The PACE program in California, short for the Program of All-Inclusive Care for the Elderly, is a health care model that bundles every medical and social service an older adult needs into a single program. The goal is to help people who qualify for nursing home care stay in their own homes instead. California currently has 40 PACE organizations operating across the state, making it one of the largest PACE networks in the country.
How PACE Works
PACE operates through local centers that serve as a home base for participants. Rather than piecing together separate doctors, specialists, therapists, and social services on your own, PACE coordinates everything under one roof. Each participant is assigned a team of professionals who jointly develop a care plan and adjust it over time. That team includes a primary care provider, registered nurse, social worker, physical therapist, occupational therapist, dietitian, a recreational therapist or activity coordinator, a home care coordinator, and even a transportation driver.
This team meets regularly to review each participant’s needs. If your health changes, the plan changes with it. The model covers preventive care, primary care, acute care (like hospitalizations), and long-term services. It also covers things traditional insurance often handles separately or poorly: rides to appointments, meals, home modifications, and personal care assistance at home.
Who Qualifies
To enroll in PACE in California, you must meet four requirements:
- Age: 55 or older
- Location: Live within the service area of a PACE organization
- Level of care: Meet the state’s criteria for nursing facility care
- Safety: Be able to live safely in the community at the time of enrollment
The nursing facility care requirement is the key threshold. It means a state assessor has determined that your health conditions, cognitive status, or functional limitations are serious enough that you would otherwise need to live in a nursing home. Many participants have multiple chronic conditions, difficulty with daily activities like bathing or dressing, or early to moderate dementia. You don’t need to be bedridden. The standard is that without comprehensive support, a nursing home would be the next step.
Not every county in California has a PACE organization, so availability depends on where you live. The state’s DHCS website maintains a directory of current PACE plans and their service areas by county and zip code.
What Services Are Included
PACE is designed to be genuinely all-inclusive. The program covers primary care visits, specialist referrals, prescription medications, hospital stays, lab work, physical and occupational therapy, mental health services, dental care, and emergency care. It also covers the kinds of support that keep people out of the hospital in the first place: nutrition counseling, social activities at the PACE center, in-home personal care aides, and adult day services.
Transportation is built into the program. PACE organizations provide rides to and from the center and to medical appointments, which removes one of the biggest barriers older adults face in getting consistent care. Many participants attend the PACE center several days a week, where they receive therapy, eat meals, socialize, and see their care team. For those who can’t come to the center, services are brought to the home.
Cost and Payment Structure
If you qualify for both Medicare and Medi-Cal (California’s Medicaid program), PACE typically costs you nothing out of pocket. The program receives a fixed monthly payment from Medicare and Medi-Cal for each participant, and in return it covers all of your care. There are no deductibles or copays for covered services.
If you qualify for Medicare but not Medi-Cal, you can still enroll, but you would pay a monthly premium to cover the Medicaid portion of costs. Some participants with income slightly above Medi-Cal limits may have a “spenddown” obligation, which works similarly to a deductible. Your local PACE organization can walk you through the financial details during the intake process.
One important trade-off: when you enroll in PACE, you agree to receive all of your care through the PACE organization and its network. If you see an outside doctor or go to the emergency room without PACE approval (except in a true emergency), the program may not cover those costs. This is how PACE keeps care coordinated, but it means giving up some flexibility in choosing providers.
The Enrollment Process
Getting into PACE is more involved than signing up for a standard health plan. The intake process includes one or more visits to your home by PACE staff, plus one or more visits by you to the PACE center. During these visits, the team evaluates your medical conditions, daily functioning, cognitive health, and home environment. They also assess your care support network, meaning family members, friends, or aides already helping you, to determine whether living in the community is safe and realistic.
A state agency conducts a separate assessment to confirm you meet the nursing facility level of care requirement. You’ll also sign a release allowing the PACE organization to access your medical and financial records. The entire process is designed to make sure PACE is the right fit and that the team can safely meet your needs outside of a nursing home. Expect it to take several weeks from first contact to enrollment.
Where PACE Is Available
California has 40 PACE organizations as of mid-2025, spread across multiple counties. Some of the larger ones operate in the San Francisco Bay Area, Los Angeles, Sacramento, and San Diego regions, but smaller organizations serve communities throughout the state. Coverage is not statewide, and rural areas are less likely to have a nearby PACE center.
To find out if PACE is available where you live, the most reliable step is checking the DHCS PACE plan directory, which lists each organization’s service area by county and zip code. Your local Area Agency on Aging can also point you to PACE options in your region.