Medicaid Benefits: Program of All-Inclusive Care for the Elderly (PACE)

This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.

2018

Location	Benefit Covered	Coverage Code	Copayment Required?	Limits on Services	Prior Approval Required	Reimbursement Methodology
United States	Yes - 27 No - 19 NR - 5	2018 data limited to CN	Yes - 3	Yes - 9	Included in "Limits on Services" for 2018	Not included in 2018 survey
Alabama	Yes	CN	No	Program Enrollment Limit	-	-
Alaska	No				-	-
Arizona	No				-	-
Arkansas	Yes	CN	NR	NR	-	-
California	Yes	CN	No	No	-	-
Colorado	Yes	CN	No	Services delivered through a PACE managed care entity	-	-
Connecticut	No				-	-
Delaware	No				-	-
District of Columbia	No				-	-
Florida	Yes	CN	No	No	-	-
Georgia	Yes	CN	NR	NR	-	-
Hawaii	No				-	-
Idaho	No				-	-
Illinois	NR	NR	NR	NR	-	-
Indiana	Yes	CN	No	No	-	-
Iowa	NR	NR	NR	NR	-	-
Kansas	Yes	CN	No	No	-	-
Kentucky	No				-	-
Louisiana	No				-	-
Maine	No				-	-
Maryland	Yes	CN	No	Level of care pre authorization	-	-
Massachusetts	Yes	CN	No	No	-	-
Michigan	Yes	CN	No	Medical necessity	-	-
Minnesota	No				-	-
Mississippi	No				-	-
Missouri	No				-	-
Montana	No				-	-
Nebraska	Yes	CN	No	No	-	-
Nevada	No				-	-
New Hampshire	NR	NR	NR	NR	-	-
New Jersey	Yes	CN	Yes - Not Specified	No	-	-
New Mexico	Yes	CN	No	No	-	-
New York	NR	NR	NR	NR	-	-
North Carolina	Yes	CN	There is not one specified PACE amount as cost sharing amounts vary depending upon that participant's payer source (Medicare-only or private pay)	No	-	-
North Dakota	Yes	CN	No	No	-	-
Ohio	Yes	CN	No	Geographic restriction - only in Cuyahoga County.	-	-
Oklahoma	Yes	CN	No	PACE is a service offered through a waiver and it is available to eligible traditional Medicaid adults but not all adults receive the service.	-	-
Oregon	Yes	CN	No	Participants eligible for PACE are 55 or older, meet the state’s criteria for long-term care eligibility with a service priority level of 1-13, and are Medicaid eligible	-	-
Pennsylvania	Yes	CN	No	No	-	-
Rhode Island	Yes	CN	No	No	-	-
South Carolina	NR	NR	NR	NR	-	-
South Dakota	No				-	-
Tennessee	Yes	CN	No	No	-	-
Texas	Yes	CN	No	Participant must meet established age and other criteria for coverage	-	-
Utah	No				-	-
Vermont	No				-	-
Virginia	Yes	CN	No	No	-	-
Washington	Yes	CN	No	Prior authorization required	-	-
West Virginia	No				-	-
Wisconsin	Yes	CN	No	No	-	-
Wyoming	Yes	CN	Cost sharing is specific to PACE participants receiving care in a Nursing Facility (NF). LTC-Eligibility Unit determines the cost sharing amount using the same logic as non-PACE NF residents.	No	-	-

