PACE, which stands for Program of All-Inclusive Care for the Elderly, is a federal program that combines Medicare and Medicaid funding to provide comprehensive medical and social services to older adults who qualify for nursing home care but want to keep living at home. As of December 2025, 198 PACE programs operate across 33 states and the District of Columbia, serving roughly 90,580 participants.
The core idea is simple: instead of moving into a nursing home, you receive all the care you need through a single program that coordinates everything, from doctor visits and prescriptions to meals, physical therapy, and rides to appointments.
Who Qualifies for PACE
To enroll in PACE, you need to meet four criteria. You must be 55 or older, live in the service area of a PACE organization, be certified by your state as needing a nursing home level of care, and be able to live safely in the community at the time you join. That third requirement is the key gatekeeping factor. Your state determines whether your physical or cognitive needs are serious enough that you would otherwise qualify for placement in a nursing facility. This typically means you need significant help with daily activities like bathing, dressing, managing medications, or getting around safely.
Most PACE participants are dually eligible for both Medicare and Medicaid. However, you don’t have to be on Medicaid to join. People who have only Medicare, or who don’t qualify for either program, can enroll and pay a monthly premium to cover the Medicaid portion of services. The exact cost varies by program and location.
What Services PACE Covers
PACE is designed to be genuinely all-inclusive. The program covers primary care, hospital stays, emergency services, prescription drugs, lab work and imaging, dental care, mental health counseling, and nursing home care if it becomes necessary. It also covers occupational therapy, physical therapy, speech therapy, nutritional counseling, personal care and support services, and preventive care.
Beyond medical needs, PACE provides adult day care at a dedicated center where participants get meals tailored to their dietary needs, recreational activities, and social interaction. Transportation to and from the PACE center, medical appointments, and specialty visits is included at no additional cost. For participants who qualify for both Medicare and Medicaid, all of these services come with no premiums, copays, or deductibles.
Prescription drug coverage is built into the program. You do not need a separate Medicare Part D plan when you’re enrolled in PACE, because the program handles all of your medications directly.
How the Care Team Works
What makes PACE structurally different from piecing together services on your own is the interdisciplinary team. Federal regulations require every PACE program to assemble a team with at least 11 roles: 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.
This team meets regularly to develop and update a care plan for each participant. If your health changes, your physical therapist, doctor, and home care coordinator are already in communication rather than operating in separate systems. The PACE center itself functions as the hub where most of this care happens, though the program also coordinates services at hospitals, specialist offices, and in your home.
The Day Center Experience
Most PACE participants spend several days a week at their local PACE center. A typical day includes primary care visits if needed, therapy sessions, meals, and group activities designed to keep participants physically and socially engaged. The center is not a nursing home. You go during the day and return home, with the program providing transportation in both directions.
For many participants, the social component matters as much as the medical care. Isolation is a serious health risk for older adults, and the day center model addresses it directly by building regular social contact into the care structure.
Health Outcomes Compared to Nursing Homes
A study from the U.S. Department of Health and Human Services tracking outcomes from 2006 to 2011 found that PACE enrollees lived significantly longer than a matched comparison group of nursing home residents and home-based care recipients. One year after enrollment, about 9 percent of PACE participants had died compared to nearly 22 percent in the comparison group. At the three-year mark, mortality rates were around 29 percent for PACE enrollees versus 44 percent for their counterparts. Even five years out, PACE participants had a measurable survival advantage, with 43 percent deceased compared to 51 percent in the comparison group.
These differences held across the entire follow-up period, with the gap in mortality ranging from 8 to nearly 17 percentage points during each six-month interval after the first year. PACE enrollees also had significantly fewer long-term nursing home stays.
Tradeoffs to Consider
PACE requires you to use the program’s own doctors and providers for virtually all of your care. If you have a longtime physician you want to keep, you’ll likely need to switch. Emergency and urgent care are covered, but routine services outside the PACE network generally are not unless the program authorizes them. This is the most common reason people who are otherwise eligible choose not to enroll.
Geographic availability is another limitation. With 198 programs in 33 states, large portions of the country have no PACE organization nearby, and you must live within a program’s designated service area to qualify. Rural areas are particularly underserved. You can check whether a PACE program operates near you through the National PACE Association or your state Medicaid office.
For people who do live in a service area and are comfortable receiving care within the PACE network, the program offers a rare combination: coordinated medical care, social support, prescription coverage, transportation, and home-based services all managed under one roof, with the explicit goal of keeping you out of a nursing home for as long as safely possible.