The Programs of All-Inclusive Care for the Elderly (PACE) represent a unique approach to healthcare, dedicated to providing comprehensive medical and social services to frail, older adults who are still living in their communities. Many PACE participants are dually eligible for both Medicare and Medicaid, highlighting the program’s role in supporting vulnerable populations. PACE utilizes an interdisciplinary team of healthcare professionals to deliver coordinated care, ensuring that participants’ diverse needs are met in a holistic manner. For the vast majority of individuals enrolled in PACE, the extensive service package enables them to continue living at home and within their communities, offering a valuable alternative to nursing home care. The financing structure of PACE is designed with a capped budget, which empowers providers to focus on delivering all necessary services to participants, rather than being restricted to the services typically reimbursable under standard Medicare and Medicaid fee-for-service arrangements. PACE operates as a Medicare program, and state governments have the option to extend PACE services to Medicaid beneficiaries as an additional benefit within their state programs. For those enrolled in PACE, the program effectively becomes their single source for both Medicare and Medicaid benefits, streamlining their care and coverage.
The capped financing model is a cornerstone of PACE, allowing providers the flexibility to offer a complete spectrum of care services tailored to each participant’s needs. This contrasts with the limitations often encountered under traditional fee-for-service plans, where reimbursement structures can restrict the range of services available. The PACE care model is recognized as an official provider within the Medicare system, and it also serves as a state option, enabling states to incorporate PACE services into their Medicaid offerings.
PACE Eligibility Criteria
To be eligible for PACE, individuals must meet specific requirements that ensure the program is reaching those who can benefit most from its comprehensive care model:
- Age Requirement: Applicants must be 55 years of age or older.
- Residency: Individuals must reside within the designated service area of a PACE organization. This ensures that participants can readily access the program’s services and facilities.
- Need for Nursing Home Level Care: A crucial criterion is that individuals must be certified as being in need of nursing home level care by the relevant state authority. This signifies that PACE is designed for those with significant care needs who, without PACE, might require institutionalization.
- Ability to Live Safely in the Community: Despite needing nursing home level care, participants must be able to live safely in a community setting with the support of PACE services. This ensures that PACE can effectively provide the necessary care to maintain individuals’ independence at home.
Once enrolled in PACE, the program becomes the exclusive provider of services covered by Medicare and Medicaid. This integrated approach simplifies care coordination and ensures that all necessary services are delivered seamlessly. It is also important to note that enrollment in PACE is voluntary, and individuals have the flexibility to disenroll from the program at any time should their needs or preferences change.
