PACE & LIFE Programs from Medicare & Medicaid: Helping the Elderly Remain Living at Home

Summary
The Program for All-Inclusive Care for the Elderly, known as PACE, streamlines Medicare and Medicaid benefits for seniors. This makes it easier for them to access healthcare and long-term services and supports, even while they are still living at home. In some states, PACE is known as LIFE (Living Independence for the Elderly). PACE/LIFE program participants are required to need care at a nursing-home level, but most of them still live in the community in their own home, the home of a loved one or an assisted living residence. While being enrolled in Medicaid and/or Medicare is not a requirement for PACE, the vast majority of PACE beneficiaries are dual-eligible (enrolled in both Medicaid and Medicare). Unfortunately, PACE/LIFE is not available in every state, or in every region of the states where it is offered.

 

What are PACE / LIFE Program?

PACE is a federally-funded program run by individual states. The state-level PACE programs administer Medicare and Medicaid healthcare benefits and long-term care services and supports to seniors. PACE also administers vision and dental care. The program’s primary purpose is to help the elderly who require a Nursing Facility Level of Care remain living at home instead of moving into a nursing home. Most people would prefer to reside in their own home rather than an institution, and providing some in-home care and other long-term care benefits 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, “90 percent of PACE participants are able to continue to live in their community.”

Being enrolled in Medicaid and/or Medicare is not an eligibility criteria for PACE, but individuals not enrolled in either would have to pay for PACE services out-of-pocket. Most PACE participants 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.

 Medicaid eligibility can be complicated and depends on a number of factors including marriage status and state of residence. For help making income and assets requirements easier to understand, click here.

For those dual-eligible program participants, PACE administers both Medicaid and Medicare benefits. This streamlined approach means that PACE participants get all of their healthcare needs covered by the same program. PACE will help coordinate and schedule care and medication from a primary care provider and multiple specialists. If needed, PACE will provide transportation to and from appointments or it will schedule in-home doctor or nurse visits. Participants can also make regular visits to their local PACE center, which provides routine health checks and medical services, as well as meals and social activities.

PACE will also coordinate and administer all the long-term care benefits available through Medicaid and Medicare. This includes durable medical equipment (like oxygen tanks), home modifications, meal delivery, homemaker services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Depending on the state and program, some of these personal services may be consumer-directed, meaning the participant can select caregivers of their choice, including some family members.

 

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 eligibility, so income and asset limits do not necessarily matter for applicants who are willing to pay for PACE services out-of-pocket. However, most PACE recipients are eligible for Medicaid and can have costs covered by the program. In 2022, Medicaid eligibility usually means monthly income below $2,523 per month and countable assets under $2,000, though those figures might be higher or lower depending on the state. More on Medicaid financial eligibility by state.

 

What is Nursing Facility Level of Care?

While PACE/LIFE 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. This means a level of care that can only be provided in a full-time nursing home.

In general, needing a Nursing Facility Level of Care means the individual requires hands-on assistance with some of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and/or the Instrumental Activities of Daily Living (such as cleaning, shopping, cooking, laundry and scheduling). However, each state has its own definition of Nursing Facility Level of Care and its own ways of assessing individual cases. In Florida, for example, Medicaid uses the Comprehensive Assessment and Review for Long-Term Care Services Program to determine if a Nursing Facility Level of Care is met for certain Medicaid programs. 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

PACE can be especially helpful for people living with Alzheimer’s disease or other related cognitive impairments, such as Lewy body dementia or vascular dementia. These types of illnesses make it difficult to live independently, but the PACE program can provide the type of comprehensive care that would allow an individual with dementia to remain in the community. According to the National PACE Association, “nearly half (49 percent) of PACE participants have been diagnosed with dementia.”

Services like adult day care, prescription management, meal delivery, homemaker services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) could all help a PACE participant continue living in the community. Plus, all of those services would be coordinated and delivered through one plan, which would also be particularly helpful for someone with cognitive issues.

In addition to living at home or in the home of a loved one, “living in the community” could also mean residing in an assisted living residence. This would include memory care residences, which specialize in housing and caring for people with dementia. These can be standalone facilities or part of a larger assisted living residence or medical facility.

 It is important to note that in most states a diagnosis of Alzheimer’s disease or dementia does not necessarily equate to requiring a Nursing Facility Level of Care, which is a requirement for the PACE program. Instead, states will conduct a level-of-care assessment for each applicant, which usually takes into consideration the applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). A cognitive illness could impact the assessment and lead to a state certification for Nursing Facility Level of Care, but Alzheimer’s disease and dementia are not automatic qualifiers.

 

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 August 2022, there are 31 states with PACE/LIFE programs. Plus, Kentucky is preparing to open its PACE program within the year, and Illinois announced it will have PACE by 2024.

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, and the District of Columbia.

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.

