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Program for All–Inclusive Care for the Elderly (PACE)
The Program for All–Inclusive Care for the Elderly is a federally and state funded program that works towards helping the elderly live independently in the community. The goal is to keep them out of long term care for as long as possible. PACE coordinates all–inclusive medical and social services that meet the particular needs of eligible seniors who have remained in the community, but would otherwise need to be in long term care. PACE provides in–home care services in addition to transportation to adult day health care centers where participants can receive medical care, rehabilitative therapies, and social services.
There are PACE providers located in San Francisco (serving Alameda, San Francisco and Santa Clara Counties), Sacramento (serving Sacramento County), Oakland (serving Alameda and Contra Costa Counties), Los Angeles (serving Los Angeles County), and San Diego (serving San Diego County).
In order to be eligible for PACE, the applicant must be at least 55 years old and able to live in the community safely, meeting the level of care requirements determined by the California Department of Health Care Services. The level of care requirements are identical to those needed for skilled nursing care. The applicant must also live in a service area served by the PACE program. (Go to www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx to view zip codes that are in service areas).
PACE is paid for by Medi–Cal and Medicare. Therefore, if an applicant has Medi–Cal, he/she is automatically eligible for PACE, paying the Share of Cost, if any, that is determined by Medi–Cal. If applicants have Medicare but no Medi–Cal, they can pay for the Medi–Cal portion of the fee privately.
If one spouse needs PACE services and the other spouse does not, it is important to note that the Medi–Cal spousal impoverishment provisions apply, which means that the non–PACE spouse can retain additional assets and income. PACE providers are paid by Medi–Cal like a managed care plan in which a set amount is paid per person whether services are used or not. Thus, there can be a substantial estate recovery claim after a Medi–Cal beneficiary dies. Consumers should take a look at CANHR’s FAQs on Medi–Cal estate recovery for planning options.
Participants of PACE are evaluated and comprehensive health care plans are developed according to individual needs. The following are among the services provided:
An interdisciplinary team evaluates the participant and develops a treatment plan involving as many of the above services as possible. Participants cannot pick and choose which services they want to make use of. It is an all–inclusive program addressing various issues that seniors face in their daily lives concerning their health, brain function, social stimulation, and general quality of life. Every aspect works toward the ultimate goal of keeping more seniors living independently in the community.
The "Interdisciplinary Team"
The PACE "interdisciplinary team" usually consists of:
All health care services received by the PACE participant are received exclusively by this team. If the participant needs to be admitted to a hospital or a nursing home, the interdisciplinary team will continue to supervise the treatment and care of the participant.
*PACE can contract with mental health specialists to provide mental health services.
Important: You have to use the PACE healthcare providers. You cannot keep your own doctor.
PACE and RCFEs
If you are a resident in a Residential Care Facility for the Elderly, you can simultaneously be a participant in PACE. While PACE will not cover the costs of your room and board in the RCFE, it will pay for medical costs. It is a good option for those who are happy living in an RCFE (don’t want to move to an SNF) but need additional care and have high medical bills. Since RCFEs do not accept Medi–Cal, PACE can help ease the financial burden of residing in one by absorbing the resident’s medical costs.
How to Apply
California PACE providers
Page Last Modified: February 25, 2013