PACE—the Program of All-Inclusive Care for the Elderly—coordinates medical care and long-term services for eligible adults who meet nursing-home level-of-care criteria but can live safely in the community with support. San Diego County has several PACE organizations with service areas that include Poway and Escondido. Enrollment changes how care is organized, so families should understand the program before assuming a residence or service is included.
The four basic eligibility questions
Medicare describes four core requirements: the person is at least 55, lives in a PACE service area, needs a nursing-home level of care as certified by the state and can live safely in the community with PACE support. A local PACE organization completes its own enrollment and assessment process within those rules.
Zip-code lists can change, and a qualifying address does not guarantee enrollment. Confirm the current service area directly with the organization and ask how a planned move could affect eligibility.
What the interdisciplinary team coordinates
PACE brings primary care, specialty care, medications, rehabilitation, transportation and social supports under one coordinated plan. The team evaluates medical, physical, social and emotional needs and decides which services are necessary to help the participant remain safe in the community.
That structure can reduce the burden of coordinating separate providers, but it also means participants agree to use the PACE organization and its contracted network for covered care except in emergencies. Ask how existing physicians, pharmacies, therapists and medical equipment will be handled before enrolling.
Where residential care may fit
Some PACE participants live in residential settings when the PACE team, resident and residence can align around a safe plan. The residence still performs its own admission assessment and must be able to meet the person’s needs within California RCFE rules. The PACE organization coordinates covered medical and supportive services through its plan and contracts.
Ask for a written explanation of which services PACE will authorize, which responsibilities belong to the RCFE and which housing or personal expenses remain with the resident. Do not assume that PACE enrollment automatically pays every residential charge.
Questions to ask before changing coverage
Enrollment can affect Medicare, Medi-Cal, prescription and provider arrangements. Prepare a complete list of current doctors, medications, equipment, therapies and upcoming procedures, then ask how each would be handled. If the person has an employer plan, retiree coverage or long-term care policy, ask the appropriate benefits counselor how those interact.
Families can also contact HICAP for independent Medicare counseling. A residence can explain its services and PACE relationships, but it should not replace individualized insurance advice.
- Which PACE organization serves the current and proposed address?
- Which physicians and specialists would change?
- How are urgent, hospital and after-hours needs handled?
- What residential services are authorized, and what remains private pay?
- Who is the family’s day-to-day contact on the interdisciplinary team?
A careful way to compare options
Compare the current arrangement, a proposed PACE plan and any CalAIM pathway on the same page. List the clinical team, pharmacy, transportation, daily support, housing payment, authorization rules and responsible contact for each. The best choice is not the program with the longest service list; it is the one that can safely deliver the services this person actually needs.
Before signing, ask the PACE organization and residence to speak directly. A coordinated conversation is more reliable than asking an older adult or family member to carry complex instructions between two systems.
A Poway perspective from Huntington Manor
Huntington Manor works with Community Health Group and San Diego PACE when the resident, program and authorization are an appropriate match. Our team can explain the residential-care side of the process, but the health plan or PACE organization makes eligibility and coverage decisions. Families should confirm every approval and cost in writing.
Sources and further reading
- Medicare: Program of All-Inclusive Care for the Elderly (PACE) (opens in a new tab)
- DHCS: San Diego County Medi-Cal and PACE plan directory (opens in a new tab)
- Family Health Centers of San Diego PACE: Frequently Asked Questions (opens in a new tab)
This article is educational and does not replace individualized medical, legal, financial or benefits advice. Program rules, provider networks and eligibility can change; confirm current details with the responsible agency or health plan.