Your mother qualifies for a nursing home. Her doctor says so. The Medicaid caseworker says so. But she does not want to leave her own house, and the family does not want her to either. You have been cobbling together a patchwork of home care, adult day care, and doctor visits, and none of it talks to any of the other. You are exhausted, and you are watching money leave the account faster than you expected.
Then someone mentions PACE. You have never heard of it. You look it up, and you cannot quite believe what you are reading. Free primary care. Free specialists. Free prescriptions. Free adult day care. Free transportation. Free home care as needed. All wrapped in one program, all coordinated by one team.
This is the reaction most families have when they first encounter PACE. The next question is almost always, “Why has no one ever told me about this?”
What PACE is
PACE stands for Program of All-Inclusive Care for the Elderly. It is a federal program created by Congress in 1997, administered jointly by Medicare and Medicaid, and operated by local nonprofit or public organizations in communities across the country. The professional association is the National PACE Association, which represents operating programs and advocates for expansion.
The premise is straightforward. Many older adults qualify medically for nursing home care but would much prefer to stay in the community. Fragmented care (separate doctors, separate pharmacies, separate home aides, separate day programs) fails them. PACE replaces the fragmentation with a single organization responsible for all of their medical and long-term care. The organization is paid a fixed monthly amount per enrollee by Medicare and Medicaid, and takes full responsibility for whatever care is needed.
The Centers for Medicare and Medicaid Services regulates PACE and publishes enrollment data. Medicare.gov offers a plain-language explanation in its coverage pages.
Who qualifies
To enroll, a person must meet four criteria.
They must be at least 55 years old. This is unusual; most long-term care programs start at 65. PACE explicitly includes younger adults with serious chronic conditions.
They must live in a PACE service area. PACE programs serve defined geographic zones, usually a set of zip codes around the day center. If your parent’s home is outside the zone, they cannot enroll in that program.
They must be certified as needing a nursing-home level of care. Each state has its own assessment tool, but the general standard is whether the person needs help with multiple activities of daily living or has a cognitive impairment requiring supervision. This is the same standard used for Medicaid long-term care eligibility.
They must be able to live safely in the community with PACE services in place. If they cannot, PACE will help arrange a move to a nursing home, but ongoing community living is the program’s purpose.
Note what is not required. You do not need to be on Medicaid. You do not need to be low-income. You just need to need the level of care.
What PACE covers
The coverage is comprehensive. Within the PACE network, enrollees receive:
Primary care, usually from a PACE physician who sees them at the day center.
All specialist visits.
All prescription medications, including drugs Medicare Part D would not cover.
Hospital care when needed, including admission, surgery, and post-hospital rehabilitation.
Adult day health services at the PACE center, typically one to five days a week depending on need.
Home care aides for help with bathing, dressing, meals, and supervision.
Transportation to and from the day center, medical appointments, and sometimes social outings.
Physical, occupational, and speech therapy.
Meals, including meals at the center and often delivered meals at home.
Social work and mental health services.
Dental, vision, and hearing care.
Hospice and palliative care when the time comes.
Durable medical equipment.
Home modifications when needed to keep the person safe at home.
If a service is not on the list but the PACE team decides it is medically necessary, PACE generally covers it. If the person’s condition worsens to the point where home is no longer safe, PACE pays for nursing home placement and continues to coordinate care.
The point of this long list is to show that PACE is not an add-on benefit. It is complete coverage of medical and long-term care needs, replacing Medicare and Medicaid from the enrollee’s point of view.
What it costs
This is the part that surprises families.
For people who qualify for both Medicare and Medicaid, known as dually eligible, PACE is free. No premiums, no deductibles, no copays for covered services. The entire cost is covered by the capitated payments PACE receives from the two programs.
For people with Medicare but not Medicaid, there is a monthly premium to cover the long-term care portion that Medicaid would otherwise fund. The premium varies by program but is typically $2,000 to $4,500 per month. Still significantly less than the cost of equivalent services paid separately.
