Q. Last week, I read what you wrote about Medicaid waivers and the long waiting list for them in Maryland and some other states. A friend of my mother’s, Linda, suffered a stroke last year and has a home health aide through the PACE program. I heard that this program is being expanded. How can she participate and is there a long waiting list for this program, as well? Thanks for your help!
A. The Program of All-Inclusive Care for the Elderly (PACE), funded by Medicare and Medicaid, has helped enable some older Americans, similar to your mom’s friend, to age-in-place. PACE offers community-based services and home-based services, primarily using an adult daycare model, including home care, nutritional counseling, occupational therapy , and dentistry, among others, to make aging in place a reality for many individuals.
PACE delivers medical and social services to eligible individuals, which include those 55 and above who live in an organization’s service area and meet its need requirements, who need nursing home-level care, and who can live in the community with assistance from PACE. A few key points about PACE are as follows:
- PACE includes doctors’ visits, tests, procedures, physical, occupational and speech therapy, social workers, home care, transportation, medication, dental care, and hearing aids.
- Participants typically are brought to a PACE center every day during the week, or at least several days each week, for meals and social activities, as well as therapy and health monitoring.
- The focus if PACE is to provide preventive services to enable individuals to remain safely in the community as long as possible. However, if someone enrolled in PACE needs a higher level of care, whether for a short period of time or for long-term care, PACE will cover the cost of nursing home care.
- PACE programs receive a set amount monthly from Medicare and Medicaid to provide nearly everything needed for people over 55 whose needs qualify them for a nursing home but who would rather age in place for as long as possible. That monthly payment is 15% less, on average, than Medicaid would ordinarily pay to care for what are primarily low-income seniors, the National PACE Association said.
Research has shown that PACE programs reduce hospitalization, emergency room visits, and nursing home stays. Participants survive longer than similar patients in less comprehensive programs. A study last year by the federal Department of Health and Human Services noted that the PACE program “stands out from our analysis as a consistently ‘high performer.’”
PACE is Expanding
The PACE model dates back to the early 1970s and has expanded greatly since then. The average PACE participant is 77 years old. In 1999, there were only 30 programs nationwide. In 2014, there were 106 programs, and in 2022, there are more than 140. PACE enrollment has increased from about 55,000 participants in 2020 to about 60,000 participants at the beginning of 2022.
In the past couple of years since COVID began, updated PACE services have included measures such as the expanded use of telehealth, mobile health vans, social support services, and more to serve the evolving needs of seniors.
While PACE has experienced substantial growth, there’s still plenty room for more growth. According to the National PACE Association, more than 885,000 adults who are potentially eligible for PACE and live in states where it operates lack access to a program. This represents a massive untapped pool of adults who could benefit from the services offered through PACE. As a list of current programs shows, however, 21 states have no PACE program, and 11 have just one.
On a positive note, 45 new programs are expected to begin enrollment in the next two years, in part because of higher federal incentives, according to the New York Times. Currently, some for-profit companies are also starting to establish or acquire PACE programs, although skeptics worry that for-profit status will lower quality.
Several bills introduced in Congress would remove barriers to growth, including one that would build partnerships with Veterans Affairs hospitals to make PACE more accessible to veterans. However, persuading state legislators to expand PACE enrollment or authorize new programs has proved challenging; such moves represent new expenditures, even if they eventually reduce costs. For example, in April 2021, Sen. Bob Casey of Pennsylvania, who is chairman of the U.S. Senate Special Committee on Aging, introduced the PACE Plus Act with the objective of improving access to the program. If passed, the bill would support PACE expansion through grants, enhance access to programs and their affordability for certain Medicare beneficiaries, and bring about updates regarding site approval and expansion, among other measures.
How to Enroll in PACE
To be eligible for PACE, you must:
- Be 55 or older;
- Live in the service area of a PACE organization;
- Need a nursing home-level of care (as certified by your state);
- Be able to live safely in the community with help from PACE.
The PACE enrollment process typically involves a state assessment to determine whether medical conditions, cognitive status, and functional limitations would warrant a nursing home, and it can take weeks. You can have either Medicare or Medicaid, or both, to join PACE.
There is typically not a long waiting list for PACE like there is for Medicaid in-home care waivers, but it depends on the specific PACE center. Also, agreeing to receive all health care from PACE often means relinquishing one’s individual doctor, and some patients dislike that idea.
What You Pay for PACE Depends on Your Financial Situation
- If you qualify for Medicare, all Medicare-covered services are paid for by Medicare.
- If you qualify for Medicaid, you will either have a small monthly payment, or no payment at all for the long-term care portion of the PACE benefit, depending upon your monthly income.
- If you don’t qualify for Medicaid, you are required to pay a monthly premium to cover the long-term care portion of the PACE benefit, and a premium for Medicare Part D prescriptions;
- There’s no deductible or copayment for any drug, service, or care approved by the PACE team;
- If you don’t have Medicare or Medicaid, you can pay for PACE privately.
To find out if you’re eligible and if there’s a PACE program near you, you can search for PACE plans in your area through the National PACE Association.
Planning for Long-term Care
Do you have a loved one who is nearing the need for nursing home level care, and might possibly be interested in the benefits of PACE? When it comes to planning for long-term care, Medicaid Asset Protection Planning can be started while your loved one is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if your loved one is already in a nursing home or receiving some other type of long-term care. In fact, a large percentage of our Lifecare Planning and Medicaid Asset Protection Planning clients come to us when nursing home care is already in place or is imminent.
Generally, the earlier someone plans for long-term care needs, the better. But, fortunately, it is never too late to begin your planning. To afford the catastrophic costs of long-term care without depleting all of your loved one’s hard-earned assets, your aunt should begin her Long-Term Care Planning as soon as possible. You should also do Incapacity Planning and Estate Planning, if you haven’t done so already. Please call us to make an appointment for an initial consultation:
Elder Law Rockville: 301-519-8041
Elder Law Fairfax: 703-691-1888
Elder Law Fredericksburg: 540-479-1435
Elder Law DC: 202-587-2797
Print This Page
About Evan H Farr, CELA, CAP
