Frequently Asked Questions
What is PACE?
PACE provides an alternative to nursing home placement that utilizes a comprehensive medical and social service delivery system coordinated through an adult day health center to meet long-term care needs of participants. Participants enroll in a capitated managed care benefit funded by Medicare and Medicaid. The program is supplemented by in-home and referral services. What services are provided by the PACE program? A team lead by a specialized physician works with participants and their families to assess their needs, develop a care plan and deliver all services — including acute care services and, when necessary, nursing facility services.
How do people qualify for PACE?
In order to be eligible for PACE, a person must be age 55 or older, certified by the state to need nursing home care, and live in an area served by PACE.
What are the financial eligibility criteria for the PACE program?
If seeking Medicaid coverage, interested participants must qualify for Medicaid under the institutional financial eligibility standards.
Are people who do not qualify for Medicaid eligible for PACE enrollment?
Yes. If a person meets the income and assets limits to qualify for Medicaid, the program pays for a portion of the monthly PACE premium. Medicare pays for the rest. If a person does not qualify for Medicaid, he or she is responsible for the portion of the monthly premium Medicaid would pay. PACE staff can help determine a person’s Medicaid eligibility.
Are prescription drugs covered?
Yes. All prescription and non-prescription drugs deemed necessary by the PACE interdisciplinary care team are paid for by the program.
How do people get to the day health center?
PACE programs provide transportation to the day health center. Transportation is a key part of the PACE benefit. Transportation is not only provided between the home and the day health center, but also to appointments with specialists and other activities.
Do PACE participants attend the Day Health center every day?
No. On average, PACE participants attend a Day Health center three times a week. Day Health center attendance is based on individual needs and can range from once a week, or every month, to several days a week, as needed.
What happens if a PACE participant needs nursing home care?
The goal of PACE is to keep participants out of a nursing home as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, PACE will pay for the care and the supervision of the interdisciplinary team will continue.
What happens if a person wants to leave PACE?
A PACE participant is free to withdraw from PACE and resume their benefits in the traditional Medicare and Medicaid programs at any time.