Bill Overview
Title: PACE Plus Act
Description: This bill modifies requirements and establishes programs regarding Programs of All-Inclusive Care for the Elderly (PACE). PACE is a program under Medicare and Medicaid that provides in-home and community services for certain individuals as an alternative to nursing home care. The bill allows Medicare beneficiaries to enroll in a PACE program at any time and provides states with the option to allow Medicaid beneficiaries to do the same. Entities may also apply to become PACE providers at any time, upon specified assurances relating to staffing and other requirements. States that provide Medicaid coverage of long-term care may also choose to expand PACE eligibility for Medicaid beneficiaries who are unable to perform at least two activities of daily living and who meet other specified criteria. Additionally, the bill establishes and provides funds for grant programs for (1) public or nonprofit PACE providers in rural or underserved urban areas for planning, administrative, capital, and other expenses that are necessary for site development; and (2) states that do not have PACE providers for expenses deemed necessary for program establishment. The bill also allows the Center for Medicare and Medicaid Innovation to test a model for expanded PACE eligibility that targets high-need and high-cost populations.
Sponsors: Rep. Dingell, Debbie [D-MI-12]
Target Audience
Population: Elderly individuals who qualify for or are beneficiaries of Medicare or Medicaid
Estimated Size: 63000000
- PACE (Programs of All-Inclusive Care for the Elderly) primarily serves elderly individuals who qualify for Medicare or Medicaid.
- The act facilitates easier enrollment for Medicare and Medicaid beneficiaries, potentially increasing the number of individuals who receive PACE services.
- PACE serves as an alternative to nursing home care, targeting individuals who require significant assistance with daily activities.
- By expanding eligibility, the act aims to include more older adults, especially those with high needs and costs, thus affecting a broader elderly population.
- Grant programs in rural and underserved urban areas may affect elderly populations in these regions more significantly.
Reasoning
- The PACE Plus Act aims to expand the coverage and accessibility of PACE services, particularly focusing on elderly individuals who are Medicare and Medicaid beneficiaries.
- Given the budget constraints, the program will initially target high-need areas and individuals, which means not everyone eligible might receive benefits immediately.
- The bill includes grants for developing PACE programs in underserved areas, which suggests rural and urban low-income areas will see initial impacts.
- The policy allows continuous enrollment, potentially increasing participation but might strain resources as demand grows beyond current capacities.
- Considering the scale and budget, not all elderly will be impacted immediately; emphasis will be likely on high-need cases first.
Simulated Interviews
Retired farmer (Rural Alabama)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- I hope this policy means I can stay at home longer instead of moving to a facility.
- Access to community services would be very helpful for my daily needs.
- I worry about whether there are enough resources in my area.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 3 |
Retired school teacher (Chicago, Illinois)
Age: 85 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- This could provide useful support without needing to go to a nursing home.
- I am concerned about whether my current benefits will change.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 4 |
Retired nurse (New York City, New York)
Age: 90 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- PACE Plus might really help with better care services.
- I hope this means more activities and social opportunities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 4 |
Retired engineer (San Francisco, California)
Age: 77 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- This seems like it could relieve my family of stress and coordination efforts.
- I'm apprehensive about how fast something like this could be implemented.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 6 | 4 |
Retired librarian (Rural Wyoming)
Age: 65 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 2/20
Statement of Opinion:
- Expanding PACE sounds promising, especially in rural areas like ours.
- Access to medical services without frequent trips would be ideal.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 9 | 3 |
Retired artist (Austin, Texas)
Age: 68 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 6/20
Statement of Opinion:
- I believe this could enhance my independence significantly.
- It's important the program also considers diverse communities like ours.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Retired government worker (Seattle, Washington)
Age: 81 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- The program sounds beneficial for those like me who want to stay at home.
- I hope they have sufficient resources to support everyone in need.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired lawyer (Miami, Florida)
Age: 88 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 5/20
Statement of Opinion:
- The expansion might ensure I receive more timely services.
- I worry about long wait times given more enrollments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
Retired educator (Phoenix, Arizona)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 12.0 years
Commonness: 3/20
Statement of Opinion:
- I think this provides an excellent alternative to full-time care facilities.
- I'd like to be sure caregivers are properly trained.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired university professor (Boston, Massachusetts)
Age: 96 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- It sounds like a program that could really uplift quality of life for old folks like me.
- How will this interact with existing health programs and my current care?
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
Cost Estimates
Year 1: $150000000 (Low: $120000000, High: $180000000)
Year 2: $300000000 (Low: $240000000, High: $360000000)
Year 3: $450000000 (Low: $360000000, High: $540000000)
Year 5: $750000000 (Low: $600000000, High: $900000000)
Year 10: $1200000000 (Low: $960000000, High: $1440000000)
Year 100: $1200000000 (Low: $960000000, High: $1440000000)
Key Considerations
- The bill's expansion of eligibility could greatly increase the number of Medicaid PACE enrollees, affecting federal and state budgets.
- The transition from institutional care to home and community-based services necessitates careful oversight to maintain care quality.
- Stakeholders must ensure that the expansion does not strain the current PACE provider network beyond operational capacities.
- The design and implementation of the grant programs for underserved areas are critical to achieving the bill's geographic expansion goals.