PACE, or the Program of All-Inclusive Care for the Elderly, is a combined Medicare and Medicaid program that provides comprehensive medical and social services to older adults who qualify for nursing home care but want to continue living at home. The program bundles everything a participant needs, from primary care and prescription drugs to transportation and meals, under one coordinated team. As of December 2024, 180 PACE programs operate across 33 states and the District of Columbia.
How PACE Works
The core idea behind PACE is simple: instead of moving into a nursing home, you receive all the care you’d get there while staying in your own home. Most of that care is organized through an adult day health center, which serves as the program’s hub. You visit the center on a schedule your care team sets, and the rest of your services are delivered at home or through referrals to specialists.
What makes PACE distinct from other Medicare or Medicaid plans is its all-inclusive structure. The program receives a fixed monthly payment per participant from Medicare and Medicaid, and in return it covers every service your care team determines you need. There are no deductibles, copayments, or coinsurance for approved services. If you qualify for Medicaid, you pay no monthly premium at all. People who don’t have Medicare or Medicaid can still join PACE and pay the premium out of pocket.
Services Covered Under PACE
PACE covers a broad range of medical and social services, and the list isn’t capped. If your care team decides you need something to maintain or improve your health, the program pays for it. The standard benefits include:
- Primary care, including doctor visits and nursing services
- Hospital care and emergency services
- Prescription drugs, covering all Part D medications and any others the team approves
- Physical, occupational, and recreational therapy
- Adult day care at the PACE center
- Home care, including personal care attendants
- Dental services
- Nutritional counseling and meals
- Social work counseling
- Lab work and X-rays
- Medical specialty services
- Nursing home care when medically necessary
- Transportation to the PACE center and medical appointments
One important detail about prescriptions: if you join PACE while on Medicare, all your medications come through the PACE program. You cannot keep a separate Medicare Part D drug plan. Enrolling in a standalone drug plan will automatically disenroll you from PACE.
The Interdisciplinary Care Team
Every PACE participant is assigned a team of at least 11 professionals who coordinate all aspects of care. This team includes a primary care provider, registered nurse, social worker with a master’s degree, physical therapist, occupational therapist, recreational therapist or activity coordinator, dietitian, PACE center manager, home care coordinator, personal care attendant, and a driver. One person can fill two roles if they’re qualified, but every role must be covered.
This team meets regularly to review each participant’s care plan and adjust it as health needs change. Because the team manages everything from doctor visits to transportation, participants and their families don’t have to navigate the healthcare system on their own. The fixed monthly payment the program receives doesn’t increase when a participant’s health declines, which gives PACE organizations a financial incentive to keep people healthy and out of the hospital.
Who Qualifies for PACE
Eligibility has four requirements. You must be 55 or older, live in the service area of a PACE organization, be certified by your state Medicaid agency as needing a nursing home level of care, and be able to live safely in the community at the time you enroll. Most participants are dually eligible for both Medicare and Medicaid, though that isn’t strictly required.
The nursing home level of care determination is the key criterion. Your state’s Medicaid agency conducts this assessment regardless of whether you’re actually on Medicaid. It essentially confirms that your health needs are serious enough that you would otherwise qualify for nursing facility placement. Common qualifying conditions include advanced dementia, significant mobility limitations, and the need for daily assistance with activities like bathing, dressing, or managing medications.
How Enrollment Works
Enrolling in PACE is more involved than signing up for a typical health plan. The process includes visits in both directions: PACE staff come to your home, and you visit the PACE center at least once. During these visits, staff explain the program in detail, including any monthly premiums, how the care team operates, and one critical rule: PACE becomes your sole provider of healthcare services. You can’t keep seeing outside doctors unless the PACE team refers you. The program guarantees access to services, but not to a specific provider.
You’ll also sign a release allowing the PACE organization to obtain your medical records and verify your Medicare and Medicaid status. The PACE team then conducts its own assessment to confirm you can be cared for safely in the community. If everything checks out and you want to proceed, you sign an enrollment agreement to formalize participation.
Effectiveness at Keeping People Home
The central promise of PACE is that it keeps people out of nursing homes, and the data supports that claim. A CMS-funded evaluation found that PACE enrollees were about 52% less likely to have any nursing home stay compared to a similar group of older adults receiving traditional care. In the first six months, roughly 10% of PACE participants had a nursing home admission versus 30% in the comparison group.
PACE enrollees also had lower rates of inpatient hospitalization. The average nursing home utilization among PACE participants was just 5% of total member days, though that varied from site to site, ranging from under 2% to nearly 10%. When nursing home care is needed, PACE covers it. The program doesn’t abandon participants whose health deteriorates. It simply works to delay or prevent that transition for as long as safely possible.
Limitations Worth Knowing
PACE isn’t available everywhere. With 180 programs in 33 states, large parts of the country have no nearby PACE center. Even in states with programs, you must live within a specific service area to qualify. Rural areas are particularly underserved.
The requirement that PACE serve as your only healthcare provider is the other major trade-off. You give up the ability to see your current doctors unless they happen to be PACE-contracted providers. For some people, especially those with long-standing relationships with specialists, this is a significant adjustment. The benefit is that all your care is coordinated by a single team that knows your full medical picture, but it does mean less choice in selecting individual providers.
To find out whether a PACE program operates near you, the National PACE Association maintains a directory of all active programs by state. Your local Area Agency on Aging or state Medicaid office can also help determine whether you or a family member might qualify.