PACE stands for Program of All-Inclusive Care for the Elderly, 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. Rather than moving into a facility, PACE participants receive all their healthcare and support services through a single organization, typically centered around an adult day center in their community.
How PACE Works
The core idea behind PACE is simple: bundle every service a frail older adult might need into one coordinated program, and keep them out of a nursing home in the process. A PACE organization becomes your sole healthcare provider. Instead of juggling separate doctors, specialists, pharmacies, and home care agencies, everything runs through one team that knows you personally.
Most PACE participants spend part of their week at a PACE center, which functions as a combination of adult day program and outpatient clinic. There, you can see your primary care provider, get physical therapy, eat meals, socialize, and receive other services all under one roof. On days you’re not at the center, PACE coordinates whatever you need at home, whether that’s a home health aide, meal delivery, or medical equipment. Transportation to and from the center is included.
What makes PACE distinct from other Medicare or Medicaid programs is the interdisciplinary team. Eight professionals are assigned to each participant: a primary care provider, registered nurse, social worker with a master’s degree, dietitian, physical therapist, occupational therapist, recreational therapist or activities coordinator, and a home care coordinator. This team conducts a thorough in-person assessment shortly after you enroll and then builds a personalized care plan. They meet regularly to adjust that plan as your needs change.
Who Qualifies for PACE
To enroll in PACE, you must meet four conditions:
- Age: 55 or older
- Location: Live in the service area of a PACE organization
- Level of care: Certified by your state as needing nursing home-level care
- Safety: Able to live safely in the community with support from PACE
That third requirement is the key qualifier. Your state’s aging services agency evaluates whether your health and functional needs are serious enough that you would otherwise qualify for a nursing home stay. This typically means significant difficulty with daily activities like bathing, dressing, managing medications, or getting around safely. You don’t need to be bedridden or have dementia, but you do need to have care needs that go beyond what a healthy older adult requires.
Most PACE participants are dually eligible for both Medicare and Medicaid. If you qualify for both, you typically pay nothing out of pocket for PACE services. If you have Medicare but not Medicaid, you can still enroll, but you’ll pay a monthly premium to cover the services Medicaid would otherwise fund. Some participants also have Medicaid spenddown obligations, meaning they contribute a portion of their income toward costs before Medicaid kicks in.
What Services Are Covered
PACE covers everything Medicare and Medicaid cover, and then some. The program wraps primary care, specialist visits, hospital stays, prescription drugs, nursing home care (when temporarily needed), home health aides, personal care, physical and occupational therapy, nutritional counseling, social services, meals, and transportation into a single package. If the interdisciplinary team determines you need a service, PACE covers it, even if it wouldn’t normally be covered by Medicare or Medicaid on its own.
This flexibility is one of the program’s biggest advantages. If the team decides you need grab bars installed in your bathroom, or a wheelchair ramp at your front door, or daily check-in calls, they can authorize it. The program is designed to be proactive rather than reactive, addressing small problems before they turn into emergency room visits.
The Enrollment Process
Enrolling in PACE is more involved than signing up for a typical health plan. The intake process includes one or more visits to your home by PACE staff and at least one visit to the PACE center. During these visits, staff explain how the program works, including a critical detail many people find surprising: PACE becomes your only healthcare provider. You cannot keep your current doctors unless they have a contract with the PACE organization. This is a dealbreaker for some people, but it’s how the program maintains coordination.
Staff will walk you through the enrollment agreement, your premium obligations (if any), and the list of providers on the PACE team. You’ll sign a release allowing the organization to access your medical and financial records. The state then conducts its own assessment to confirm you meet the nursing home level of care requirement. Once enrolled, your interdisciplinary team performs a comprehensive in-person assessment and develops your care plan.
How Well PACE Performs
The program’s track record at keeping people out of nursing homes is striking. Despite every participant being certified as needing nursing home-level care, only about 5% of PACE enrollees actually reside in a nursing home at any given time. The rest are living in the community with support.
PACE participants also tend to spend less time in hospitals. Hospitalization rates run about 24% lower than those of similarly eligible Medicaid beneficiaries receiving nursing home services. Rehospitalization rates tell a similar story: PACE’s 30-day all-cause readmission rate sits around 19.1%, compared to 22.9% for dual-eligible enrollees age 65 and over nationally. That 16% reduction in rehospitalizations reflects the advantage of having a dedicated team monitoring your health daily and catching problems early.
Limitations Worth Knowing
PACE isn’t available everywhere. The program operates through individual PACE organizations, each serving a defined geographic area. Many regions of the country, particularly rural areas, don’t have a PACE organization nearby. You can check whether one operates in your area through your state Medicaid office or the Medicare plan finder.
The requirement to give up your existing doctors is the most common barrier for people who otherwise qualify. If you have a long-standing relationship with a specialist or primary care physician, switching entirely to the PACE team can feel like a significant trade-off. For some, the comprehensive coordination is worth it. For others, especially those who are managing well with their current providers, it’s not the right fit.
PACE also isn’t designed for people who need full-time institutional care right now. The program’s entire model depends on participants being able to live safely in the community with support. If someone’s needs are too complex or their home environment too unsafe for community-based care, they won’t be enrolled.
PACE vs. Other Long-Term Care Options
Compared to traditional Medicaid home and community-based services, PACE offers significantly more coordination but less flexibility in choosing providers. Medicaid waiver programs let you pick from a broader network of home health agencies and doctors, but you’re responsible for managing those relationships yourself, and gaps in communication between providers are common.
Compared to nursing home placement, PACE is both less expensive for the healthcare system and strongly preferred by most participants. The ability to sleep in your own home, maintain your routine, and spend time at a day center with social activities offers a quality of life that institutional care rarely matches. For families, PACE can relieve much of the caregiving burden while keeping their loved one close to home rather than in a facility.