PACE Program in New York: How It Works and Who Qualifies

Your parent needs daily help but isn't ready for a nursing home. They qualify for Medicaid, but you're not sure an MLTC plan or CDPAP gives them enough medical oversight. PACE might be the missing piece — and it's one of the most comprehensive care programs most New York families have never heard of.

What PACE Actually Provides

PACE (Program of All-Inclusive Care for the Elderly) is a combined Medicare and Medicaid program that bundles every service an elderly person might need into a single coordinated package. Unlike MLTC plans that focus primarily on custodial home care, PACE covers:

• Primary and specialty medical care — your parent sees doctors and other clinicians through the PACE organization
• Prescription drugs — no separate Part D plan needed
• Home care and personal assistance
• Adult day health services — the centerpiece of most PACE programs
• Physical, occupational, and speech therapy
• Hospital and nursing facility care when needed
• Transportation to and from the PACE center and medical appointments
• Social services, nutritional counseling, and meals
• Dental, vision, and hearing services

The adult day center is where PACE differs most from other programs. Attendance follows the care plan; adult day health services are generally offered one to five days per week, with medical monitoring, therapies, meals, socialization, and needed personal care — all under one roof.

Eligibility Requirements

To enroll in PACE in New York, your parent must meet the program's eligibility criteria:

1. Age 55 or older (federal minimum; most NY PACE organizations serve 55+)
2. Live in a PACE service area — coverage is limited to specific counties and zip codes
3. Have Medicaid; if Medicare-eligible, have Medicare Part A and B and enroll in the PACE plan's aligned Medicare plan
4. Need nursing-home-level care and at least one community-based long-term service for more than 120 days
5. Be able to live safely in the community at the time of enrollment

Your parent must have Medicaid to enroll under New York's current PACE eligibility page. Medicare-eligible participants also need Medicare Part A and B and an aligned Medicare plan through PACE.

Where PACE Is Available in New York

PACE coverage in New York is limited to specific counties and ZIP codes, and not every county has a PACE option. Check current availability with New York Medicaid Choice at 1-888-401-6582. If your parent lives outside a covered service area, MLTC or CDPAP through Community Medicaid are the primary alternatives for home-based care.

PACE vs. MLTC vs. CDPAP

Each program serves a different niche:

PACE is best for parents who benefit from structured daily activities and need coordinated medical oversight. The trade-off: your parent must use PACE-network providers for virtually all medical care. Seeing an outside specialist requires PACE approval.

MLTC (Managed Long-Term Care) provides custodial home care hours through a managed care plan, but your parent keeps their existing doctors and Medicare coverage. Less comprehensive than PACE, but more flexible.

CDPAP (Consumer Directed Personal Assistance Program) lets your parent hire their own caregiver — including a family member — and direct their own care. Maximum autonomy, but no bundled medical services.

For families weighing all three options, the New York Medicaid Long-Term Care Guide includes a comparison framework that maps each program against common care scenarios.

The Financial Structure

For participants with both Medicare and Medicaid, PACE services are fully covered under New York's program information. Medicare and Medicaid jointly fund the program, and the PACE organization receives a fixed monthly capitation payment per enrollee. Confirm any plan-specific cost-sharing and covered-service limits directly with the PACE organization before enrolling.

Limitations Worth Knowing

PACE requires commitment. Your parent must receive all care through the PACE network — switching to an outside doctor or specialist without prior approval can mean paying out of pocket. If your parent has long-standing relationships with specific physicians, this restriction can be a dealbreaker.

The adult day center attendance expectation can also be a barrier for parents who strongly prefer staying home. The care plan sets the attendance schedule, and the program is designed around regular center participation.

Finally, enrollment is voluntary. New York's PACE information says a participant can disenroll at any time, with no lock-in period; ask the plan about the effective date and transition of services.

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