One variation of Managed Care plans that acts as one of Medicaid alternatives is the nationwide PACE program. The San Francisco-based On Look program that provides the housing, long term care and programming for the area’s senior population led to the development of the larger PACE program. The program aims to keep seniors who normally would require placement in a skilled nursing health care facilities a choice to stay in the wider community by providing a breadth of interdisciplinary services. By utilizing adult day care programs, PACE integrates social and medical services.
Those enrolled in PACE programs have their care overseen by a multidisciplinary team, which can include doctors, nurses, social workers, nutritionists, occupational and speech therapists, as well as health and transportation workers. For you to be able to enroll in a PACE program sometimes requires the payment of a monthly premium. For a listing of PACE programs nationwide, click here.
What It Covers: Take note that PACE enrollees recieve all health care services through PACE, including doctors’ services, hospitalization, therapies, pharmaceuticals and equipment along with:
Adult day health care.
Medical care, which is provided by a PACE doctor along with specialists
Home health care and personal care
Prescription drugs
Social services
Respite care
Hospital and nursing home care when necessary
Hospice care
Eligibility and Qualifications
Coverage is available to persons who are:
55 or older.
Certified by their state to need nursing home care
Able to live safely in the community at the time of enrollment
Living in a PACE service area
Note: Individuals interested in enrolling in the PACE program can be eligible for both Medicare or Medicaid. However, PACE enrollment’s primary qualification is one’s health status rather than age or income level.
Trends In Reimbursement
In some countries, Medicaid recipients are often required to enroll in Managed Care programs. The reasoning behind this trend is to maintain low cost of services for the provider by contracting and centralizing all medical needs. It also means consumers are not given a choice. This change is occurring on a county level for now, but as it gains popularity may become more prevalent.
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