2012

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 31 No - 25		Yes - 0 No - 31
Alabama	Yes	CN		See service-specific FN		Capitated payment
Alaska	No
American Samoa	No
Arizona	No
Arkansas	Yes	CN			Yes	Capitated payment
California	Yes	CN & MN		See service-specific FN		Capitated payment
Colorado	Yes	CN		See service-specific FN		Capitated payment
Connecticut	No
Delaware	Yes	CN				Capitated payment
District of Columbia	No
Florida	Yes	CN & MN		See service-specific FN		Capitated payment
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	No
Iowa	Yes	CN & MN				Capitated payment
Kansas	Yes	CN & MN		See service-specific FN		Capitated payment based on eligibility
Kentucky	No
Louisiana	Yes	CN			See service-specific FN	Capitated payment
Maine	No
Maryland	Yes	CN & MN		See service-specific FN		Capitated payment with varying rates
Massachusetts	Yes	CN & MN		See service-specific FN		Capitated payment
Michigan	Yes	CN & MN		See service-specific FN		Capitated payment
Minnesota	No
Mississippi	No
Missouri	Yes	CN		See service-specific FN		Capitated payment
Montana	No
Nebraska	No
Nevada	No
New Hampshire	No
New Jersey	Yes	CN				Capitated payment
New Mexico	Yes	CN		A - this benefit is not covered	Yes	Contracted rate
New York	Yes	CN & MN		See service-specific FN		Capitated payment
North Carolina	Yes	CN & MN		See service-specific FN	Yes	Capitated payment
North Dakota	Yes	CN & MN				Capitated payment
Northern Mariana Islands	No
Ohio	Yes	CN		See service-specific FN		Capitated payment
Oklahoma	Yes	CN				Capitated payment
Oregon	Yes	A & B - See state-specific FN		See service-specific FN		Capitated payment
Pennsylvania	Yes	CN & MN		See service-specific FN		Capitated payment
Puerto Rico	No
Rhode Island	Yes	See state-specific FN		LTC level of care criteria must be met		Capitated payment
South Carolina	Yes	CN		See service-specific FN		Capitated payment
South Dakota	No
Tennessee	Yes	A & B - See state-specific FN		See service-specific FN	Yes	Capitated payment
Texas	Yes	CN & MN		See service-specific FN		Capitated payment
Utah	No
Vermont	Yes	A - See state-specific FN				Capitated payment
U.S. Virgin Islands	No
Virginia	Yes	CN & MN				Capitated payment
Washington	Yes	CN		See service-specific FN		Capitated payment
West Virginia	No
Wisconsin	Yes	CN & MN		See service-specific FN		Capitated payment
Wyoming	Yes	CN				capitated payment

2010

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 30 No - 26		Yes - 0 No - 30
Alabama	No
Alaska	No
American Samoa	No
Arizona	No
Arkansas	Yes	CN			Yes	Capitated payment
California	Yes	CN & MN		See service-specific FN		Capitated payment
Colorado	Yes	CN		See service-specific FN		Capitated payment
Connecticut	No
Delaware	No
District of Columbia	No
Florida	Yes	CN & MN		See service-specific FN		Capitated payment
Georgia	No
Guam	No
Hawaii	Yes	CN & MN				Capitated payment
Idaho	No
Illinois	No
Indiana	No
Iowa	Yes	CN & MN				Capitated payment
Kansas	Yes	CN & MN		See service-specific FN		Capitated payment based on eligibility
Kentucky	No
Louisiana	Yes	CN			See service-specific FN	Capitated payment
Maine	No
Maryland	Yes	CN & MN		See service-specific FN		Capitated payment with varying rates
Massachusetts	Yes	CN & MN		See service-specific FN		Capitated payment
Michigan	Yes	CN & MN		See service-specific FN		Capitated payment
Minnesota	No
Mississippi	No
Missouri	Yes	CN		See service-specific FN		Capitated payment
Montana	Yes	A - See state-specific FN				Capitated payment
Nebraska	No
Nevada	No
New Hampshire	No
New Jersey	Yes	CN				Capitated payment
New Mexico	Yes	CN		A - this benefit is not covered	Yes	Contracted rate
New York	Yes	CN & MN		See service-specific FN		Capitated payment
North Carolina	Yes	CN & MN		See service-specific FN		Capitated payment
North Dakota	Yes	CN & MN				Capitated payment
Northern Mariana Islands	No
Ohio	Yes	CN		See service-specific FN		Capitated payment
Oklahoma	Yes	CN				Capitated payment
Oregon	Yes	A & B - See state-specific FN		See service-specific FN		Capitated payment
Pennsylvania	Yes	CN & MN		See service-specific FN		Capitated payment
Puerto Rico	No
Rhode Island	Yes	See state-specific FN		LTC level of care criteria must be met		Capitated payment
South Carolina	Yes	CN		See service-specific FN		Capitated payment
South Dakota	No
Tennessee	Yes	A - See state-specific FN		See service-specific FN	Yes	Capitated payment
Texas	Yes	CN & MN		See service-specific FN		Capitated payment
Utah	No
Vermont	Yes	A - See state-specific FN				Capitated payment
U.S. Virgin Islands	No
Virginia	Yes	CN & MN				Capitated payment
Washington	Yes	CN		See service-specific FN		Capitated payment
West Virginia	No
Wisconsin	Yes	CN & MN		See service-specific FN		Capitated payment
Wyoming	No

