Could your family be eligible for a significant amount of assistance through Medicaid and Medicare's Program of All-Inclusive Care for the Elderly (PACE)? More than 40,000 elders with significant care needs take advantage of the services provided by this little-known program.
What is PACE?
PACE is an optional benefit under both Medicare and Medicaid that focuses entirely on older people who meet their state's standards for nursing home-level care. It features comprehensive medical and social services that can be provided at an adult day health center, in a participant’s home, and/or in an inpatient facility. For most patients, these services permit them to continue living at home, rather than moving to a long-term care facility.
A team of PACE doctors, nurses, and other health professionals assess each participant’s needs and deliver all services via an integrated health care plan. There are currently 122 PACE programs provided at 233 PACE centers in 31 states.
Enrollment in a PACE program is voluntarily. Eligible individuals must:
- Be at least 55 years old
- Live in a PACE service area
- Be certified as requiring their state's nursing home-level of care
- Be able to safely live in a community setting with the addition of PACE support at the time of enrollment
Services Offered through PACE
PACE offers and manages all of the medical, social and rehabilitative services enrollees need to preserve or restore their independence, remain in their homes and communities, and maintain their quality of life. The PACE service package must include all Medicare and Medicaid services provided by that state. In addition, PACE provides any service determined necessary by the interdisciplinary team.
Minimum services that must be provided include the following:
- Adult day health care to offer nursing, physical, occupational, and recreational therapies
- Nutritional counseling
- Social work counseling
- Social services (caregiver training, respite care, support groups, etc.)
- Medical care provided by a PACE physician who is familiar with the patient's history, needs, and preferences
- Home health care and personal care
- All necessary prescription drugs
- Medical specialists as required (audiologists, dentists, optometrists, podiatrists, etc.)
- Transportation to and from the PACE center and some medical appointments
Generally, these services are provided in an adult day health care setting, but may also include in-home care and other referral services. This includes medical specialists, laboratory and other diagnostic services, and hospital and nursing home care.
Who Provides Care?
An enrollee's initial and ongoing needs are determined by PACE's medical team of care providers. The PACE team has frequent contact with the patient so that they can detect subtle changes in the senior’s condition and react quickly to changing medical, functional, and psycho-social problems.
The team usually includes primary care physicians and nurses, physical, occupational, and recreational therapists, social workers, personal care attendants, dietitians, and drivers.
What Does PACE Cost?
These nationwide programs are funded by Medicare and Medicaid. According to the National PACE Association, 90 percent of participants are dual-eligible beneficiaries who are enrolled in both Medicare and Medicaid.
Seniors who are eligible for Medicaid do not have to pay a monthly premium for long-term care services provided through the PACE program. Medicare beneficiaries who do not qualify for Medicaid will have to pay the monthly long-term care premium as well as a premium for Medicare Part D prescriptions. There are no deductibles or copayments for products and services that are approved by the PACE health care team.
PACE services can also be paid for privately if a senior does not have Medicare yet or qualify for Medicaid.
For a listing of PACE organizations nationwide, visit Medicare’s plan search website.
Information compiled from Medicare.gov.