PACE Programs

The Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides all of a person’s medical and long-term care through one organization, so they can keep living at home instead of moving to a nursing home. PACE is built around an adult day health center and a team of professionals who manage everything from doctor visits to home care to prescriptions. It is not available everywhere, but where it is, it can be an excellent option. This guide explains how PACE works, who can join, what it costs and what to consider.

Figures change periodically. Double-check current amounts before relying on them.

The short version

PACE serves people who are 55 or older, live in a PACE service area, are certified by the state as needing a nursing-home level of care, and can live safely in the community with PACE support when they enroll.
The PACE organization provides all Medicare- and Medicaid-covered services, plus anything else the team decides is needed, with no deductibles or copayments.
For people with Medicaid, PACE usually costs nothing in premiums (though some may owe a share of cost for long-term care, depending on the state). People with Medicare only pay a monthly premium for the long-term care portion and Part D.
Participants agree to receive services only from PACE and its network, except in emergencies.
Enrollment is voluntary, and participants can leave at any time.
PACE is available in many states, but only in specific areas served by a PACE organization.

How PACE works

PACE is defined in federal law (Social Security Act sections 1894 and 1934) and regulations (42 CFR Part 460). A PACE organization is paid a fixed monthly amount by Medicare and Medicaid for each participant and is responsible for all their care. This gives the organization a reason to keep participants healthy and at home.

The interdisciplinary team

Each participant has a team that typically includes:

a primary care doctor;
a registered nurse;
a social worker;
physical and occupational therapists;
a recreational therapist or activity coordinator;
a dietitian;
a PACE center manager;
home care coordinator and personal care aides;
drivers.

The team assesses the participant, writes a care plan, and adjusts it as needs change.

The PACE center

Most participants attend a PACE center on a regular schedule, such as two or three days a week. The center usually includes a clinic, therapy rooms, a dining area and activity space. Transportation is provided.

Services covered

PACE covers all services covered by Medicare and Medicaid, and any other service the team decides is needed, including:

primary care and specialist visits;
hospital and emergency care;
prescription drugs;
adult day care and social services;
home care, including personal care and homemaker services;
physical, occupational and speech therapy;
dental, vision and hearing care;
medical equipment and supplies;
lab tests and X-rays;
transportation;
nutritional counseling and meals at the center;
nursing home care, if needed, while remaining enrolled.

Who can join

To enroll in PACE, a person must:

be 55 or older;
live in the service area of a PACE organization;
be certified by the state as needing a nursing-home level of care;
be able to live safely in the community with PACE services at the time of enrollment.

A person does not need to have Medicare or Medicaid to join, but most participants have both. Most PACE participants are dually eligible.

Costs

Participant has	What they pay
Medicare and Medicaid	Usually no monthly premium; possible share of cost for long-term care, depending on state rules
Medicaid only	Usually no premium; possible share of cost
Medicare only	Monthly premium for the long-term care portion, plus a Part D premium
Neither	Private monthly premium

There are no deductibles or copayments for services approved by the PACE team.

Medicaid financial eligibility for PACE

For Medicaid to pay, the person must meet the state’s Long-Term Care Medicaid financial rules, generally the same as for nursing home or waiver programs: an asset limit (often $2,000 for one person), an income rule, spousal protections and, in most states, the look-back. States may treat PACE enrollees under the special income limit ($2,982 a month in many states in 2026) and the spousal impoverishment rules.

Advantages

One organization coordinates all care.
No copayments for approved services.
Regular contact with a care team that knows the participant well.
Transportation included.
Social activities and meals at the center.
A strong focus on keeping people at home.

Things to consider

Provider network. Participants must use PACE’s doctors and providers. A person who wants to keep a long-time doctor who is not in the network would need to switch.
Center attendance. The model works best for people willing to attend the center.
Availability. PACE is available only in certain areas.
Home care hours. PACE decides how much home care is provided based on the team’s assessment, which may be less than families expect.
Nursing home care. If a participant later needs a nursing home, PACE pays for it, but the participant stays enrolled and the nursing home must be in PACE’s network.

How to enroll

Find out whether a PACE organization serves your ZIP code, through the state Medicaid agency, the Area Agency on Aging, or the official Medicare website’s PACE search.
Contact the PACE organization for an intake visit.
The PACE team assesses the person and the state certifies the level of care.
Apply for Medicaid if not already enrolled (the PACE organization often helps).
Sign an enrollment agreement. Enrollment usually starts on the first day of the next month.

Leaving PACE

Participants can disenroll at any time, effective the first day of the month after the request. They then return to regular Medicare and Medicaid, including any waiver services they qualify for (subject to waiting lists).

A simple example

Vera, 76, has diabetes, heart disease and early memory loss. She lives alone in a city with a PACE program and qualifies for Medicaid. She enrolls in PACE. A van takes her to the PACE center three days a week, where she sees her doctor, gets physical therapy and has lunch with friends. An aide comes to her apartment on the other mornings to help her bathe and dress. PACE covers her medications, eyeglasses and a new walker. When she has a hospital stay, the PACE team manages her discharge and increases her home care for a few weeks.

Getting help

The PACE organization can explain its services and help with enrollment. A Certified Medicaid Planner can help with the Medicaid financial application, particularly for married couples or people with income above the limit.

Frequently asked questions

Is PACE a Medicare Advantage plan? No. It is a separate program, although it covers all Medicare services. A person cannot be in PACE and a Medicare Advantage plan at the same time.

Can PACE participants live in assisted living? Yes, in many cases, though PACE does not pay room and board.

What if I travel? PACE covers emergency care anywhere. Routine care must be arranged with the team.

Do I lose my Medicaid if I leave PACE? No. You return to regular Medicaid if you still qualify.

Key terms

PACE organization: the provider that runs a PACE program and is responsible for all of a participant’s care.
Interdisciplinary team: the group of professionals who plan and manage each participant’s care.
Service area: the ZIP codes a PACE organization serves.
Capitation: the fixed monthly payment PACE receives for each participant.

Questions to ask a PACE program

Which doctors and hospitals are in your network?
How often would I attend the center, and is transportation provided?
How many hours of home care do participants typically receive?
What happens if I need a nursing home?
How do I reach the team after hours?
How long does enrollment take?

A second example: a couple in different situations

Arthur, 80, and his wife Edna, 78, live together. Arthur has dementia and meets the nursing-home level of care; Edna is healthy. Their city has a PACE program. Arthur enrolls, and Medicaid pays for PACE after the couple applies, with Edna keeping her spousal allowances under the federal spousal impoverishment rules. Arthur attends the PACE center four days a week, which gives Edna time for herself, and the PACE team sends an aide in the mornings to help him bathe and dress. When Arthur needs a hospital stay, PACE manages the discharge and increases his home care for a few weeks. Edna keeps her own doctors and Medicare plan, because PACE enrollment is individual.

Common mistakes

Assuming PACE is available everywhere; check the ZIP code first.
Enrolling without understanding that PACE replaces a person’s current doctors and plans.
Not applying for Medicaid at the same time, which can leave the person paying a private premium.
Assuming PACE will provide unlimited home care hours.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.