PACE Program Florida | Program of All Inclusive Care for the Elderly
As an elder law attorney, I try to be a resource for my clients. Many parts of Miami-Dade and Broward (I’ll list the applicable zip codes below) have an option for those who are 55 years old or older to receive home and community-based care services rather than going into a nursing home.It is a special program known as Program of All Inclusive Care for the Elderly - a/k/a "PACE" or Florida PACE Program. Florida PACE is an affiliate of Miami Jewish Health.
Think of PACE as an all-in-one / one-stop shop health insurance and home and community based long term care management program. PACE covers all services one ordinarily gets under Medicare and more. PACE provides both medical and long-term care services from a single source. PACE provides primary care and medical specialty care (e.g. dentists, optometrists, audiologists, podiatrists, psychiatrists, physical therapy, occupational therapy, and speech therapy) at one of their day health care centers.
Florida PACE also works with ALFs, and will provide a stipend to assist in the care of the resident. If medically necessary, PACE will also provide adult diapers, beds, equipment, meals, transportation to doctor appointments, and, again, handling all of the ALF resident's care-related services.
In addition to adult day care and respite care, PACE also provides durable medical equipment, Medicare Part D prescription drug coverage and in-home / home-health / home nursing services along with transportation to and from the day health center and to and from doctor's appointments. To read more about what services PACE offers, click the link.
Who is Eligible for the Florida PACE Program?
PACE candidates must be over the age of 55, require assistance with three activities of daily living (i.e. nursing home level of care), be able to live safely in the community with the help of PACE services, be eligible for Medicaid. Miami-Dade and Broward PACE is based out of Miami Jewish Health Systems. Because our firm is based in South Florida, this article focuses on the PACE programs offered in Miami-Dade and PACE in Broward County.
Links to the PACE programs in Palm Beach, Lee, Collier, Pinellas, and Charlotte Counties are under the resources section below.
Potential enrollees must and live in the following service areas surrounding their four South-Florida PACE center locations, based on your zip code:
PACE Program coverage for Miami
Site – Miami Jewish Health located at 5200 NE 2nd Avenue, Miami, FL 33137:
33125, 33127, 33128, 33129, 33130, 33131, 33132, 33135, 33136, 33137, 33138, 33139, 33140, 33141, 33142, 33147, 33150, 33154, 33161,33167, 33168, 33181
PACE coverage for Hialeah
Site – 60 E. 3rd Street, Hialeah, FL 33010:
33015, 33016, 33018, 33010, 33012, 33013, 33014, 33054,33122, 33126, 33133, 33134, 33144, 33166.
PACE coverage for Westchester (West Miami)
Site - 2700 S.W. 97th Avenue, Miami, FL 33165.
33143, 33145, 33146, 33155, 33156, 33158, 33165, 33172,33173, 33174, 33175, 33176, 33182, 33183, 33184, 33185, 33186, 33193, 33194, 33196.
PACE coverage for Miramar
Site – 2814 Corporate Way, Miramar, FL 33025.
33004, 33009, 33019, 33020, 33021, 33023, 33024, 33025,33026, 33027, 33028, 33029, 33055, 33056, 33068, 33069, 33160, 33162, 33169, 33179, 33180, 33301, 33304, 33305, 33306, 33308, 33309, 33311, 33312, 33314,33315, 33328, 33330, 33331, 33332, 33334.
Who are ideal PACE program candidates?
The goal of PACE is to help their participants live in the community for as long as possible (i.e. delay entrance into a nursing home). About 69% of PACE participants have a dementia diagnosis and need help coordinating their care.
A typical example of an ideal PACE participant would be one whose family works or otherwise cannot take a primary care giving role during a significant number of hours each day. PACE can provide transportation to the PACE center, schedule and provide transportation to doctors appointments, and associated home needs in order to prepare for those appointments or time spent at the PACE center (e.g. provide a shower, assist with dressing, laundry, medication management, etc...) essentially PACE take the lead on all aspects of you or your loved one's care.
Or perhaps the primary caregiver needs more limited assistance such as a son who does not want to give his mother a shower.
The PACE Medical and Long-Term Care program also offers additional benefits:
There is No Wait List to Enroll in Florida PACE Program
Perhaps one of the most exciting reasons to consider PACE is that there is no wait list. However, Florida PACE enrollment typically takes between 1 and 3 months in order to process. This is because PACE has to coordinate with DCF and the Florida Department of Elder Affairs to confirm Medicaid eligibility. During the enrollment period, you / the PACE enrollee would be seen by the interdisciplinary team at the site for assessment to establish a care plan once enrolled.
Free Help with Florida Medicaid Application
Those who desire PACE must also be qualified for Medicaid long-term care benefits, which is why an elder care attorney may be needed. But, for those applying for PACE, the medicaid long term care application is handled for free.
Who are not ideal Florida PACE candidates?
PACE is a fantastic alternative to Medicaid Waiver benefits, but it wont be a perfect fit for all South Floridians who need long-term care management assistance.
For example, an individual who is bed-bound, or who is in need of extensive home-health care, is not likely to benefit as much from the Florida PACE model. In addition, those who are simply looking for more financial assistance to go toward their ALF bill are, similarly, not ideal PACE candidates.
The reason for this is that the "PACE model" centers care around the South Florida PACE locations in Miami, Westchester, Hialeah and Miramar. As a result their home-health aid services are based around assisting those who need help at home before heading over to the PACE center (which are still valuable services such as laundry, cleaning, medication management and showering) but may not be best suited for the the applicant who wants to spend all of their time at home or in the ALF. If the applicant qualifies, the Medicaid Waiver program will likely provide more home-health care hours when compared side-by-side with PACE.
Along the same lines, those simply looking for more money to be put toward their ALF bill may prefer to join a wait list for the Medicaid Long Term Care Waiver in Florida), which will typically pay between $1,200 - $1,350 toward an ALF that accepts Medicaid.
What Do I need to get Started with PACE Enrollment?
A PACE enrollment specialist will get some basic demographic information from you, a picture ID, proof of residency, social security and medicare card. They will provide a form (called the 3008) to be filled out by your primary care physician that certifies that you need long-term care assistance. In addition, PACE will gather your medical records and will ask for a list of prescriptions.
Finally, they will require income statements (i.e. a copy of your social security benefits verification letter) and three months of bank statements.
You may contact a PACE representative at 305.988.1364. If your income or assets are too high, an experienced Medicaid Planning attorney can assist.
Other Florida PACE Program Resources