PACE is primarily a MediCARE paid for program at a day center for those who otherwise would be eligible for skilled nursing care in a facility but prefer to be in their home or a family member’s home. It’s a day program (1-4 days per week) & does health care at the center via mainly NPs or PAs with oversight by a MD, plus meals, activities & transportation. Your mom will need to be assessing medically to be eligible.
Income may be looked at with perhaps a smallish copay & Assets are not looked at and both of these happen if she opts to go onto Medicaid for health insurance and Community Medicaid. Although MediCARE is the main payor there are secondary health insurance costs and these usually billed to your States Medicaid as health insurance and there are ancillary costs billed to Community Health Medicaid program. I know this can seem way waaaAaAAy confusing. The states tend to push participants to become “duals” for health insurance so go onto Medicare and Medicaid and also file for community Medicaid. Paperwork wise it’s absolutely easier for the PACE.
But a participant does not have to go onto Medicaid at all they can just be on Medicare and do a monthly Co pay and keep their secondary health insurance. If she has really good secondary health insurance coverage she may not want to exit it. Also if she owns her home, if CT includes community health Medicaid in estate recovery, the costs billed by PACE will become a claim or a lein to her estate.
PACE is usually run by a social service organization nonprofit and partners with a specific hospital group or health science center. Eventually should an elder be assessed to need higher level of care beyond what PACE & being at home is suitable for, they go into a NH/SNF affiliated with PACE. It’s a closed system. They only see providers within PACE program. Their old Medicare and old insurance # cease and they get a new PACE #. This is part of reasoning why they want you to become a “dual” too.
If elder needs oversight non PACE time, a staffer could drop by the home a bit over the weekend or during the week, HOWEVER & to me beyond mucho importante, family needs to be there able to do 24/7 oversight all the other time when their elder is not at PACE or when a staffer not visiting their home. Please pls pls read that last sentence again!!!
PACE is like hospice- another Medicare benefit - in that both require family is in the home and they are there as 24/7 oversight to caregive, do medication management, help transition to bathroom, bathe, hygiene, cook meals, etc all the other times. Neither PACE or hospice can pay family. So if your elder has $ they can do a personal services contract to pay you all above board with taxes done or elder hires outside caregivers or family does it for free.
Both hospice & PACE have it so that participants / POA sign off they acknowledge their understanding on this. Think carefully if this is realistically feasible.
The 2 PACE in my area are run by a specific healthcare division of Catholic Charities and partner with LSU Tulane new LSMC hybrid for all their healthcare. 1 PACE is way more urban, low income and “duals”, widows mainly, many coming from congregate housing & already on community Medicaid and Medicaid as health insurance. The other PACE is more affluent, lots of married retirees owing their home, still travel, many where only 1 spouse needs a day program, absolutely not going on Medicaid & they do a flat rate monthly copay to enroll a spouse in the PACE. The only requirement for PACE is to be fully eligible for MediCARE and to be assessed to be “at need” medically, the additional costs can be handled via a copay if your mom does not want to go onto Medicaid.
There’s been a couple of posts last month on PACE. Just type in PACE in the upper R “Q” and I bet they come up. Interesting reading.
Thanks, Igloo, for your advice about PACE and being so knowledgeable about the program. None of the websites on PACE that I visited explains how this program works the way you did and that a caregiver still has to be in the home with the patient during the hours that the patient is not under the care of PACE. I also found out that once a person joins PACE, his/her personal doctors and healthcare facilities cease and the patient then has to be seen by PACE’s doctors and healthcare facilities. In other words, if a patient was going to his/her doctors for years, the patient will have to stop going to that doctor and he/she will have to go to a PACE’s doctor instead. Also, of importance, the patient has to be under the Medicare drug program that PACE offers. If the patient decides to seek another Medicare drug program, he/she will be disenrolled from the program.
Barb is correct and as PACE is a governmental program that I THINK combines state and federal funds, I think that it varies a good deal state to state. Igloo here is the best person to explain these programs, but I would also go directly to those involved in your own state to see just what's right for your senior. You might consider looking up Igloo's responses to others because I know on this Forum she has several times addressed PACE program's extensively. Go up to the timeline (bluegreen at top of page) and go to the magnifying "search" symbol. Type in Igloo. You will see her responses show up and can try to access those that are about PACE. They are lengthy and will give you some great reading.
