FAQs about FHCSD’s Program of All-Inclusive Care for the Elderly (PACE®).
PACE provides individualized care by an interdisciplinary care team (IDT) of medical professionals. The IDT is focused on working with older adult participants to establish care goals and address specific needs so older adults can continue to live safely at home.
Q What is PACE?+
PACE (Program of All-inclusive Care for the Elderly) 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.
Q What makes PACE different from a standard health plan?+
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.
Q Why is PACE the best option?+
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.
Eligibility and Enrollment
Q Am I eligible to join PACE?+
You are eligible to join if you:
- Are 55 years or older
- Live in a designated PACE service area
- Are able to live in the community safely
- Meet the level of care requirements as determined by the California Department of Health Care Services
Q How do I enroll and what is the process?+
- 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 FamilyHealth-Center for Older Adults 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!
Q How do I appoint a representative, such as a Durable Power of Attorney (DPOA)?+
Q If I do not qualify for Medi-Cal, am I eligible to enroll in PACE?+
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.
Q If I belong to a Medicare HMO, can I also enroll in PACE for long-term care services?+
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.
Q Can I keep my own doctor?+
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.
Services and Cost
Q Which services are covered?+
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)
- Emergency services
- Home care
- Hospital care
- Laboratory/X-ray services
- 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.
Q How do I pay for PACE?+
PACE is a health plan that takes the place of Medi-Cal, Medicare or both (dual eligible) depending on eligibility status. Participants with Medi-Cal only, or are dual eligible, have no out-of-pocket costs. Participants with Medicare only may be responsible for a share-of-cost including Part D medications.
*PACE participants may be fully and personally liable for the costs of unauthorized or out-of-PACE program agreement services.
Q Is medication covered as part of PACE?+
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.
Q If I enroll in PACE, can I still receive assistance through In Home Support Services (IHSS)?+
You will have to discontinue IHSS. However, PACE provides a comparable level of service as IHSS, along with many additional benefits.
Q Is there transport to FamilyHealth-Center for Older Adults?+
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.