New York Estate Planning & Elder Law Blog
More than one dozen U.S. senators from both sides of the aisle are pushing the Obama administration to broaden the Medicaid program for the nation’s frailest seniors. They are pushing the idea as a proven alternative to pricier nursing home options, as states are looking to minimize long term medical costs. The senators released a statement to the Centers for Medicare and Medicaid Services to follow through on plans to loosen restrictions on the Program of All Inclusive Care for the Elderly (PACE).
Broadening the PACE Program
The PACE program is offered to Medicaid eligible seniors and people with disabilities who need nursing home care. The program offers an alternative to nursing homes that allows the elderly to stay in their homes and receive coordinated care from a team of doctors, nurses, and social workers at an independently operated day center. However, enrollment in this program has been small due to the limiting federal regulations and a push by states to move patients into more cost-effective health care plans.
Currently, the PACE program has enrolled 31,000 Americans aged 55 or older that are served by 196 PACE centers in 31 states. Pennsylvania has the most centers at 32, with California, New York, Massachusetts, Virginia, and North Carolina following right behind. Spokespeople for Medicaid Services stated last year that it would propose changes to the PACE program that would allow for more flexibility and the option for more seniors to enroll. However, they have yet to do so.
Senators’ Requests
The letter released by the senators states that the PACE program is in a unique position to help Medicaid achieve “its goals of better care, better health, and increased cost-effectiveness.” The senators are asking the Centers for Medicare and Medicaid Services to allow PACE in a wider range of community settings like adult day centers or senior centers in order to increase access to the program. They also asked for a quicker application process and to allow the elderly to keep their own doctors instead of a PACE physician.
PACE versus Nursing Home Care
Many seniors that have used the PACE program are happy with the freedom and independence that it provides. For one participant who suffered a stroke five years ago, instead of going into a nursing home she chose to enroll in PACE. She is picked up five days per week and taken to a day facility where she is monitored by doctors, fed, and can participate in daily activities before returning home. The costs are all picked up by Medicare and Medicaid.
Nursing homes cost on average $75,000 per year per person, not including the charges made separately to Medicare for medication, emergency services, and hospital stays. On average, PACE enrollees spend 14% less on costs than they would in a nursing home. While patient satisfaction and health outcomes in PACE have been positive so far, no long term studies have been done on the effectiveness of the program. Regardless, senators are pushing for Medicare and Medicaid to follow through on their promise to make this program available to more seniors as soon as possible.