Try the PACE link on Medicare/Medicaid government pages also by typing in "PACE programs Medicare and Medicaid" on your search engine. The dot-gov. page will show right up for you. Search also under Connecticut PACE Medicaid Programs.
I would contact your local Area Agency on Aging. I'm not sure Connecticut has PACE programs. The AAA would know.
In general, PACE programs serve elders who are eligible for both Medicare and Medicaid, and who are certified as being frail enough to need NH Care. PACE coordinates their care through day care, physician visits, dietician services and home attendants. In theory, it should provide coordinated benefits for an elder that enable them to remain in the community.
It is not available in CT. It is available if she lives in MA
Income may be looked at with perhaps a smallish copay & Assets are not looked at and both of these happen if she opts to go onto Medicaid for health insurance and Community Medicaid. Although MediCARE is the main payor there are secondary health insurance costs and these usually billed to your States Medicaid as health insurance and there are ancillary costs billed to Community Health Medicaid program. I know this can seem way waaaAaAAy confusing. The states tend to push participants to become “duals” for health insurance so go onto Medicare and Medicaid and also file for community Medicaid. Paperwork wise it’s absolutely easier for the PACE.
But a participant does not have to go onto Medicaid at all they can just be on Medicare and do a monthly Co pay and keep their secondary health insurance. If she has really good secondary health insurance coverage she may not want to exit it. Also if she owns her home, if CT includes community health Medicaid in estate recovery, the costs billed by PACE will become a claim or a lein to her estate.
PACE is usually run by a social service organization nonprofit and partners with a specific hospital group or health science center. Eventually should an elder be assessed to need higher level of care beyond what PACE & being at home is suitable for, they go into a NH/SNF affiliated with PACE. It’s a closed system. They only see providers within PACE program. Their old Medicare and old insurance # cease and they get a new PACE #. This is part of reasoning why they want you to become a “dual” too.
If elder needs oversight non PACE time, a staffer could drop by the home a bit over the weekend or during the week, HOWEVER & to me beyond mucho importante, family needs to be there able to do 24/7 oversight all the other time when their elder is not at PACE or when a staffer not visiting their home. Please pls pls read that last sentence again!!!
PACE is like hospice- another Medicare benefit - in that both require family is in the home and they are there as 24/7 oversight to caregive, do medication management, help transition to bathroom, bathe, hygiene, cook meals, etc all the other times. Neither PACE or hospice can pay family. So if your elder has $ they can do a personal services contract to pay you all above board with taxes done or elder hires outside caregivers or family does it for free.
Both hospice & PACE have it so that participants / POA sign off they acknowledge their understanding on this. Think carefully if this is realistically feasible.
The 2 PACE in my area are run by a specific healthcare division of Catholic Charities and partner with LSU Tulane new LSMC hybrid for all their healthcare. 1 PACE is way more urban, low income and “duals”, widows mainly, many coming from congregate housing & already on community Medicaid and Medicaid as health insurance. The other PACE is more affluent, lots of married retirees owing their home, still travel, many where only 1 spouse needs a day program, absolutely not going on Medicaid & they do a flat rate monthly copay to enroll a spouse in the PACE. The only requirement for PACE is to be fully eligible for MediCARE and to be assessed to be “at need” medically, the additional costs can be handled via a copay if your mom does not want to go onto Medicaid.
There’s been a couple of posts last month on PACE. Just type in PACE in the upper R “Q” and I bet they come up. Interesting reading.
Igloo here is the best person to explain these programs, but I would also go directly to those involved in your own state to see just what's right for your senior.
You might consider looking up Igloo's responses to others because I know on this Forum she has several times addressed PACE program's extensively.
Go up to the timeline (bluegreen at top of page) and go to the magnifying "search" symbol. Type in Igloo. You will see her responses show up and can try to access those that are about PACE. They are lengthy and will give you some great reading.
Try the PACE link on Medicare/Medicaid government pages also by typing in
"PACE programs Medicare and Medicaid" on your search engine.
The dot-gov. page will show right up for you. Search also under Connecticut PACE Medicaid Programs.
In general, PACE programs serve elders who are eligible for both Medicare and Medicaid, and who are certified as being frail enough to need NH Care. PACE coordinates their care through day care, physician visits, dietician services and home attendants. In theory, it should provide coordinated benefits for an elder that enable them to remain in the community.