Program of All-Inclusive Care for the Elderly

The Program of All-inclusive Care for the Elderly (PACE), offers a benefit that combines medical care, long-term care and prescription drugs to help frail and disabled individuals age 55 and older live independently within the community.

Eligibility

To be eligible for PACE, individuals must be: 

• Age 55 or over
• Live in the counties served by a PACE center
• Meet Iowa's criteria for nursing facility level of care
• Be able to live safely in the community with help from the PACE center

Covered Services & Appointments

PACE services include, but are not limited to, all Medicare and Medicaid services. 

A PACE center is facility where the PACE organization is housed and provides medical services to support and assist you. 

Other medically necessary services that cannot be provided at the PACE center or in your home will be coordinated for you. PACE staff will schedule appointments for you and schedule transportation to your appointments, if needed. Any services not available at the PACE center must be authorized by the PACE team of professionals. 

Appointments for medical care outside of the PACE center are required to have prior authorization by the PACE team. You will need to pay for unauthorized appointments and services. 

If approved, the services listed can be provided, but are not limited to the following: 

Urgent Care

Call a PACE center if you need urgent care. Urgent care examples include: 

• Fever
• Acute respiratory conditions
• Vomiting
• Common cold or flu
• Other common infections including bladder, ear, skin, etc.
• Falls
• Minor injuries

Please note: Emergency services are the exception and do NOT need prior approval.

Emergency Care

An emergency is any condition that places your life in danger or causes permanent disability if not treated immediately. If you have an emergency:

• Call 911 or go directly to the nearest hospital emergency room.
• Take your PACE card with you.
• You do not need to call your PACE center first. 

However, call, or ask someone to call your PACE center as soon as possible to let the PACE staff know that you needed emergency care. PACE staff will assist you with any follow-up care that you need. The following are examples of emergencies: 

• Serious accidents or falls
• Poisoning
• Heart attack
• Stroke
• Severe bleeding
• Severe burns
• Severe shortness of breath

Follow-up Care After Emergencies

You must contact your PACE center for all follow-up care. Do not return to the emergency room for follow-up care. The PACE center will either provide or authorize this care for you. Please remember that you will need to pay for services that are not authorized by the PACE organization.

How to Apply

Contact the PACE program for the county in which you live. A representative will explain the comprehensive benefits package available through PACE and assist with the application process. The PACE representative can also provide guidance related to the Medicaid application process. 

Estate Recovery Program

The State of Iowa has the right to ask for money back from your estate after your death, called the Estate Recovery Program. All medical assistance paid out by the Department is subject to recovery. This includes: fee-for-service (FFS) claims, capitation fees to manage care organizations (MCOs), including PACE (regardless of how much the actual services cost) and interest.

Estate recovery only applies to Medicaid recipients who:

• Are age 55 or older, or
• Are under age 55 and live in a medical facility and will probably not return home.

PACE Cards

A PACE card takes the place of the Medicaid and Medicare cards. You will be provided with a card once you are approved for PACE. This card helps you get medical care and services. 

Medicare/Medicaid Coordination & Fees

• Individuals may have to pay the PACE centers monthly rate using private funds.
• The monthly rate will be consistent with the PACE rates paid by Medicaid or Medicare.
• You can have either Medicare or Medicaid, or both, to join PACE.
• Medicare eligible participants must apply for Medicare and get Medicare. PACE participants are not required to enroll in Medicaid. 

Medicare and Medicaid pay the PACE program to take care of your medical needs. Your Medicare and/or Medicaid card are replaced with a PACE card. The PACE center becomes your primary care provider's office. All your care has to be coordinated by the PACE team.

Monthly Share & Costs

You may have a monthly share of cost to remain eligible for Medicaid. If you live in an assisted living facility you have to pay for your room and board each month. If you are enrolled in Medicaid, you may have a monthly financial responsibility for your care. It is possible that you may have to pay for both. 

However, the absence of Medicare or Medicaid copays and deductibles are a major benefit to the PACE program.

You Have The Right To Appeal

• Appeals
• How to Appeal

Iowa Counties & PACE

At this time, PACE is not available in all Iowa counties. To learn more about the PACE program or for assistance with an application, contact the PACE center in the county where you reside.

Frequently Asked Questions

Explore answers to frequently asked questions about PACE.