This benefit, authorized by the Balanced Budget Act of 1997, features a comprehensive service delivery system and integrated Medicare and Medicaid financing for frail, elderly individuals who meet Long-Term Care level of care criteria.

For most PACE participants (enrollees), the comprehensive service package permits them to continue living at home while receiving services rather than being institutionalized.

Participants must meet the following criteria:

≤ Medically qualified (must meet Medicaid’s LTC eligibility criteria).

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≤ Must be at least 55 years of age or older.

≤ Must live within the approved geographic area of the PACE organization.

≤ Must be able to live safely in the community (not residing in a nursing facility) at the time of enrollment.

≤ Must not be concurrently enrolled in the Medicaid MIChoice waiver.

≤ Must not be concurrently enrolled in a Health Maintenance Organization (HMO).

The PACE organization receives referrals from providers in the community who believe a person meets Medicaid eligibility and LTC eligibility criteria.

The PACE organization will assist a person in applying for Medicaid and with initial asset and income assessments and will also help the person obtain required information and verification.

The PACE organization is responsible for performing the medical/functional assessment that determines if a person meets the Medicaid LTC criteria.

An interdisciplinary team consisting of professional and paraprofessional staff assesses the participant’s needs, develops care plans, and delivers all services, including acute care services, hospital services and, if necessary, nursing facility services.

PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant’s needs.

The PACE service package must include all Medicare- and Medicaid-covered services, and other services as determined necessary by the interdisciplinary team.