerings, thereby extending these benefits to Medicaid beneficiaries as an optional state-level benefit. Upon enrollment in PACE, the program becomes the single, integrated source for all Medicare and Medicaid benefits for the participant, streamlining access to care and services.
PACE Program Eligibility Criteria
To be eligible for enrollment in the Program of All-Inclusive Care for the Elderly, individuals must meet several key requirements:
- Age Requirement: Applicants must be 55 years of age or older.
- Location: Individuals must reside within the defined service area of a designated PACE organization.
- Need for Nursing Home Level Care: Applicants must be certified as being in need of a level of care typically provided in a nursing home. This determination ensures that PACE serves those who require significant support.
- Community Living Safety: It must be possible for the individual to live safely in a community setting with the support of PACE services. The program is designed to facilitate independent living whenever possible.
Once enrolled in PACE, the program effectively becomes the sole provider of services that would otherwise be covered by Medicare and Medicaid. It is also important to note that participation in the PACE program is voluntary, and individuals retain the right to disenroll at any time should their needs or preferences change.
