Page Reviewed / Updated - October 10, 2020
Expert Reviewed By: Joshua Iversen, President, Syzygy Financial LLC
Medicare PACE is not a source of funds for paying for senior care. Rather, it is an optional program that covers all of a participating senior’s medical needs as well as some personal care. The program is open to both Medicare and Medicaid beneficiaries. It provides comprehensive medical and social services at home, adult day health centers, and inpatient facilities as an alternative for those who would otherwise need nursing home care.
All of a patient’s medical needs are determined and provided by a set group of medical service providers. This includes medications and medically-necessary transportation.
This model of care is sometimes referred to as Managed Care at Home, and in certain states, PACE Programs are called LIFE Programs. PACE is an acronym for Programs of All-inclusive Care for the Elderly and LIFE is an acronym for Living Independence for the Elderly.
PACE programs are intended for families that wish to have the care recipient live at home instead of in a skilled nursing home / facility. Participating families are expected to provide some personal care themselves and not rely entirely on the program for 24-hour care. But if a PACE program can no longer safely support the care of an enrolled participant at home or in adult day care, the program will pay for care in a skilled nursing home.
PACE programs are a very good option for families that are able to provide some level of care. Unfortunately, as of June 2019, PACE programs were not available nationwide. Currently there are PACE / LIFE Programs at 260 locations spread through 31 states. Another drawback to this program is that seniors must give up their primary care physician to enroll in the program. Finally, in some areas it can take many months to apply and have the application processed before enrollment.
The following is a list of states with PACE / LIFE programs and states without such programs. Of the states that do have PACE / LIFE programs, each of these states has at least one such program. That said, there may not be programs available statewide.
|States with PACE / LIFE Programs||States without PACE / LIFE Programs|
|Alabama Arkansas California Colorado Delaware Florida Indiana Iowa Kansas Louisiana Maryland Massachusetts Michigan Nebraska New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Virginia Washington Wisconsin Wyoming||Alaska Arizona Connecticut Georgia Hawaii Idaho Illinois Kentucky Maine Minnesota Mississippi Missouri Nevada New Hampshire South Dakota Utah Vermont Washington D.C. West Virginia|
PACE benefits come only in the form of medical and care services. Seniors do not receive cash payments. Benefits are determined on a case-by-case basis and are provided by a dedicated team of health care professionals and can include any of the following.
PACE / LIFE programs receive monthly payments from Medicare or Medicaid. Participating seniors do not make payments to the PACE program. If a participant qualifies for Medicaid, there is no monthly premium for long term care. Seniors that are not Medicaid eligible, but have Medicare, will pay a monthly premium, but do not have deductibles or copayments. For persons who do not have Medicaid or Medicare, benefits and services are still available via private pay.
Persons can apply for the PACE or LIFE Program with the individual, regional PACE providers. Click here for a list. For more information about PACE Policy, please visit the National PACE Association website.
While there are many positives to these programs, an unfortunate reality is the application process can require patience and perseverance. For some programs in certain areas, the application and approval process can take as long as nine months. This is by no means the case everywhere, but applicants and their families should be aware of this possibility.