For people with neither Medicare nor Medicaid, PACE enrollment is technically possible on a private-pay basis, but it is rare and expensive. Most private-pay enrollees use PACE as a bridge to Medicaid.
Compare this to fragmented care. A home care aide at 30 hours a week costs $3,500 to $6,000 a month. Adult day care adds $1,500 to $2,500. Medications and copays add more. Transportation to appointments adds more. Families stitching together the same services pay far more and receive far less coordination. Our guide on seven ways to pay for residential care covers the broader financing landscape, and our Medicaid pays for residential care guide explains how Medicaid long-term care works outside of PACE.
The tradeoffs
PACE is not right for everyone, and the tradeoffs are real.
The biggest is the closed network. When you enroll in PACE, PACE becomes your provider. You cannot see your longtime family doctor unless that doctor is part of the PACE network. You cannot fill prescriptions at your usual pharmacy unless it is part of the network. You cannot go to any specialist you want; specialists are chosen by the PACE medical team. If you do see an outside provider without PACE approval, you may be responsible for the bill.
For families who have a trusted doctor relationship they want to preserve, this can be a dealbreaker. For families already adrift, it is usually a relief.
The second tradeoff is geography. PACE programs only operate in specific service areas. If your parent moves out of the service area, the PACE enrollment ends. Urban and near-suburban programs are most common. Rural coverage is expanding but still limited.
The third is variability. Different PACE programs have different cultures, different staff quality, and different day center facilities. As with any care program, visiting in person matters before enrolling.
Where PACE exists
As of 2026, PACE operates in 33 states plus the District of Columbia, with over 170 operating programs serving tens of thousands of participants. The program has been expanding steadily since 2010. States with significant PACE coverage include California, Pennsylvania, New York, North Carolina, Michigan, Massachusetts, and Colorado. States with no or minimal PACE include Wyoming, Utah, Idaho, Mississippi, and several others.
The National PACE Association’s program locator is the most reliable way to check whether a program serves your parent’s zip code. Do not assume, even within a covered state, that every city has PACE.
How to enroll
Enrollment works differently than Medicare Advantage or Medicaid long-term care programs.
Start with an interest call to the local PACE program. The intake staff will confirm geographic eligibility and schedule a comprehensive assessment.
The assessment is conducted by the PACE interdisciplinary team, which typically includes a physician, a nurse, a social worker, a physical therapist, and an occupational therapist. They visit the person at home and evaluate medical, functional, cognitive, and social needs.
If the assessment confirms nursing-home level of care and safe community living is possible, the state certifies eligibility. This part is paperwork and usually takes a few weeks.
Enrollment is effective the first of the following month. There is no open enrollment period; PACE enrollment happens year-round.
Disenrollment is always possible. Participants can leave PACE for any reason and return to standard Medicare and Medicaid benefits. This reversibility is an underappreciated feature, and it means that trying PACE is less risky than it might first appear.
How PACE fits with residential care
This article is on an AgeSong site, so the natural question is how PACE compares to residential care homes. The honest answer is that PACE is often what lets a family postpone residential care for years. It is a community-based alternative, not a replacement for a home-like environment when that becomes necessary.
When PACE is no longer enough (when supervision needs exceed what home care can provide, when behaviors require 24-hour staffing, when the person is consistently unsafe alone), PACE can help coordinate placement in a nursing home or, in some cases, a small board and care home. But the core of PACE is keeping people out of institutional care for as long as possible, and for many families it succeeds at exactly that.
Your next step
Go to the National PACE Association program locator and type in your parent’s zip code. If a program comes up, call them this week and ask two questions: Does my parent’s home fall inside your service area? And what does the enrollment process look like? That fifteen-minute phone call has changed the trajectory of many families. If no program comes up, call your local Area Agency on Aging to ask about similar community-based care options in your parent’s area.