The PACE model is a gold standard of all-inclusive care for seniors as it takes into account more than just their medical needs. The PACE program centers on providing its participants with community-based support, opportunities for social engagement, and a better quality of life. The widespread acceptance of this model has led to lowered rates of emergency room visits, unnecessary hospital admissions, and reduced cost of care for family members. At Gary and Mary West PACE, we strive to provide integrated and comprehensive medical support to seniors with chronic care needs. With a focus on enabling independent and healthy living, our dedicated team of professionals is here to help you receive the best medical resources based on your needs and preferences.
PACE Qualification and Eligibility
To join the Gary and Mary West PACE program, you must meet a set of qualification requirements and criteria. If you have more questions on your mind or inquiries regarding the eligibility criteria, call us today
. To qualify, you must:
- Be at least 55 years of age
- Live in the service area of Gary and Mary West PACE
- Meet California state requirements for nursing home level of care
- Be able to live safely in the community with the help of PACE services
What Does PACE Cost & What Are the Income Limits?
To enroll in PACE, individuals must meet specific medical and financial requirements. Many participants join PACE at low or no cost. What you pay for PACE depends on your financial situation and whether you qualify and meet the income limits for MediCal, MediCare or both.
- Medical: No cost for all covered services
- MediCal and MediCare: No cost for all covered services
- MediCare Only: Pay the MediCal portion, plus a monthly premium for MediCare Part D Prescriptions
- Neither MediCal nor MediCare: Self pay for all covered services
At PACE, there is never a deductible or co-payment for any drug, service or care approved by our team. Your ability to pay will never keep you from getting the care you need. All services including medical care are provided by the program.
Nursing Home Level of Care Requirements
As mentioned above, to qualify for PACE, participants must meet California state requirements for Nursing Home Level of Care (NHLOC) — a designation commonly used to determine if someone is eligible for Medicaid-funded nursing home care. In California, NHLOC is determined by taking into consideration the level of care required by Medi-cal beneficiaries who do not require the full range of healthcare services provided in a hospital, but require the continuous availability of skilled nursing care provided by registered nurses. Skilled nursing care comprises necessary observation, assessment, judgement, supervision, and documentation of the patient. If a person is unable to care for themselves, meaning, if a lack of assistance would result in them being prone to mishaps, they would likely meet the requirement for nursing home level of care. However, a requirement for one or more skilled nursing procedures does not necessarily indicate a medical need for NHLOC. Rather, the need must be for a level of service which includes the continuous availability of certain tasks and procedures — typically those that provide relief from conditions that hinder the individual’s ability to care for themselves. These include, but aren’t limited to:
- Medical: Frequent requirement of assistance with ventilators, IV drips, administration of intravenous and intramuscular injections; gastronomy feedings; application of dressings involving prescribed medications; skin disorders, and heat treatments.
- Cognitive: Memory problems resulting from Alzheimer’s / dementia, or any age-related cognitive decline.
- Behavioral: Inability to control actions, moods, and overall behavior due to underlying cognitive / mental health conditions.
- Functional: Inability to manage activities of daily living (ADLs). This includes daily activities such as dressing, personal sanitary care, eating and meal preparation.
Each state uses different processes to determine whether or not an individual qualifies for nursing home level of care. Most states require that the individual must receive a doctor’s diagnosis to accurately assess the severity of their medical irregularities. Along with that, the individual must also be observed by occupational, behavioral and physical therapists to determine the types of assistance required. In California, seniors who have medical conditions that hinder their ability to self-administer medication and food; require help with ADLs, require round the clock skilled nursing monitoring, and/or require mental health care, typically qualify for nursing home level of care.
Contact Us to Know More
To know more about qualifying for PACE and to discuss your eligibility options, simply fill out the form below and we will be in touch with you shortly.