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Imo a lot is going to depend on just what non-profit runs your specific PACE Center and also how much non-PACE in your home support time you have realistically. PACe will be maybe 2-4 days a week so your family will be responsible for caregiving the rest of the time. As you are still living in the community, you likely will have your monthly income to be able to private pay for inhome caregivers. PACE may be able to have a weekend aide stop by for a quick check in but realize PACE is really about 6 hr day time program at a fixed location. The PACE by us does transportation to/from fixed sites & it works as majority of the folks going to the PACE center all live in CC run IL & AL low income apartments (aka HUD 202 supportive housing) .

We have one by us, the Benson Center and it along with another, is run by a division of Catholic Charities. It’s a really great program in a wonderful redone facility. This arm of CC also manages health care institutions and hospice. They are pros at dealing with the mice maze that is Medicaid and Medicare. Most PACE seem to require participants to be “duals” that is on MediCARE and on community based Medicaid (more on this to follow). The reason why is that the billing for PACE services are set up to come from both…. for example flu shots, the injection itself is provided by Medicare and the pharmacy technician or nursing aide is being paid by Medicare but administration of the shot is being billed to Medicaid. Pace is set up to do cost sharing via Medicaid & Medicare.

So if your center absolutely requires you to be on community based Medicaid, that in & of itself will have all sorts of requirements. Please please pls realize that if you do community based Medicaid and enroll over age 55, Medicaid is required to do an attempt to recover all costs paid from your estate via MERP. Estate recovery is not just attempted on those on NH /SNF LTC Medicaid but on anyone filing for Medicaid other than Medicaid as health insurance if over age 55.

Because of this, there has been successful challenges made to the “dual” requirement. The center will have to set up copays for services and it’s cumbersome to do that. It’s flat easier to fill an open spot with someone who is a dual.

Also for PaCE you will be evaluated for “at need”. So that whatever you require can be done at a PaCE center. If it’s way way over 35 hrs a week, you may not be eligible as yiu are too close to needing 40 hrs a week care & oversight and that means in a facility with FT staffing.
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