Program of All-Inclusive Care for the Elderly (PACE): Helping Seniors Remain Living at Home

Summary
The Program of All-Inclusive Care for the Elderly (PACE) coordinates healthcare and long-term care coverage for people over age 55 who require a high-level of care but would prefer not to live in a nursing home. Being in enrolled in Medicaid or Medicare is not a requirement for PACE, but the majority of program participants are dual-eligible, meaning they’re enrolled in both Medicaid and Medicare. In some states, PACE is known as Living Independence for the Elderly, or LIFE.

What are PACE / LIFE Programs?

PACE is a federally-funded program run by individual states. The state-level PACE programs coordinate healthcare, long-term care and social service benefits and coverage for program participants. An interdisciplinary team of PACE healthcare professionals will create a streamlined approach for all PACE beneficiaries so they can receive all their care through one plan. This includes Medicaid and Medicare benefits for seniors who are dual-eligible, meaning they are enrolled in both Medicaid, which is for low-income individuals, and Medicare, which is for anyone over age 65.

Every PACE program also has adult day health center where program participants can go on a daily basis. These PACE centers aren’t identical, but most of them provide medical oversight, nursing services, therapies, social activities, exercise programs, meals, snacks and access to audiologists, optometrists, dentists and podiatrists. PACE will also provide transportation to and from the center, as well.

The program’s primary purpose is to help individuals who require a Nursing Facility Level of Care remain living at home (or somewhere else in the community) instead of moving into a nursing home. Most people would prefer to reside in their own home or the home of a loved one rather than an institution, and providing some in-home care and support is less expensive for the government than paying for a full-time bed in a nursing home. So, providing long-term care at home is usually beneficial to all parties, and the National PACE Association says that, “95 percent of PACE participants are able to continue to live in their community.”

What are the Eligibility Requirements for PACE/LIFE Programs?

Individuals need to meet four basic requirements in order to be eligible for PACE:

• Age: Must be 55-years-old or older
• Physical/functional need: Must require a Nursing Facility Level of Care
• Demonstrable benefit: The benefits provided through PACE must make it safe for the individual to live in the home or assisted living community
• Geographic region: A PACE program must be available in the area where the individual lives

There are no financial requirements for PACE. However, the program is fully covered for Medicaid beneficiaries. In most states in 2024, the individual asset limit for Medicaid for individuals is $2,000 and the individual income limit is $2,829/month. However, these limits can change depending on the program, the state and the applicant’s marital status and financial situation. To find the specific financial eligibility criteria for your situation, use our Medicaid Eligibility Requirements Finder.

People who are not Medicaid beneficiaries can pay a monthly premium to join PACE. Once enrolled, PACE program participants never have to pay a deductible or co-pay for any care, medication or service provided by the PACE interdisciplinary team.

What is a Nursing Facility Level of Care?

While PACE is intended to prevent nursing home placement, one of its requirements for applicants is to be certified by their state as needing a Nursing Facility Level of Care (NFLOC). In general, this means the kind of care and supervision that is normally associated with a nursing home. However, states can differ on how they define and measure NFLOC.

For example, one state may define a NFLOC  as needing help with two of the five Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Another state may define a NFLOC as needing help with three of the five. Many states also have their own evaluation procedures and tools. In Florida, for example, Medicaid uses the Comprehensive Assessment and Review for Long-Term Care Services Program to determine if a NFLOC is met for Medicaid requirements. In New York, the Uniform Assessment System tool is used by a registered nurse from the New York Medicaid Choice’s Conflict-Free Eligibility & Enrollment Center to determine what level of care Medicaid applicants might need.

PACE for People with Dementia

A diagnosis of Alzheimer’s disease or dementia does not necessarily equate to needing a NFLOC, which is a requirement for the PACE program, as we just discussed. However, the National PACE Association estimates that nearly half of its program members have been diagnosed dementia, and the program can be especially helpful for these people. Dementia makes it difficult to live independently, but PACE’s coordinated and comprehensive approach provides a safety net. PACE will manage all aspects of its members care, including things like scheduling appointments, setting reminders, providing transportation and medication management that can be crucial for people with cognitive impairments.

What’s more, PACE will provide benefits to program members who reside in memory care units for people with Alzheimer’s and other dementias. These can be standalone facilities or part of a larger assisted living residence or medical facility.

Which States Have PACE / LIFE Programs?

Medicare benefits and eligibility requirements are the same for recipients across the country, but Medicaid benefits and eligibility requirements all vary significantly by state. Since PACE is funded by both Medicare and Medicaid, it is up to each state and its legislators to decide if they want to create and run a PACE program. As of January 2024, 32 states and the District of Columbia have PACE/LIFE programs.

The states without PACE/LIFE programs (or plans to have them) are Alaska, Arizona, Connecticut, Georgia, Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia and Wyoming.

The table below lists the states that currently have PACE/LIFE programs, the number of programs in the state, the location of those programs and their names.

What Benefits Do PACE/LIFE Programs Provide?

PACE programs administer all healthcare and long-term care services and supports that are deemed medically necessary to maintain or improve the health of its members. This includes all of the benefits available under both Medicaid and Medicare. And PACE will cover these benefits in the beneficiary’s home, the home of a loved one and assisted living facilities, including memory care units for people with Alzheimer’s disease and other dementias. However, PACE will not cover room and board expenses in these settings.

Every PACE plan includes routine care visits to a primary care provider with an office that is on-call 24 hours a day, seven days a week. PACE covers all prescription medication and over the counter supplements that are considered medically necessary. PACE also handles hearing, vision, eye and foot care, if needed, as well as other special needs like cardiology, rheumatology and women’s services. Outpatient and inpatient services are covered as well, such as lab work, x-rays, radiology, hospitalizations, inpatient specialists and skilled rehab, as are psychiatric assessments and care for grief, loss and other issues.

PACE’s in-home benefits can include:

• Meal delivery
• Homemaker services
• Chore services
• Physical therapy
• Occupational therapy
• Skilled nursing
• Transportation
• Personal care assistance with the Activities of Daily Living
• Wheelchairs
• Walkers
• Oxygen
• Hospital beds
• Diabetic testing supplies
• Respite care for family caregivers

PACE adult day health centers can very depending on the location. However, many of them will offer the following benefits:

• Medical oversight
• Nursing services
• Physical therapy
• Social activities
• Exercise programs
• Lunch/snacks
• Social services
• Vision, hearing, dental and foot care
• Transportation

Individuals residing in nursing homes can be enrolled in PACE benefits, but only about 5 percent of program participants live in institutions, according to the National PACE Association. In most cases, the nursing home or skilled medical facility will coordinate all of the healthcare and long-term services their residents need.

While PACE offers many benefits, it does not necessarily offer all of them to every program participant. Instead, an in-home assessment will be conducted for each PACE applicant by the local PACE interdisciplinary team.  This assessment will be done early in the application process, and after the applicant has been accepted into the program, the assessment will be used to help create an individualized care plan.

How to Apply for PACE / LIFE Programs

People already enrolled in Medicaid and/or Medicare, or people who are willing to pay out-of-pocket, can contact their local PACE office to find out how to apply and receive benefits.

Americans over the age of 65 can sign up for Medicare online here.

Applying for Medicaid is more complicated, and the rules can vary by state. For help finding one’s specific eligibility criteria, try our Medicaid Eligibility Requirements Finder tool. For more information on alternative pathways to eligibility, click here.