PACE FAQs

FHCSD PACE is an alternative to nursing facilities for people 55 and over that provides customized health care and social engagement to older adults to help them stay independent and in their homes. PACE participants receive most of their health care and social support at a PACE center in their community. Each person in the program has an interdisciplinary team of medical experts and a personal care plan that is focused on providing a customized experience.

PACE provides comprehensive care and services, including services not covered by Medi-Cal and Medicare as deemed medically necessary by the PACE plan. For instance, PACE not only offers medical care, but also transportation to and from appointments, meals on-site or delivered to the home, physical and occupational therapy, home care and a place for older adults to enjoy recreational activities.

As a PACE participant, you will have access to our team of health care professionals who truly understand aging. Our PACE team gets to know each participant as an individual and can help you and your family make the best health care decisions for your specific needs and goals.

• A Certified Enrollment Specialist will meet you at your home for a detailed overview of the PACE program and services, and to conduct an assessment for your program eligibility.
• A visit to our PACE center will be scheduled for you to meet the provider, nurses and staff.
• You will receive a no-cost interdisciplinary team assessment during this visit to complete a Level of Care application for the California Department of Health Care Services (DHCS).
• Upon approval from DHCS, we will finalize your enrollment paperwork, and you will become an official FHCSD PACE participant!

A representative is someone who you trust to make decisions related to your health coverage. To appoint a representative, please download and complete the form below:

• CMS 1696 Form (English)
• CMS 1696 Form (English – Large Print)
• CMS 1696 Form (Spanish)

Yes. If you meet the income and asset limits to qualify for Medi-Cal, the program pays for a portion of the monthly PACE premium. Medicare pays for the rest.

If you need assistance applying for Medi-Cal, our team of Certified Enrollment Specialists can provide guidance during the application process.

You can only enroll in one Medicare health plan at a time. PACE health plans are both Medicare providers and long-term care providers. When enrolling in a PACE health plan, you will need to disenroll from your current Medicare or HMO.

If you enroll in a PACE health plan, you are assigned an FHCSD PACE primary care provider who is part of our coordinated care team.

As a PACE participant, you agree to receive all health care services exclusively from our interdisciplinary team, which consists of a medical provider, clinic and home care nurses, social worker, physical, occupational, speech and recreational therapists, dietician, health care worker and transportation representative.

PACE provides all the care and services covered by Medicare and Medi-Cal if deemed medically necessary by your interdisciplinary care team (IDT). If your IDT decides you need medically necessary care and services that Medicare and Medi-Cal don’t cover, PACE may still cover them.

Here are some of the services PACE covers:

• Adult day center with socialization and recreational therapy
• Primary care (including doctor and nursing services)
• Dentistry
• Emergency services
• Home care
• Hospital care
• Laboratory/X-ray services
• Meals
• Medical specialty services
• Nursing home care
• Nutritional counseling
• Occupational, physical and speech therapy
• Prescription drugs
• Preventive care
• Resources such as caregiver training, support groups and respite care
• Social work and spiritual counseling
• Transportation to the PACE center for activities or medical appointments, if medically necessary. Transportation may also be available to some medical appointments in the community.

PACE is a health plan that takes the place of Medi-Cal, Medicare or both (dual eligible) depending on eligibility status.

*PACE participants may be fully and personally liable for the costs of unauthorized or out-of-program agreement services, except for emergency services.

Yes, whenever medically necessary. PACE organizations offer Medicare Part D prescription drug coverage.

If you join a PACE program, you don’t need to join a separate Medicare drug plan because you will receive your Part D-covered prescriptions and all other necessary medication from the PACE program. Your prescriptions will be delivered to your door and/or available for pick up at the PACE center.

You will have to discontinue IHSS. However, PACE provides a comparable level of service as IHSS, along with many additional benefits.

Yes, whenever medically necessary. We will provide transportation from your home to the center and back. Transportation is also provided between your home and outside appointments scheduled with our specialists, as well as recreational activities.