 Moving for Benefits – PACE Programs have no length of residency requirements. Therefore, aging parents can move from one state where there are no PACE programs, such as Arizona, to another state, such as California, where they are multiple programs. This is mostly relevant when aging parents are wanting to move to be closer to their adult children.
States with Medicare & Medicaid PACE / LIFE Programs (Updated Aug. 2022)
State Number of Programs Locations & Program Names
Alabama 1 Mobile, Mercy LIFE of Alabama (Trinity)
Arkansas 3 Jonesboro, Total Life Health Care

North Little Rock, Complete Health with PACE

Springdale, PACE of the Ozarks

California 21 Eureka, Redwood Coast PACE

Fresno (2), Innovative Integrated Health, WelbeHealth Sequoia PACE

Long Beach, WelbeHealth Coastline PACE

Los Angeles, AltaMed PACE

Modesto, Central Valley PACE

Oakland, Center for Elders’ Independence

Orange, CalOptima

Pasadena, WelbeHealth Pacific PACE

Reseda, Brandman Centers for Senior Care

Riverside, Neighborhood Healthcare PACE

Sacramento (2), InnovAge California PACE – Sacramento, Sutter SeniorCare

San Bernardino, InnovAge California PACE – San Bernardino

San Diego (3), Family Health Centers of San Diego PACE, San Diego PACE/SYH, St. Paul’s PACE

San Francisco (2), North East Medical Services, On Lok PACE

San Marcos, Gary and Mary West

Stockton, WelbeHealth Sierra PACE

Colorado 5 Colorado Springs, Rocky Mountain PACE

Denver, InnovAge Colorado PACE

Grand Junction, HopeWest PACE

Lafayette, TRU PACE

Montrose, Senior CommUnity Care of CO

Delaware 2 Milford, PACE Your LIFE

Wilmington, Saint Francis LIFE (Trinity)

Florida 5 Fort Myers, Hope PACE

Jacksonville, The PACE Place

Miami, Florida PACE Centers

St. Petersburg, Suncoast PACE

West Palm Beach, Palm Beach PACE

Iowa 2 Council Bluffs, PACE Iowa

Sioux City, Siouxland PACE

Indiana 4 Fort Wayne, PACE of Northeast Indiana

Indianapolis, Franciscan Senior Health & Wellness

Mishawaka, Saint Joseph PACE (Trinity)

Richmond, Reid Health PACE Center

Kansas 3 Newton, Bluestem PACE

Topeka, Midland Care PACE

Wichita, Ascension Living HOPE

Louisiana 2 Baton Rouge, PACE Baton Rouge

New Orleans, PACE Greater New Orleans

Massachusetts 8 Boston, Upham’s PACE

Cambridge, CHA PACE

Dorchester, Harbor Health Services

East Boston, Neighborhood PACE

Holyoke, Mercy LIFE MA (Trinity)

Lynn, Element Care

Springfield, Serenity Care,

Worcester, Summit ElderCare

Maryland 1 Baltimore, Hopkins ElderPlus
Michigan 14 Battle Creek, Senior Care Partners PACE

Detroit, PACE Southeast Michigan

Flint, Ascension Living PACE Michigan

Fort Gratiot, Sunrise PACE

Grand Rapids, Care Resources

Jackson, Thome PACE

Lansing, Senior CommUnity Care of Michigan

Mount Pleasant, PACE Central Michigan

Muskegon, LifeCircles

Newaygo, Community PACE at Home

Saginaw, Great Lakes PACE

St. Joseph, PACE of Southwest Michigan

Traverse City, PACE North

Ypsilanti, Huron Valley PACE

Missouri 1 St. Louis, New Horizons PACE
North Carolina 11 Asheboro, Randolph Health StayWell Senior Care

Asheville, CarePartners PACE

Carrboro, Piedmont Health SeniorCare

Charlotte, PACE of the Southern Piedmont

Durham, Senior CommUnity Care of NC

Fayetteville, LIFE St. Joseph of the Pines (Trinity)

Gastonia, Senior Total Life Care

Greensboro, PACE of the Triad

Lexington, Carolina Senior Care

Newton, [email protected]

Wilmington, Elderhaus PACE

North Dakota 1 Bismarck, Northland PACE
Nebraska 1 Omaha, PACE Nebraska
New Jersey 6 Atlantic City, AtlantiCare LIFE Connection

Camden, Trinity Health LIFE New Jersey (Trinity)

Jersey City, Lutheran Senior Life at Jersey City

Oceanport, Beacon of LIFE

Trenton, LIFE St. Francis (Trinity)

Vineland, Inspira Health Network LIFE

New Mexico 1 Albuquerque, InnovAge New Mexico PACE
New York 9 Amherst, Fallon Health Weinberg

Bronx, CenterLight Healthcare

Buffalo, Catholic Health LIFE

New York, ArchCare Senior Life

Niagara Falls, Complete SeniorCare

North Syracuse, PACE CNY

Olean, Total Senior Care, Inc.

