What is PACE, and where it works in Texas

Most of the ways families pay for senior care in Texas cover one slice of the problem: Medicaid pays for the nursing home, the VA helps a veteran, a waiver pays for care at home. PACE is different. It is the one program that bundles nearly everything into a single plan, and for the right person it can replace the whole patchwork. It is also the most underused option in senior care, largely because people have never heard of it.

What PACE is

PACE stands for the Program of All-Inclusive Care for the Elderly. It is a joint Medicare and Medicaid program designed for people who qualify for a nursing-home level of care but want to keep living in the community. Instead of paying separate providers for separate services, PACE gives you one care team that coordinates and covers all of it.

The model is built around a PACE center, a day center staffed with doctors, nurses, therapists, social workers, and aides. A typical enrollee visits the center a few times a week for medical care, therapy, meals, and social activity, with transportation provided both ways, and receives additional care at home as needed. The same team manages everything, which is the point: there is no hand-off between a doctor who does not talk to the home aide who does not talk to the pharmacy.

What PACE covers

PACE covers effectively all of a person's care needs, including:

• Primary care and specialist doctor visits
• Hospital and, if it ever becomes necessary, nursing-home care
• Prescription drugs
• Physical, occupational, and speech therapy
• Adult day care at the PACE center
• In-home personal care and nursing
• Meals and nutrition counseling
• Transportation to the center and to medical appointments
• Social work and family caregiver support

If the PACE care team decides a service is necessary, PACE covers it, and there are no separate deductibles or copays for enrollees. That comprehensiveness is what sets it apart from a single Medicaid waiver like STAR+PLUS, which covers long-term-care services but not the full medical picture.

Who qualifies

There are four requirements to enroll in PACE:

1. Be 55 or older.
2. Live in the service area of a PACE organization.
3. Be certified as needing a nursing-home level of care by the state.
4. Be able to live safely in the community with PACE's help at the time you enroll.

Most enrollees qualify for Medicaid, Medicare, or both, and the great majority are what is called "dual eligible," meaning they have both. You do not have to be dual eligible to join, but it changes what you pay.

What PACE costs

This is where PACE gets genuinely appealing:

• If your parent qualifies for both Medicaid and Medicare, PACE is usually free, no monthly premium, no copays, no deductibles.
• If your parent has Medicare but not Medicaid, they pay a monthly premium for the long-term-care portion of PACE plus a premium for Part D drug coverage, but still no copays or deductibles for approved services.
• If your parent has neither, they can pay privately, though this is uncommon.

For a family staring down the cost of memory care or a nursing home, a program that covers nearly everything at little or no cost for a dual-eligible parent is worth taking seriously. Compare it against what those settings cost in your area on our cost-of-care pages.

The catch: PACE is not everywhere

The single biggest limitation is geography. PACE operates only in specific service areas, generally clustered around certain cities, so whether it is an option for your family depends entirely on your parent's county. Some parts of Texas have a PACE program nearby; many do not.

The way to check is the National PACE Association's program finder, which lists the organizations and the areas they currently serve. If a program serves your parent's county, it is worth a call, because the enrollment process involves an assessment and can take a little time.

How PACE compares to the alternatives

It helps to see where PACE sits among the options:

• Against a nursing home, PACE keeps a parent living at home while still covering nursing-home care if it ever becomes necessary. For someone who qualifies for that level of care but does not want to move, it is often the better life.
• Against the STAR+PLUS waiver, PACE is more comprehensive, it wraps in all the medical care alongside the long-term services, but it exists only where there is a program, while STAR+PLUS covers the whole state. If PACE is available, weigh both.
• Against paying privately for in-home dementia care, PACE can be dramatically cheaper for a dual-eligible parent, and it adds the medical coordination that a private aide cannot. See how to pay for dementia and Alzheimer's care in Texas for the fuller comparison.

Deciding between staying home and moving into a facility is rarely only about money. If you are weighing that larger question, signs it's time for a nursing home walks through it, and nursing home vs. assisted living vs. memory care lays out the settings.

When to get help

This is information, not medical, legal, or financial advice. Enrollment in PACE runs through the PACE organization itself, and the staff there will walk you through eligibility and cost for your specific situation. Start with the program finder, then call the nearest program. And if there is a home or meaningful savings in the picture, the same advice that applies to any Medicaid route applies here: talk to a Texas elder-law attorney or a certified Medicaid planner before making transfers. To see how the costs stack up for your family, use our cost calculator.