PACE stands for the Program of All-Inclusive Care for the Elderly, a Medicare and Medicaid program that bundles every medical and social service a frail older adult needs into one coordinated package. The goal is straightforward: help people who qualify for nursing home care stay in their own homes instead. As of April 2025, about 83,500 people are enrolled in PACE across 33 states and the District of Columbia, served by 190 PACE organizations.
How PACE Works
PACE operates through local organizations that function as a one-stop shop for healthcare. Each participant is assigned an interdisciplinary team that manages every aspect of their care. Federal regulations require this team to include, at minimum, a primary care provider, registered nurse, social worker with a master’s degree, physical therapist, occupational therapist, recreational therapist or activity coordinator, dietitian, center manager, home care coordinator, personal care attendant, and a driver.
The centerpiece of daily life in PACE is the adult day center. Participants visit the center for primary care appointments, therapy sessions, meals tailored to dietary needs, and social activities. When they need something the center can’t provide, like hospital care or specialty appointments, the PACE team arranges and covers it. Transportation to and from the center and all medical appointments is included.
What makes PACE unusual is the scope of authority the care team has. They can approve any service they determine a participant needs, even if it isn’t specifically listed as a Medicare or Medicaid benefit. That flexibility lets the team address small problems (a grab bar in the bathroom, a change in diet) before they become hospitalizations.
Who Qualifies for PACE
Four criteria determine eligibility:
- Age: You must be 55 or older.
- Location: You must live within the service area of a PACE organization.
- Level of care: Your state must certify that you need a nursing home level of care.
- Community safety: You must be able to live safely in the community at the time of enrollment, with the support PACE provides.
That third requirement is the key filter. “Nursing home level of care” typically means you need help with several daily activities like bathing, dressing, or managing medications, or you have chronic conditions that require regular monitoring. Each state sets its own specific threshold. If your state determines that your health or safety would be jeopardized by living in the community even with PACE support, the organization must deny enrollment.
Most PACE participants are dually eligible for both Medicare and Medicaid. You don’t need to have both to enroll, but your costs change significantly depending on your coverage.
What PACE Covers
PACE covers everything Medicare and Medicaid cover, plus anything else the care team decides you need. The service list is extensive:
- Primary and specialty medical care
- Prescription drugs
- Hospital and emergency services
- Nursing home care (when medically necessary)
- Physical, occupational, and speech therapy
- Dental care
- Mental health counseling
- Home care and personal care services
- Nutritional counseling and meals
- Lab work and x-rays
- Preventive care
- Transportation
This is more comprehensive than most insurance plans. Dental care, for instance, is not covered by standard Medicare but is included in PACE. The same goes for transportation, which removes one of the biggest barriers older adults face in getting to appointments.
What It Costs
If you qualify for both Medicare and Medicaid, you typically pay nothing out of pocket for PACE services. Medicare and Medicaid jointly fund the program through monthly payments to the PACE organization, which then takes on financial responsibility for all of your care.
If you have Medicare but not Medicaid, you’ll pay a monthly premium to cover the Medicaid portion of services. This premium varies by organization and location. If you have Medicaid but not Medicare, you may owe nothing or a small amount depending on your state. One important trade-off: when you enroll in PACE, you agree to receive all your care through the PACE organization and its network. You can’t use outside providers except in emergencies unless the PACE team authorizes it.
Health Outcomes for Participants
The evidence suggests PACE keeps people out of hospitals at rates that are remarkable given how sick participants tend to be. A study published in the Journal of the American Geriatrics Society found that PACE participants used about the same number of hospital bed-days per year as the general Medicare population (2,046 per 1,000 participants versus 2,014 for standard Medicare). That’s notable because PACE enrollees are significantly sicker and more disabled than average Medicare beneficiaries. The median time before a participant’s first hospitalization was over two years.
End-of-life care patterns also stand out. Only 8% of PACE participant deaths occurred in acute hospitals, and fewer than one-third of those who died spent any time in a hospital during their final six months. For a population that qualifies for nursing home placement, these numbers reflect a care model that largely delivers on its promise of keeping people in the community.
Reasons You Could Lose Enrollment
PACE organizations can involuntarily disenroll participants only under specific circumstances. Moving out of the service area for more than 30 consecutive days is one. Failing to pay required premiums after a 30-day grace period is another. Behavior that threatens your own safety or the safety of others can also lead to disenrollment, though simply being noncompliant with medical advice is not grounds for removal unless it creates a safety risk.
You can also lose eligibility if your state reassesses you and determines you no longer meet nursing home level of care requirements. And if the PACE organization itself loses its license or its agreement with CMS, all participants would need to transition to other coverage.
On your end, disenrollment is voluntary at any time. You can leave PACE and return to traditional Medicare and Medicaid coverage.
How to Find a PACE Program Near You
PACE is currently available in 33 states and the District of Columbia, but coverage is not uniform. Programs are clustered in urban and suburban areas, and many rural regions have no PACE organization nearby. The service area requirement means you need a local program to participate.
To check availability, you can search by zip code on Medicare.gov or contact your state Medicaid office. If a program operates in your area, the enrollment process generally involves an in-person assessment where the PACE team evaluates your health, daily functioning, and care needs. Your state must also formally certify that you meet nursing home level of care. Once approved, you can begin attending the day center and receiving services relatively quickly, though exact timelines vary by organization.