The Programs of All-Inclusive Care for the Elderly (PACE) is designed to provide a comprehensive suite of medical and social services to specific elderly individuals who are considered frail and are living within their communities. A significant portion of PACE participants are dually eligible for both Medicare and Medicaid benefits. Care coordination is central to the PACE model, delivered through an interdisciplinary team of healthcare professionals. This coordinated approach aims to support participants in remaining in their homes and communities, offering an alternative to nursing home care for most. The program operates under a capped financing structure, enabling providers to offer all necessary services, extending beyond the limitations of standard Medicare and Medicaid fee-for-service models. PACE is recognized as a Medicare program, and states have the option to include PACE services as a Medicaid benefit for eligible beneficiaries. For those enrolled in PACE, the program becomes the single source for their Medicare and Medicaid benefits.
The financing structure of PACE, being capped, is a key feature. It allows PACE providers the flexibility to deliver the full spectrum of services that participants require, rather than being restricted to services solely reimbursable under traditional Medicare and Medicaid plans. The PACE model is officially established as a recognized provider within the Medicare framework. Furthermore, it empowers states to offer PACE services to Medicaid beneficiaries, positioning it as a valuable state option within their healthcare systems.
PACE Eligibility Criteria
To be eligible for PACE, individuals must meet several specific requirements:
- Age Requirement: Be 55 years of age or older.
- Location: Reside within the service area of a designated PACE organization.
- Nursing Home Level Care: Qualify for nursing home level of care as determined by the state.
- Community Safety: Be able to live safely in a community setting with the support of PACE services at the time of enrollment.
Upon enrollment in PACE, the program acts as the exclusive provider of services covered by Medicare and Medicaid. It is also important to note that enrollment in the PACE program is voluntary, and individuals have the option to disenroll at any point if they choose to do so.
