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Great resource. Thank for posting that.

PACE is a Medicaid waiver program.
So what PACE will do depends on just how your state wants to divert its LTC Medicaid funding. PACE is viewed as a way to divert the required skilled nursing care funding for facility based LTC Medicaid (aka a NH) to instead go to a PaCE program which is coordinated by a nonprofit organization.

In my city PACE has 2 Centers - it’s nonprofit is Catholic Charities - that have a 2 fully freestanding multi building community center that hosts 2-5 day a week day programs that the elder is picked up from their home to be taken to the PACE center OR does a much smaller in-home care provided by PaCE partner companies. The elder will have to be evaluated aka a “needs assessment” as to what type of care and # of hours of care to determine their care plan AND if PACE can provide it.

Just being old & needing help with ADLs may not be enough to be eligible. They may be assessed or determined to need only 2 days a week at a center, so family is responsible for all the rest of the time to caregiver or hire caregivers. If you are hoping PACE will do 24/7 care, imo, not gonna happen UNLESS you are in a state or area with a huge cost of living (NYC) that 24/7 aides are actually cheaper than a full time NH resident would cost if there were even enough Medicaid beds available.

For in-home care, you have to watch what you wish for..... there will be a tipping point - maybe 28hrs / 36hrs- to what PACE will do. If it gets above a certain # of hours, it’s not cost effective for in-home care. They need to go into a NH.

Most PACE programs are set up that they need to be “duals”, that is they are both on MediCare & Medicaid as the services provided get paid between the M&Ms. Like for example flu & pneumonia shots are covered by Medicare but the transportation to the PACE center is paid via a Medicaid waiver. Any services that Medicaid pays thru PACE are subject to Medicaid Estate Recovery if they are over 55 at time of application.

The PACE in my city, now does NOT require elders to be on Medicaid. It seems a lawsuit was filed regarding this. So instead they need to have a Medicare advantage plan that fits the provider network that is used for the 2 PACE Centers and the plan will pay the secondary costs that Medicare doesn’t. The PaCE Centers does a good bit of routine care at the center, it has RNs, PAs, plus rotating medical students/interns & residents. It’s basically set up so all health care and all clinic & hospital visits gets coordinated thru PACE. It’s a closed network for providers. & it has to be that way to get a hold on cost containment.

The ones by us have waiting lists.
The health care / hospital management division of Catholic Charities seem to do most PACE programs in the US.

I looked into it at the medicare website here =
It Looks like an interesting program I will look into it some more later.
Looks like it's free if you are on Medicaid but you get charged two separate premiums for it if you are on Medicare only.

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