Bill Overview
Title: PACE Expanded Act
Description: This bill modifies requirements 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. The bill also (1) allows the Center for Medicare and Medicaid Innovation to test a model for expanded PACE eligibility that targets high-need and high-cost populations, and (2) requires an evaluation of the effectiveness of PACE in rural and underserved areas.
Sponsors: Rep. Dingell, Debbie [D-MI-12]
Target Audience
Population: Medicare and Medicaid beneficiaries who are elderly and require nursing home level care
Estimated Size: 38300000
- PACE serves older adults who require nursing home level care, allowing them to stay in their homes while receiving comprehensive services.
- The bill modifies enrollment requirements, potentially increasing the number of people eligible to enroll in PACE programs.
- By allowing states to enable Medicaid beneficiaries to enroll any time, more low-income elderly people may join these programs.
- The expansion of eligibility through innovative models targets high-need populations, suggesting an increased impact on individuals with severe healthcare requirements.
- Rural and underserved areas may see new PACE options, expanding access to care for elderly populations there.
Reasoning
- The majority of the target population are elderly individuals who may not currently have access to personalized eldercare at home, which PACE aims to provide.
- The budget allows for significant expansion but must also ensure the quality of care remains consistent with increased enrollment.
- Different individuals will experience varied levels of impact based on current care situations, rural versus urban settings, and cost burden of care—especially for those dual-eligible members.
- Given the American elderly population distribution, more significant efforts might be needed to reach rural areas as infrastructure for healthcare can be less developed there.
Simulated Interviews
Retired farmer (Rural Iowa)
Age: 78 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I have been managing okay, but it's getting harder to live alone without help.
- I worry about ending up in a nursing home.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 8 | 2 |
Retired nurse (New York City)
Age: 85 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I'm content with the current care I receive but more frequent services would ease the burden on my children.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 6 |
Retired teacher (Rural Maine)
Age: 82 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Access to doctors has always been a challenge. I hope this program could make those visits more consistent.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 2 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 2 |
Retired software engineer (San Francisco)
Age: 65 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 12/20
Statement of Opinion:
- An ongoing program like PACE might be ideal as my physical health declines over time.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 4 |
| Year 20 | 9 | 3 |
Retired businessman (Suburban Florida)
Age: 91 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 15/20
Statement of Opinion:
- I have managed to stay active and prefer not much change, but enhanced options are always good.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Retired librarian (Urban Texas)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 25.0 years
Commonness: 6/20
Statement of Opinion:
- My spouse's condition has been heavy on us. Such a program could help us stay at home longer.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 4 |
Retired social worker (Downtown Chicago)
Age: 66 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 14/20
Statement of Opinion:
- I need better at-home care after surgery, and this program could address that.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Retired military (Seattle)
Age: 79 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Having access to something like PACE would provide better tailored care and more autonomy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
Retired school principal (Atlanta)
Age: 74 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- Pain management has been tough to manage alone; I hope this program offers better support.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 7 | 2 |
Retired professor (Boston)
Age: 80 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- Having a comprehensive care plan closer to home could significantly improve my daily life.
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 | 8 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 3 |
Cost Estimates
Year 1: $4000000000 (Low: $3000000000, High: $5000000000)
Year 2: $4500000000 (Low: $3500000000, High: $5500000000)
Year 3: $5000000000 (Low: $4000000000, High: $6000000000)
Year 5: $6000000000 (Low: $5000000000, High: $7000000000)
Year 10: $8000000000 (Low: $7000000000, High: $9000000000)
Year 100: $30000000000 (Low: $25000000000, High: $35000000000)
Key Considerations
- Aging U.S. population continuously increases PACE's potential participant population, necessitating adaptable program funding models.
- Implementation challenges in rural and underserved areas which may be traditionally lacking in healthcare infrastructure.
- Scalability of PACE provider entities to meet potential surges in participant needs.