What’s What in Medicaid Planning: Program of All Inclusive Care for the Elderly (PACE)

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You’re researching Florida Medicaid and now you are inundated with terms for terms within terms, right?

One of the most important facts you need to know when it comes to Medicaid policies, procedures, terms, and requirements, is that all are subject to change and can be intensive. In your research of Florida Medicaid, one term you may come upon is “PACE waiver” or Program for All Inclusive Care for the Elderly in combination with Statewide Medicaid Managed Care Long Term Care Program (SMMC LTC).

What is the PACE “waiver”?

The Program of All Inclusive Care for the Elderly provides Home and Community Based Services (HCBS) for individuals who may otherwise qualify for Medicaid nursing home placement and would prefer to remain independent, in their own homes. The program provides recipients with a wide-ranging assortment of home and community-based services at a cost less than nursing home care.

Individuals who qualify for PACE have both their medical and long-term care needs managed through a single provider. In addition to services covered under Medicaid, the PACE project includes all services covered by Medicare. To be eligible for PACE, an individual must:

  • Be 55 years of age or older
  • Live within the defined service area of the PACE Center
  • Meet medical eligibility requirements as determined by CARES
  • Be able to live safely in the community
  • Be dually eligible for Medicaid and Medicare, or Medicaid only. There is also a private pay option with PACE, however this is not regulated by the State.

What you need to be prepared for with PACE: all HCBS waivers are now proficed under the Statewide Medicaid Managed Care, Long Term Care (SMMC-LTC) Waiver. Funding is LIMITED and is needs based.

Therefore, there may be a waiting list, which you may be on for an undefined amount of time.  Medicaid planning strategies are tailored to each Medicaid applicant based on their income and assets, but ALSO a good strategy is based on being informed about local benefits available to Medicaid applicants.

As always, consult with a knowledgeable Florida Bar licensed attorney who specializes in Elder Law.

*This information is provided only to inform and is not legal advice. For your specific situation, please contact an experienced elder law attorney in your area.

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