You Can Apply for PACE If You Exceed the Medicaid Income Threshold
Understanding the Benefits of the Cost Share Approach
Many individuals who are considering PACE for themselves or a loved one have some questions about whether they must qualify for Medicaid in order to be eligible for PACE. The answer is no: PACE participants do not need to qualify for or be on Medicaid.
While Medicaid is a common source of funding for PACE programs and many participants qualify for Medicaid, PACE is designed to be accessible to individuals with a variety of financial circumstances. PACE programs are required to accept Medicaid beneficiaries if they meet the eligibility criteria, but they can also enroll individuals who are not on Medicaid. If you or your loved one’s income exceeds the minimum requirement for Medicaid, you will pay a cost share to make up the difference.
PACE programs have a unique financing model that combines Medicaid and Medicare funding, making it possible for participants to receive comprehensive and coordinated care regardless of their insurance status. Additionally, participants who are not on Medicaid may have the option to pay privately or through other insurance sources.
The primary goal of PACE is to provide integrated and person-centered care to older adults who meet the criteria for nursing home care but wish to continue to live at home in their community. The PACE services include medical care, social services, rehabilitation, and other supportive services. The flexibility of PACE in terms of payment options helps ensure that a broader range of participants can benefit from the program’s comprehensive care model.
It’s important for individuals interested in PACE to reach out to McGregor PACE to understand the specific enrollment criteria, payment options, and services available in Cuyahoga County. We can provide detailed information about eligibility, enrollment, and the financial aspects of participation.