Rochester, ElderONE

Schenectady, Eddy SeniorCare (Trinity)

Ohio 1 Cleveland Heights, McGregor PACE
Oklahoma 3 Oklahoma City, Valir PACE

Tahlequah, Cherokee Elder Care

Tulsa, LIFE PACE

Oregon 2 Grants Pass, AllCare PACE

Portland, Providence ElderPlace PACE Oregon

Pennsylvania 19 Aliquippa, LIFE Beaver County

Bethlehem, SeniorLIFE Washongton

Butler, LIFE Butler County

Chambersburg, SpirTrust Lutheran LIFE

Danville, LIFE Geisinger

Ebensburg, SeniorLIFE Ebensburg

Erie, LIFE NWPA

Greensburg, SeniorLIFE Greensburg

Johnstown, SeniorLIFE Johnstown

Kittanning, LIFE Armstorng County

Langhorne, LIFE St. Mary (Trinity)

Philadelphia (3), InnovAge Pennsylvania LIFE, Mercy LIFE – West Philadelphia (Trinity), Mercy LIFE PA (Trinity)

Pittsburgh (2), LIFE Pittsburgh, Community LIFE

Washington, SeniorLIFE Washington

Williamsport, Albright LIFE

York, SeniorLIFE York

Rhode Island 1 Providence, PACE Organization of Rhode Island
South Carolina 3 Columbia, Prisma Health SeniorCare PACE

Greenville, Prisma Health SeniorCare PACE – Upstate

Orangeburg, Orangeburg Senior Helping Center

Tennessee 1 Chattanooga, Ascension Living Alexian PACE
Texas 3 Amarillo, The Basics at Jan Werner

El Paso, Bienvivir Senior Health Services

Lubbock, Silver Star PACE

Virginia 8 Alexandria, Cherry Blossom PACE

Big Stone Gap, Mountain Empire PACE

Cedar Bluff, AllCARE for Seniors

Charlottesville, InnovAge Virginia PACE – Blue Ridge

Lynchburg, Centra PACE

Greater Richmond, InnovAge Virginia PACE – Richmond and Peninsula

Roanoke, InnovAge Virginia PACE Roanoke Valley

Virginia Beach, Sentara PACE

Washington 3 Seattle (2), International Community Health Services, Providence ElderPlace Seattle

Tacoma, Pacific Northwest PACE Partners

Wisconsin 1 Milwaukee, Community Care

What Benefits Do PACE/LIFE Programs Provide?

PACE programs administer all of the benefits available under both Medicaid and Medicare. This includes healthcare and a wide array of long-term services and supports that can help PACE program participants remain living “in the community” instead of than living in a nursing home. Living “in the community” can mean living in one’s home, the home of a loved one or an assisted living residence, including memory care units for individuals with Alzheimer’s disease or other related dementias. While PACE will provide services in those settings in most states, it will not cover the room and board expenses in most states. PACE also administers vision and dental care for program participants.

Individuals residing in nursing homes can receive PACE benefits, but only about 10 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 a local PACE or Medicaid worker. 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. A team of medical professionals (including doctors, social workers and dieticians) will collaborate with the local PACE or Medicaid worker to create the care plan, which will outline the benefits and services PACE will administer for that individual.

PACE participants do not have co-pays or deductibles for their doctors’ appointments and other healthcare services. PACE will coordinate and cover all care and visits (including transportation) with primary care physicians (on-call 24 hours a day, seven days a week), and for the following medical specialists and inpatient services:
• Audiology and hearing aids
• Cardiology
• Dentistry and dentures
• Emergency Room visits
• Hospitalizations
• Inpatient specialist
• Optometry and eye glasses
• Podiatry, diabetic shoes, orthotics
• Rheumatology
• Women’s Services

PACE will also coordinate and manage all prescriptions and over-the-counter medications for program participants.

The following home health services, durable medical equipment and outpatient services are administered and covered by PACE:
• Caregiver education
• Diabetic testing supplies
• Hospital beds
• Lab tests
• Outpatient surgery
• Oxygen
• Radiology
• Respite care for primary caregiver
• Skilled Nursing visits
• Physical and Occupational therapy
• Walkers
• Wheelchairs

PACE administers home and personal care services, as well. This includes chore services, meal delivery, non-medical transportation and assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as cleaning, shopping, cooking, laundry and scheduling). In some cases, PACE program participants will be able to self-direct their benefits and choose a caregiver of their choice to provide some benefits, such as personal care assistance with the Activities of Daily Living. This can often be a person who is already providing that care, such as a family member, including adult children and even spouses in certain situations. Even if the PACE participant can not self-direct their care, the PACE program will provide a licensed caregiver who will learn about the participant’s wants and needs (what kind of food they like, for example) and will deliver personalized care.

PACE programs also offer adult day health centers. These provide daytime supervision (also known as adult day care) for program participants, as well as other benefits. PACE day health center workers will do regular health checks on visiting participants, and there are skilled nurses available to handle routine, or unexpected, healthcare situations. Social work/counseling services are available in most PACE day health centers, as well as physical, occupational, speech and recreational therapies.

PACE day health centers provide snacks, meals and nutritional counseling. The day centers also offer activities, exercise and opportunities for social interaction that seniors might not get otherwise.

 

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. In general, applicants need to meet the following financial criteria to be eligible for Medicaid in 2022:
• Income below $2,523 / month
• Countable assets below $2,000

For help finding one’s specific eligibility criteria, try our Medicaid Eligibility Requirements Finder tool. For more information on countable versus uncountable assets (the home is often uncountable, for example), and strategies for qualifying, click here.