What You Need to Know About Medicaid’s PACE Program
Medicaid’s Programs of All-Inclusive Care for the Elderly (PACE) offers community-based care to adults age 55 and older who need nursing-home level care, allowing them to continue living at home as long as possible. Each individual receives services that are tailored to their needs based on their current health conditions. The PACE program covers a range of services, from transportation to doctor’s visits and much more. Are you or a loved on qualified for the PACE program?
Who Is Eligible?
To be eligible to join PACE, you are required to meet the following four conditions:
- You must be at least 55 years of age.
- You must live in a PACE program service area.
- You are certified by the state as requiring a nursing-home level of care.
- Receiving PACE services would allow you to continue living in the community.
After you enroll in the PACE program, it takes the place of Medicare and Medicaid as your sole source of healthcare services. You are allowed to disenroll from the program at any point.
How Does It Work?
At the time of enrollment, the PACE enrollee’s healthcare needs are assessed by a team of providers. Each member is assigned services based on demonstrated need and recommendations from the physicians spearheading their care.
Having one consistent team of providers means the PACE enrollee’s health status is carefully monitored and care providers are immediately alerted to changes in their physical, mental or emotional well-being. This elevates the level of care they receive by shortening treatment response times, keeping them healthy and at home as long as possible.
A PACE provider team could consist of primary care physicians, nurses, physical or occupational therapists, social workers, personal care assistants, drivers, health consultants and more.
PACE’s Unique Benefits
The PACE program is ideal for older adults who need specialized care but who also wish to continue living at home. When family members want to be involved in day-to-day care, but can’t manage every task alone, PACE steps in.
By providing transportation to and from adult day care, ensuring attendance at all medical appointments and even helping with chores around the house, the interdisciplinary team makes sure the enrollee’s medical and social needs are completely met through cooperative coordination.
What Does It Cost?
PACE is funded by Medicare and Medicaid. If you are eligible for Medicaid, you do not have to pay an annual premium for any services offered through the PACE program. If you have Medicare but don’t qualify for Medicaid, you are required to pay the monthly long-term care premium as well as Medicare Part D premiums. You will not pay any deductibles or co-payments for PACE provided services.
If you do not yet qualify for Medicare or Medicaid, you can arrange to pay for PACE services privately.
Is the PACE program right for you? Is it offered in your zip code? You can call My Senior Health Plan for help when you have questions about your healthcare coverage.