All Inclusive Care For The Eldery (PACE)
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- What Do You Mean By PACE?
- How Do People Qualify For PACE?
- Are Prescription Drugs Covered?
- Are People Who Do Not Qualify For Medicaid Eligible For PACE Enrollment?
- If I Belong To A Medicare HMO, Can I Also Enroll In PACE For Long-Term Care Services?
- Can I Keep My Own Doctor?
- How Do People Get To The Day Health Center?
- Can I Just Use A Specific Service Such As Home Care, Transportation Or The Day Health Center?
- Do PACE Participants Attend The Day Health Center Every Day?
- What Happens If A PACE Participant Needs Nursing Home Care?
- If I Want To Join A PACE Plan, What Do I Do Next?
- What Happens If A Person Wants To Leave PACE?
1. What Do You Mean By PACE?
The Program of All Inclusive Care for the Elderly (PACE) creatively coordinates the care of each participant enrolled in the program based on his or her individual needs with the goal of enabling older individuals to remain living in their community.
2. How Do People Qualify For PACE?
A person qualifies if she or he:
- Is 55 years of age or older;
- Meets the requirement for skilled nursing home care as determined by the PACE organization’s interdisciplinary team assessment and certified by the California Department of Healthcare Services;
- Lives in a service area (county and zip code) served by a PACE program, and;
- Can live in the community without jeopardizing his or her health or safety.
3. Are Prescription Drugs Covered?
Yes. All prescription and non-prescription drugs deemed necessary by the PACE interdisciplinary care team are paid for by the PACE program.
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4. Are People Who Do Not Qualify For Medicaid Eligible For PACE Enrollment?
Yes. If a person meets the income and assets limits to qualify for Medicaid, the program pays for a portion of the monthly PACE premium. Medicare pays for the rest. If a person does not qualify for Medicaid, he or she is responsible for the portion of the monthly premium Medicaid would pay. PACE staff can help determine a person's Medicaid eligibility.
5. If I Belong To A Medicare HMO, Can I Also Enroll In PACE For Long-Term Care Services?
No. You can only enroll in one Medicare health plan. PACE health plans are both Medicare providers and long-term care providers. By enrolling in a PACE health plan you will be automatically disenrolled from your current Medicare/HMO.
6. Can I Keep My Own Doctor?
Not at this time. When a person enrolls in a PACE health plan, she or he is assigned a primary care physician who is part of an interdisciplinary team skilled in treating the problems of the aging. This primary care physician works with other members of the team to coordinate all services a member receives.
PACE participants agree to receive all health care services exclusively from the PACE plan’s interdisciplinary team which usually consists of a physician, clinic & home care nurses, social worker, physical, occupational, speech, and recreational therapists, healthcare worker and transportation representative.
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7. How Do People Get To The Day Health Center?
PACE programs provide transportation to the day health center. Transportation is a key part of the PACE benefit. Transportation is not only provided between the home and the day health center, but also to appointments with specialists and other activities.
8. Can I Just Use A Specific Service Such As Home Care, Meals, Transportation Or The Day Health Center?
No. Focusing on a single aspect of care does not provide the older person with the best chance of remaining independent in the community. For example, a member may need rehabilitation after a stroke, which could include a special diet or medications for hypertension, diabetes and other chronic problems. The member may also feel lonely and isolated. The PACE plan can address these problems through a team of experienced professionals and a treatment plan that deals with the complete picture.
9. Do PACE Participants Attend The Day Health Center Every Day?
No. On average, PACE participants attend the day center three times a week. Day center attendance is based on individual needs and can range from once a week, or every month, to several days a week, as needed.
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10. What Happens If A PACE Participant Needs Nursing Home Care?
The goal of PACE is to keep participants out of a nursing home as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, PACE will pay for the care and the supervision of the interdisciplinary team will continue.
11. If I Want To Join A PACE Plan, What Do I Do Next?
- Consult California PACE Plans Service Counties & Zip Codes document available on DHCS PACE website (http://www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx) to determine if PACE is available in the area in which you reside.
- Contact PACE plan so they can schedule a home visit with you and your caregiver to tell you more about their plan.
- Attend a tour of the PACE site with your family/caregiver(s).
- The PACE plan will then schedule a complete medical and social assessment for you by their interdisciplinary team.
12. What Happens If A Person Wants To Leave PACE?
A PACE participant is free to disenroll from PACE and resume their benefits in the traditional Medicare and Medicaid programs at any time.