The Programs of All-Inclusive Care for the Elderly (PACE) is designed to provide a comprehensive suite of medical and social services to specific groups of older adults who are living within their communities while managing frailty. A significant portion of PACE participants are those who qualify for both Medicare and Medicaid. Care within PACE is delivered through an interdisciplinary team of healthcare professionals, ensuring a coordinated approach for each participant. This comprehensive care model is crucial as it enables the majority of participants to continue living in their homes and communities, avoiding the need for nursing home placement.
A key feature of PACE is its capped financing structure. This unique financial model empowers PACE 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 plans. PACE operates as a program under Medicare, and individual states have the option to extend PACE services to Medicaid beneficiaries as part of their state Medicaid benefits. For those enrolled in PACE, the program effectively becomes the single source for their Medicare and Medicaid benefits, streamlining care and coverage.
PACE Eligibility Criteria
To be eligible for PACE, individuals must meet specific requirements:
- Age Requirement: Be 55 years of age or older.
- Location: Reside within the defined service area of a PACE organization.
- Nursing Home Level of 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.
Once enrolled in PACE, the program becomes the participant’s exclusive source for all Medicare and Medicaid covered care and services. It is important to note that enrollment in PACE is voluntary, and individuals have the flexibility to disenroll from the program at any time should they choose to do so.
