Program for All-Inclusive Care for the Elderly (PACE) is a nationwide model of care designed to help elders stay living in the community (instead of in nursing homes) as long as possible.
A team of health professionals assesses each elder’s needs and develops a plan of total care. Services are in the elder’s home, adult day health center or an assisted living facility.
The PACE program is for elders who are 55 or older (individuals under 65 must meet the Social Security disability definition), live in a PACE service area, are able to live safely in the community (with assistance through PACE), are certified by the state as eligible for nursing home care, and agree to receive health services exclusively through the PACE.
What is the difference between PACE and Elder Service Plan?
Elder Service Plans are part of the PACE program.
What are the income and asset rules for PACE?
If an elder has gross monthly income of $2,205 or less in 2017, there is no monthly spenddown and he or she gets to keep all of their income. In contrast, if the elder’s gross monthly income in 2017 is over $2,205, there is a monthly spenddown to $542. In other words, if the elder’s income exceeds the threshold of 300% of the federal Supplemental Security Income (SSI) benefit ($2,205 in 2017), he or she gets to keep only $542.
For PACE, the asset limit for an unmarried elder is $2,000 or less of countable assets. There is a long list of noncountable assets. Most notable, the home is noncountable as long as the equity value does not exceed $840,000 (2017). However, an advantage of the PACE program is that the assets belonging to the healthy spouse will not count toward the asset limit. Under MassHealth regulations, transfers between spouses do not affect eligibility. As a result, a commonly-used strategy for an unhealthy married elder is to transfer assets to his or her healthy spouse and thereby qualify for the PACE program.
What is the private pay rate for PACE?
The 2014 monthly private pay rate for the PACE program is $3,933.
Does PACE help pay for Assisted Living?
Some Elder Service Plans contract with assisted living facilities. For example, Harbor Health Elder Service Plan contracts with the Arbors in Stoughton, MA. Typically, a large portion of the expense of assisted living care is the home-care component. PACE pays for the home-care component at some of the assisted living facilities with which the Elder Service Plans have contracts.
Can you keep your doctor and specialist when enrolled in PACE?
No, a PACE physician will coordinate your care. With regard to Harbor Health Elder Service Plan, they contract with specialists and specialists who do not contract with PACE are considered on a case-by-case basis.
Where is the closest PACE program?
Harbor Health Elder Service Plan (Brockton and Mattapan locations) services the following communities: Avon, Boston, Braintree, Bridgewater, Brockton, Brookline, Canton, Dedham, Easton, East Bridgewater, Foxboro, Halifax, Hanson, Hanover, Holbrook, Mansfield, Milton, Norton, Norwood, Newton, Pembroke, Plympton, Quincy, Randolph, Raynham, Rockland, Sharon, Stoughton, Taunton, West Bridgewater, Weymouth, and Whitman.
Nothing in this Q&A should be considered legal advice as this is a complicated area of the law.