Committed to improving the health and well-being of all people across every state.

Five States’ Progress toward Expanding Access to PACE Services

The Program of All Inclusive Care for the Elderly (PACE) was one of the first programs to deliver fully integrated care to Medicaid beneficiaries who are frail elders. The goal of PACE is to maintain members in the community as long as safely possible, and, although all members must qualify for nursing home care to join the program 95 percent of all members live in the community. PACE Organizations (POs) deliver both Medicare and Medicaid services, operate under a three-way agreement with Medicare and Medicaid, and receive capitation payments from Medicare and Medicaid. Every PACE member’s needs are assessed and managed by an interdisciplinary team which includes physicians, nurses, transportation providers, and others.

Despite the promising results produced by PACE, the National PACE Association estimated that, in 2019, over 1.2 million (67 percent) of the Medicaid beneficiaries who could benefit from PACE do not have access to PACE. The greatest barrier to access is geography. As of January 2022, 20 states did not operate PACE at all, and no state operated the program statewide. In addition, the PACE enrollment process can be cumbersome and PACE’s interplay with other programs that deliver managed long-term services and supports can be complicated. To help address these challenges, NASHP convened the NASHP State PACE Action Network (Network) by bringing together teams from five states seeking to expand access to PACE services. Although the Network only operated from May 2021 until January 2022, all five of the participating states made significant progress during that time — and continue to progress now.

  • At the time the Network ended Iowa was piloting a new PO application process with one organization that, if approved, will add three new counties to its service area.
  • In July 2021 Louisiana issued a request for information (RFI) seeking either new or existing organizations willing to serve new areas of the state. The RFI included a special focus on behavioral health to ensure that POs were ready to serve Medicaid beneficiaries with severe mental illness. The state ultimately received eight responses to the RFI and, by March 2022, had selected two organizations to develop into new POs.
  • In September 2021, Maryland issued a competitive solicitation seeking up to three new POs to serve 200 participants in three urban areas, as well as one PACE site to serve up to 100 participants in a rural area. Maryland anticipates that the selected POs will provide encounter data to the state. The state received multiple responses and, as of March 2022, had announced the selection of four new POs, including one serving a rural area.
  • As of January 2022, Massachusetts had announced its plan for expanding PACE and completed several major planning steps. Most significantly, the state had decided to invite existing POs to apply for additional zip codes and then allow for new PACE locations and alternative care sites to be built within the expanded geographical territories.
  • Over the course of the Network, Massachusetts also analyzed its enrollment process to identify changes it could make to make the process more efficient, and, by January 2022, had implemented some of the changes. The improvements will ultimately include creating a dedicated team of specialists to process PACE applications, revising policies to reduce the number of days between consumer decisions to enroll in PACE and enrollment, and revising consumer outreach and enrollment policies to ensure that those who qualify for the program can make an informed choice about enrolling in PACE.
  • Because New Jersey already had a PO selection process in place before joining the Network, this state’s goal for the Network focused on improving its enrollment process. At the end of the Network, New Jersey had identified potential improvements and was working to implement them.

Acknowledgements: The National Academy for State Health Policy (NASHP) would like to thank the members of the NASHP State PACE Action Network (Network) for their hard work and dedication to expanding access to PACE. Network members included both state officials and PACE Organization representatives from Iowa, Louisiana, Maryland, Massachusetts, and New Jersey. We also thank Peter Fitzgerald and Liz Parry, our partners at the National PACE Association, who made valuable contributions. Finally, the author wishes to thank Hemi Tewarson, Kitty Purington, and Luke Pluta-Ehlers of NASHP for their contributions to the Network and this blog. The Network and this blog was supported by The John A. Hartford Foundation, the Gary and Mary West Foundation, and the Harry and Jeanette Weinberg Foundation.

For more information about these states’ approaches to securing new POs, please see State Approaches to Expanding PACE.

Strategies to Increase Access to PACE: Findings from the NASHP State PACE Action Network

Tuesday, May 10, 2022, 2–3 p.m. ET

Search

Sign Up for Our Weekly Newsletter

* indicates required
Please enter a valid email address.
Areas of Interest