2008

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 30 No - 26		Yes - 0 No - 30
Alabama	No
Alaska	No
American Samoa	No
Arizona	No
Arkansas	Yes	CN			Yes	Capitated payment
California	Yes	CN & MN		See service-specific FN		Capitated payment
Colorado	Yes	CN		See service-specific FN		Capitated payment
Connecticut	No
Delaware	No
District of Columbia	No
Florida	Yes	CN & MN		See service-specific FN		Capitated payment
Georgia	No
Guam	No
Hawaii	Yes	CN & MN				Capitated payment
Idaho	No
Illinois	No
Indiana	No
Iowa	Yes	CN & MN				Capitated payment
Kansas	Yes	CN & MN		See service-specific FN		Capitated payment based on eligibility
Kentucky	No
Louisiana	Yes	CN			See service-specific FN	Capitated payment
Maine	No
Maryland	Yes	CN & MN		See service-specific FN		Capitated payment
Massachusetts	Yes	CN & MN		See service-specific FN		Capitated payment
Michigan	Yes	CN & MN		See service-specific FN		Capitated payment
Minnesota	No
Mississippi	No
Missouri	Yes	CN		See service-specific FN		Capitated payment
Montana	Yes	A - See state-specific FN				Capitated payment
Nebraska	No
Nevada	No
New Hampshire	No
New Jersey	Yes	CN				Capitated payment
New Mexico	Yes	CN			Yes	Contracted rate
New York	Yes	CN & MN		See service-specific FN		Capitated payment
North Carolina	Yes	CN & MN		See service-specific FN		Capitated payment
North Dakota	Yes	CN & MN				Capitated payment
Northern Mariana Islands	No
Ohio	Yes	CN		See service-specific FN		Capitated payment
Oklahoma	Yes	CN				Capitated payment
Oregon	Yes	A & B - See state-specific FN		See service-specific FN		Capitated payment
Pennsylvania	Yes	CN & MN		See service-specific FN		Capitated payment
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN				Capitated payment
South Carolina	Yes	CN		See service-specific FN		Capitated payment
South Dakota	No
Tennessee	Yes	A - See state-specific FN		See service-specific FN	Yes	Capitated payment
Texas	Yes	CN & MN		See service-specific FN		Capitated payment
Utah	No
Vermont	Yes	A - See state-specific FN				Capitated payment
U.S. Virgin Islands	No
Virginia	Yes	CN & MN				Capitated payment
Washington	Yes	CN		See service-specific FN		Capitated payment
West Virginia	No
Wisconsin	Yes	CN & MN		See service-specific FN		Capitated payment
Wyoming	No

