FAQS: PROGRAM OF ALL-INCLUSIVE CARE FOR CALIFORNIA ELDERLY
April 26, 2022
You or an elderly loved one may have heard about PACE—the Program of All-Inclusive Care for the Elderly—and you have questions about what exactly it is and which services it provides. Does it offer more than Medicare? How about Medi-Cal? Is it merely a nursing home alternative? It’s natural to have questions about something that will provide medical care and other services to you or your elderly loved one.
If you live in the Redlands, California area—or anywhere in Southern California—and want to know more about PACE or need help applying for PACE, contact The Elder & Disability Law Firm, APC. For three decades the firm has been helping the elderly plan for their long-term care and their estate planning needs.
HOW DID PACE ORIGINATE?
The PACE model of care for seniors began in the 1970s in the Chinatown-North Beach area of San Francisco when adult children of immigrants from Italy, China, and the Philippines began looking for solutions to the long-term health care needs of the elderly. When they deemed that opening a nursing home would be too expensive, they opted instead to open a daycare center for seniors.
The concept of senior daycare centers survives to this day in PACE. Seniors who enroll in PACE mostly stay in the communities where they live but can avail themselves of services in the daycare centers. Attendance at daycare centers depends on the individual and their needs. Some seniors come three days a week, others once a month.
WHAT’S THE DIFFERENCE BETWEEN PACE & MEDI-CAL?
PACE is a program functioning under federal Medicare. Medi-Cal is California’s version of the Medicaid program for low-income individuals.
Medi-Cal offers medical, dental, and other services. Most recipients must enroll in a Medi-Cal managed care plan, which will help them locate the health care and other providers they need. From the list of available doctors, you can choose your own. Medi-Cal also provides long-term services and supports such as nursing home care and home and community-based services.
PACE offers the same benefits, but the program chooses the doctor or doctors most suited to your particular needs. If you transfer from Medi-Cal to PACE, you will not be able to continue seeing your previous physician. PACE is tailored for those with multiple chronic conditions who need help in obtaining all the support and care they need while remaining in their homes as much as possible. It is more of a coordinated, interdisciplinary approach.
HOW DO I PAY FOR PACE?
If you qualify for Medi-Cal, you will have no out-of-pocket expenses. If you qualify only for Medicare, you will be required to cover the portion that Medi-Cal would otherwise pay for but Medicare won’t.
Note also that once you enter the PACE program, you will be required to exit any provider arrangements you have under Medicare or Medi-Cal. You will be assigned a whole new team of interdisciplinary providers.
WHAT HAPPENS IF A PERSON WANTS TO LEAVE PACE?
PACE participants are free to disenroll from PACE and resume their benefits in the traditional Medicare and Medi-Cal programs at any time. You are not ‘locked in’ to the PACE program.
WHO REGULATES & OVERSEES PACE?
Congress authorized PACE as a permanent Medicare provider and Medicaid state option in 1997. The PACE program is implemented through three-way program agreements among the Centers for Medicare & Medicaid Services (CMS), states, and PACE organizations themselves. CMS, in conjunction with the state, is responsible for monitoring the quality and effectiveness of PACE programs.
HOW CAN AN ATTORNEY HELP ME?
Navigating the different benefit programs available for the elderly can be a bit confusing. Finding the right solution and approach for you or a loved one is essential, and that’s where The Elder & Disability Law Firm, APC can prove invaluable. The firm will help you assess your needs or the needs of your loved one and provide you with a comprehensive overview of the options available, including PACE. An attorney can review your financial and estate planning needs in conjunction with any program you may wish to pursue to provide a clear picture of what works best for you.
If you’re in or around Redlands, California, or in nearby communities like Riverside, Palm Springs, and Rancho Cucamonga, set up a consultation today.