Program of All-Inclusive Care for the Elderly (PACE): FAQ

The PACE model was developed to address the needs of long-term care clients, providers, and payers. Specifically, it helps low-income older adults stay at home for as long as possible before entering a nursing home. It has capitated benefits, meaning there is a fixed amount of money per patient and per unit of time.

This article outlines the Program of All‑Inclusive Care for the Elderly (PACE). Keep reading to find answers to common questions about PACE eligibility, services provided, and more. 

You can also bring your questions to an attorney near you. They can provide answers tailored to your situation and help if you or a loved one’s enrollment is denied, delayed, or limited by geography.

How Did PACE Begin?

This budget was authorized by the Balanced Budget Act of 1997 (BBA). The program features a comprehensive service delivery system and integrates with Medicare and Medicaid financing.

The PACE program was modeled on the system of acute and long-term care services developed by On Lok Senior Health Services in San Francisco, California. The model was tested through Health Care Finance Administration (HCFA) demonstration projects that began in the mid-1980s.

Who Benefits From PACE?

Typically, PACE benefits older adults facing medical issues and their informal caregivers. It also helps home health care providers and other medical staff ensure individuals get the care they need.

Most PACE participants are 70+ years old and have numerous medical conditions and special needs. Many of these are chronic conditions.

For most participants, the comprehensive service package lets them continue living at home while receiving services. This is ideal for many participants rather than being institutionalized in a nursing home or assisted living facility.

It is intended to help maintain their quality of life, continue their activities of daily living, and support their care needs in their own community. In about 5% of cases, they may be in assisted living or nursing home care facilities, which PACE pays for.

Does PACE Work With Medicare and Medicaid?

Capitated financing allows providers to deliver all the services participants need. Otherwise, they would be limited to services reimbursable under the Medicare and Medicaid fee-for-service systems. 

The BBA established the PACE model of care as a permanent entity within the Medicare program. It enables states to provide PACE services to Medicaid beneficiaries as a state option.

The state plan must include PACE as an optional Medicaid benefit. This must happen before the state and the Secretary of the Department of Health and Human Services (DHHS) can enter into program agreements with PACE providers.

Once approved, the PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees.

Is PACE Available Across the U.S.?

PACE is not available in every state, and no state offers the program statewide. As of 2026, PACE programs operate in 33 states, with access limited to specific service areas rather than full statewide coverage. Geography and lengthy enrollment processes remain major barriers for older adults seeking PACE services.

What Medical Professionals Work With PACE?

The program requires an interdisciplinary team consisting of professional and paraprofessional staff. They will need to:

• Assess participants’ needs
• Develop care plans
• Deliver all services, including acute care services and nursing facility services, when necessary

These teams and services are integrated for a seamless delivery of total care.

What Types of Care Does PACE Provide?

PACE programs provide social and medical services primarily in adult day centers and health centers. This is supplemented by in-home and referral services according to the participant’s needs.

The PACE service package must include:

• All Medicare and Medicaid-covered services
• Other necessary services set by the multidisciplinary team

How Are PACE Providers Paid?

PACE providers receive monthly Medicare and Medicaid capitation payments for each eligible enrollee.

Medicare-eligible participants, who are not eligible for Medicaid, pay monthly premiums. These are equal to the Medicaid capitation amount. They do not pay:

• Deductibles
• Coinsurance
• Other types of Medicare or Medicaid cost-sharing

PACE providers assume the full financial risk for participants’ care without limits on amount, duration, or scope of services.

What Is a PACE Organization?

A PACE organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services.

The following characteristics apply to a PACE organization. It must:

• Have a governing board that includes community representation
• Be able to provide the complete service package regardless of frequency or duration of services
• Have a physical site to provide adult daycare services
• Have a defined service area
• Have safeguards against conflict of interest
• Have demonstrated fiscal soundness
• Have a formal Participant Bill of Rights

Who Qualifies as a PACE Participant?

To be eligible for PACE, you must be:

• Age 55 or older, although typically the participants are 70+
• Meet a nursing facility level of care
• Live in the PACE service area

You may need to be certified as eligible for nursing home care by the appropriate state agency.

How Do Participants Enroll?

Enrollment in the PACE program is voluntary. If a participant meets the eligibility requirements and elects PACE, an enrollment agreement is signed.

This contains information such as:

• Participant demographic data
• Description of benefits
• Program effective date
• Explanation of policy regarding premiums, emergency care, etc.

Enrollment continues as long as desired by the PACE participant. It continues regardless of changes to health status. The program ends with:

• Death
• Voluntary disenrollment
• Involuntary disenrollment

What Services Does PACE Provide?

PACE services include all Medicare and Medicaid services.

At a minimum, there are a number of essential services that a PACE organization must provide in its PACE center, including:

• Social work/social services
• Cleaning and chore services
• Prescription drugs
• Nursing facility services
• Primary care services
• Restorative and physical therapies
• Personal care
• Supportive services for family members and caregivers
• Nutritional counseling
• Recreational therapy
• Occupational therapy
• Daily meals
• Activities and exercise
• Dental care
• Vision and hearing care, including glasses and hearing aids
• Podiatry and orthotics
• Transportation services
• Medical equipment like wheelchairs, walkers, and oxygen

Where Do Participants Receive Services?

The service delivery settings include an adult day health center, home, and inpatient facilities.

Who Is the Multidisciplinary Team at a PACE Center?

At a minimum, the multidisciplinary team is composed of a:

• Primary care physician
• Nurse
• Social worker
• Physical therapist
• Occupational therapist
• Recreational therapist or activity coordinator
• Dietitian
• PACE center supervisor
• Home care liaison
• Health workers/aids or their representatives
• Drivers or their representatives

How Does PACE Handle Reimbursement?

Under the Medicare program, the monthly capitation rate paid by HCFA to the PACE provider equals the Adjusted Per Capita Cost (AAPCC). This is calculated by HCFA for Health Maintenance Organization (HMO) reimbursement with adjustment for frailty factors. Frailty factors are adjustments Medicare makes to payment rates because PACE participants typically have multiple chronic conditions and higher care needs than the average older adult.

Under the Medicaid program, the monthly capitation rate is negotiated between the PACE provider and the State Medicaid Agency. It is specified in the contract between them. The capitation rate is fixed during the contract year regardless of changes in the participant’s health status. The rates are considered payment in full.

How Can I Find a PACE Location Near Me?

You can search participating states and areas on the National PACE Association website.

Can an Attorney Help Me With PACE?

Yes. If you are facing issues with the program or need legal advice, reach out to an elder law attorney near you. An attorney can explain eligibility, challenge incorrect determinations, and help if you or a loved one isn’t receiving the full scope of services PACE is legally required to provide.

FindLaw’s directory of elder law attorneys can get you started. Enter your city or ZIP code for a list of qualified legal professionals in your area. Because state rules are relevant, your lawyer should be licensed in your state.