2006

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 21 No - 35		Yes - 0 No - 21
Alabama	No
Alaska	No
American Samoa	No
Arizona	No
Arkansas	No
California	Yes	CN & MN		See service-specific FN		Capitated payment
Colorado	Yes	CN		See service-specific FN		Capitated payment
Connecticut	No
Delaware	No
District of Columbia	No
Florida	Yes	CN & MN		See service-specific FN		Capitated payment
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	No
Iowa	No
Kansas	Yes	CN & MN		See service-specific FN		Capitated payment
Kentucky	No
Louisiana	Yes	CN			See service-specific FN	Capitated payment
Maine	No
Maryland	Yes	CN & MN		See service-specific FN		Capitated payment
Massachusetts	Yes	CN & MN		See service-specific FN		Capitated payment
Michigan	Yes	CN & MN		See service-specific FN		Capitated payment
Minnesota	No
Mississippi	No
Missouri	Yes	CN		See service-specific FN		Capitated payment
Montana	No
Nebraska	No
Nevada	No
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN			Yes	Contracted rate
New York	Yes	CN & MN		See service-specific FN		Capitated payment
North Carolina	Yes	CN & MN		See service-specific FN		Capitated payment
North Dakota	No
Northern Mariana Islands	No
Ohio	Yes	CN		See service-specific FN		Capitated payment
Oklahoma	No
Oregon	Yes	A & B - See state-specific FN		See service-specific FN		Capitated payment
Pennsylvania	Yes	CN & MN		See service-specific FN		Capitated payment
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN				Capitated payment
South Carolina	Yes	CN		See service-specific FN		Capitated payment
South Dakota	No
Tennessee	Yes	A - See state-specific FN		See service-specific FN	Yes	Capitated payment
Texas	Yes	CN & MN		See service-specific FN		Capitated payment
Utah	No
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN		See service-specific FN		Capitated payment
West Virginia	No
Wisconsin	Yes	CN & MN		See service-specific FN		Capitated payment
Wyoming	No

2004

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 19 No - 37		Yes - 0 No - 19
Alabama	No
Alaska	No
American Samoa	No
Arizona	No
Arkansas	No
California	Yes	CN & MN		See service-specific FN		Capitated payment
Colorado	Yes	CN		See service-specific FN		Capitated payment
Connecticut	No
Delaware	No
District of Columbia	No
Florida	Yes	CN & MN		See service-specific FN		Capitated payment
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	No
Iowa	No
Kansas	Yes	CN & MN		See service-specific FN		Capitated payment
Kentucky	No
Louisiana	No
Maine	No
Maryland	Yes	CN & MN		See service-specific FN		Capitated payment
Massachusetts	Yes	CN & MN		See service-specific FN		Capitated payment
Michigan	Yes	CN & MN		See service-specific FN		Capitated payment
Minnesota	No
Mississippi	No
Missouri	Yes	CN		See service-specific FN		Capitated payment
Montana	No
Nebraska	No
Nevada	No
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN			Yes	Contracted rate
New York	Yes	CN & MN		See service-specific FN		Capitated payment
North Carolina	No
North Dakota	No
Northern Mariana Islands	No
Ohio	Yes	CN		See service-specific FN		Capitated payment
Oklahoma	No
Oregon	Yes	A & B - See state-specific FN		See service-specific FN		Capitated payment
Pennsylvania	Yes	CN & MN		See service-specific FN		Capitated payment
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN				Capitated payment
South Carolina	Yes	CN		See service-specific FN		Capitated payment
South Dakota	No
Tennessee	Yes	A - See state-specific FN		See service-specific FN	Yes	Capitated payment
Texas	Yes	CN & MN		See service-specific FN		Capitated payment
Utah	No
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN		See service-specific FN		Capitated payment
West Virginia	No
Wisconsin	Yes	CN & MN		See service-specific FN		Capitated payment
Wyoming	No

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Medicaid Benefits: Program of All-Inclusive Care for the Elderly (PACE)

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Medicaid Benefits: Program of All-Inclusive Care for the Elderly (PACE)

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