Could your aging loved one be eligible for a significant amount of assistance through the Medicaid and Medicare Program of All-Inclusive Care for the Elderly (PACE)? According to the National PACE Association, more than 53,000 elders with significant care needs currently take advantage of the services provided by this little-known program.
What Is PACE for Seniors?
PACE is an optional Medicare and Medicaid benefit that focuses entirely on older adults who meet their state’s standards for nursing home-level care. PACE offers 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 enable them to continue living in their own homes, rather than moving to a long-term care facility.
A multidisciplinary team of PACE doctors, nurses, therapists, social workers and other professionals assesses each participant’s needs and delivers all services via an integrated elder care plan. Studies have shown that participation in PACE programs reduces family caregiver burden and decreases emergency room visits, hospital admissions, hospital readmissions and nursing home admissions for seniors. There are currently 133 PACE programs provided at 264 PACE centers in 31 states.
PACE Eligibility Requirements
Enrollment in a PACE program is voluntary. To be eligible for PACE, an individual must:
- Have Medicare, Medicaid or both;
- Be at least 55 years old;
- Live in a PACE service area;
- Be certified as requiring their state’s nursing home-level of care; and
- Be able to safely live in a community setting with the addition of PACE support at the time of enrollment.
PACE Services for Seniors
PACE offers and manages all the medical, social and rehabilitative services enrollees need to maintain or regain their independence, remain in their own homes and communities, and maintain their quality of life. The PACE service package must include all Medicare services. If a state has chosen to extend PACE to its Medicaid beneficiaries, then all services covered by the state’s Medicaid program are also included. In addition, PACE provides any service determined necessary by a senior’s interdisciplinary team.
Minimum services that must be provided include the following:
- Adult day health care to offer nursing care and 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
- Laboratory and imaging services
- Medical specialty services as required (audiology, dentistry, optometry, podiatry, etc.)
- Transportation to and from the PACE center and some community 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.
Who Provides PACE 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 they can detect subtle changes in the senior’s condition and react quickly to new or worsening medical, functional and psycho-social problems.
The PACE 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 current enrollees are dually eligible for both Medicare and Medicaid.
Seniors with limited income and assets who qualify for Medicaid do not have to pay a monthly premium for the long-term care services provided through the PACE program. However, Medicare beneficiaries who do not qualify for Medicaid will have to pay a monthly long-term care premium as well as a premium for Medicare Part D prescription drugs. 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 yet qualify for Medicare or Medicaid.
For a listing of PACE organizations nationwide, visit Medicare’s PACE plan search website.
Sources: PACE by the Numbers (https://www.npaonline.org/sites/default/files/images/NPA%20infographic%203%2020%20%281%29.pdf); Medicare: PACE (https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/pace); Programs of All-Inclusive Care for the Elderly Benefits (https://www.medicaid.gov/medicaid/long-term-services-supports/pace/programs-all-inclusive-care-elderly-benefits/index.html); Program of All-Inclusive Care for the Elderly (https://www.medicaid.gov/medicaid/long-term-services-supports/program-all-inclusive-care-elderly/index.html)