Veterans Care: Guide to the PACE Program for Veterans

This article about the Program for All-Inclusive Care (PACE) for veterans by VA-accredited attorney Nicole Wipp is not legal advice.  It is for informational purposes only.  For advice specific to your situation, contact us today.

Navigating health care options as a veteran can feel overwhelming, especially when considering long-term care needs. One valuable resource is the PACE Program, designed to provide comprehensive care for the elderly, including veterans who may not qualify for other VA benefits.

This guide will explain PACE's offerings and services and why it might be the right choice for you or a loved one.

What is PACE?

PACE, or the Program of All-inclusive Care for the Elderly, is a Medicare program that provides medical and social services to frail 55-year-olds who wish to live in the community.

Originating in San Francisco during the 1970s, PACE was formally established as a permanent Medicare Advantage option by the Centers for Medicare and Medicaid Services (CMS) in 1997. PACE includes all Medicaid and Medicare-covered services, ensuring comprehensive support for enrollees.

PACE is not a VA benefit.  It is a government benefit that is available to all eligible citizens.

Key Features of PACE

• Customized Care: Each PACE participant receives personalized care planned by an interdisciplinary team of professionals.

• Community-Based Services: The program helps participants delay or avoid long-term nursing home care by providing services both at a community-based center and in their homes. Most services are coordinated through PACE centers, which serve as the central hub for various essential health and personal care services.

What Nursing Services Are Covered Under PACE?

PACE covers a wide range of services, including:

• Primary care and prescription drugs

• Adult day health care

• Home and personal care services

• Hospital and nursing home care when necessary

• Transportation for medical appointments

These services ensure comprehensive support for participants, allowing them to receive care in a familiar setting whenever possible.

Eligibility and Enrollment

We can help with eligibility and enrollment, especially if you've been told you don't qualify. Contact us today.

To qualify for the PACE Program, individuals must meet the following criteria:

1. Be 55 years of age or older.

2. Require a nursing home level of care.

3. Be able to live safely in the community with PACE-provided services.

4. Reside within the service area of a PACE organization.

PACE organizations are responsible for providing services, which include a range of coordinated healthcare and support services.

Participants can disenroll at any time, with assistance to return to previous Medicare or Medicaid plans if needed.

PACE Organizations

PACE organizations are non-profit entities that primarily provide health care services to PACE participants. They are responsible for delivering comprehensive services and are approved by CMS.

Each PACE program has a covered service area, and you must live in that area to access its benefits.

How PACE Helps Veterans

For veterans who do not qualify for VA monetary benefits or require less intensive care, PACE can be a suitable alternative. The program offers a community-based approach to health care, ensuring veterans receive necessary medical attention without the constraints of traditional nursing home environments.

What Does All-Inclusive Care for the Elderly Mean at PACE?

PACE programs are designed to provide all-inclusive care, encompassing all services covered by Medicare and Medicaid, plus additional services deemed necessary by a professional interdisciplinary team. The aim is to ensure holistic care that addresses medical, pharmaceutical, and psychosocial needs.

Benefits of PACE

• Comprehensive Care: PACE offers a blend of medical, pharmaceutical, and psychosocial services, primarily delivered at adult day health centers.

• End-of-Life Care: Participants receive compassionate end-of-life care, with the option to disenroll for hospice benefits if preferred.

• Cost-Effective: Medicaid-eligible enrollees pay no fees, while those with Medicare alone pay monthly premiums equal to Medicaid rates, without additional cost-sharing burdens.

Support and Resources For Veterans Within PACE

Each PACE organization offers true all-inclusive care, which means there is a wide range of support and resources to ensure participants and their families receive the help they need. This support is crucial to many veterans and their families.

These include:

• Care Coordination and Case Management: Assistance in navigating the healthcare system and accessing necessary services.

• Social Work Services: Support for social and emotional needs, helping participants cope with various life challenges.

• Transportation Services: Reliable transportation to medical appointments and other essential services.

• Home Maintenance and Repair Services: Help maintain a safe and independent living environment through home safety assessments and modifications.

• Adult Day Services: Socialization, recreational activities, and meals provided at the PACE center to enhance participants’ quality of life.

• Comprehensive Medical Services: Access to diagnostic tests, treatments, and therapies to address a wide range of health issues.

• Nursing Services: Skilled nursing care, including wound care and other specialized medical needs.

• Nursing Facility Services: Both short-term and long-term care options for participants who require more intensive support.

In addition to these services, each PACE organization also provides valuable support and resources to family members and caregivers, including:

• Respite Care Services: Temporary relief from caregiving responsibilities, allowing caregivers to rest and recharge.

• Caregiver Support Services: Education, counseling, and support to help caregivers manage their responsibilities effectively.

• Family Counseling Services: Guidance and support for family members dealing with the challenges of caregiving.

• Support Groups: Forums for family members and caregivers to share experiences and connect with others in similar situations.

By offering these comprehensive support services, PACE organizations help ensure that both participants and their caregivers receive the assistance they need to maintain a high quality of life.

Care for the Elderly

PACE centers provide a broad spectrum of services, including therapeutic recreation, socialization, and restorative therapies, all tailored to promote participants' independence and well-being.

Costs and Payment

The cost of PACE services varies depending on the participant’s eligibility and payment source. For those eligible for Medicaid, the long-term care portion of the PACE benefit does not have a monthly premium.

Participants who have Medicare but do not qualify for Medicaid will pay a monthly premium, which each PACE organization determines. Those without Medicare or Medicaid can opt to pay for PACE services privately.

A PACE organization receives a capitated payment from Medicare and Medicaid for each participant. This payment covers the cost of all services provided and is based on the participant’s level of care and the services they receive.

PACE organizations manage these funds to ensure participants receive high-quality, cost-effective care. This model allows PACE to provide a comprehensive and coordinated approach to health care, minimizing participants' out-of-pocket expenses.

Find A PACE Organization Near You

Find out if there is a center providing PACE services near you.

MICHIGAN: Click Here

SOUTH CAROLINA: Click Here

Please note that there is no PACE organization in Georgia at this time.

How to Apply For PACE Services

To apply for the PACE Program, contact the PACE organization in your area. If you're unsure about eligibility or need more information, contact VA-accredited attorney Nicole Wipp at The Veterans Law Center.

We Can Help: Contact Us Today

The PACE Program represents a vital resource for veterans and elderly individuals seeking comprehensive, community-based health care. With services tailored to individual needs, PACE helps participants maintain independence while ensuring access to essential medical and social support. If you or your loved one is exploring care options, consider the benefits of enrolling in PACE.

For more information or to see if you qualify, contact Nicole Wipp at The Veterans Law Center. Your path to comprehensive care and support begins here.