What is the Program for All-Inclusive Care for the Elderly (PACE)?
Program for All-Inclusive Care for the Elderly (PACE) is a nationwide model of care designed to help elders stay living in the community (instead of in nursing homes) as long as possible.
A team of health professionals assesses each elder's needs and develops a plan of total care. Services are in the elder's home, adult day health center or an assisted living facility.
The PACE program is for elders who are 55 or older (individuals under 65 must meet the Social Security disability definition), live in a PACE service area, are able to live safely in the community (with assistance through PACE), are certified by the state as eligible for nursing home care, and agree to receive health services exclusively through the PACE.
What is the difference between PACE and Elder Service Plan?
Elder Service Plans are part of the PACE program.
What are the income and asset rules for PACE?
If an elder has gross monthly income of $2,163 or less in 2014, there is no monthly spenddown and he or she gets to keep all of their income. In contrast, if the elder's gross monthly income in 2014 is over $2,163, there is a monthly spenddown to $542. In other words, if the elder’s income exceeds the threshold of 300% of the federal Supplemental Security Income (SSI) benefit ($2,163 in 2014), he or she gets to keep only $542.
For PACE, the asset limit for an unmarried elder is $2,000 or less of countable assets. There is a long list of noncountable assets. Most notable, the home is noncountable as long as the equity value does not exceed $750,000. However, an advantage of the PACE program is that the assets belonging to the healthy spouse will not count toward the asset limit. Under MassHealth regulations, transfers between spouses do not affect eligibility. As a result, a commonly-used strategy for an unhealthy married elder is to transfer assets to his or her healthy spouse and thereby qualify for the PACE program.
What is the private pay rate for PACE?
The 2014 monthly private pay rate for the PACE program is $3,933.
Does PACE help pay for Assisted Living?
Some Elder Service Plans contract with assisted living facilities. For example, Elder Service Plan of Harbor Health contracts with the Arbors in Stoughton, MA. Typically, a large portion of the expense of assisted living care is the home-care component. PACE pays for the home-care component at some of the assisted living facilities with which the Elder Service Plans have contracts.
Can you keep your doctor and specialist when enrolled in PACE?
No, a PACE physician will coordinate your care. With regard to Elder Service Plan of Harbor Health, theycontract with specialists and specialists who do not contract with PACE are considered on a case-by-case basis.
Where is the closest PACE program?
There are six or so PACE programs in Massachusetts.
The PACE program in this area is Elder Service Plan of Harbor Health, which services the following communities: Avon, Boston, Braintree, Brookline, Canton, Dedham, Holbrook, Milton, Norwood, Quincy, Randolph, Sharon, Stoughton, and Weymouth.
How Can an Elder Law Attorney Help?
There is nothing more important than avoiding nursing home care (not always possible, but if possible). Often the key to avoiding nursing home placement is in-home care. Elder law attorneys are an important resource as they know the ins and outs of the various programs available to assist elders in covering the cost of in-home care.
Elder law attorneys often assist elders in applying for in-home care programs. Notwithstanding asset limits of the various in-home care programs, there typically are methods for attaining eligibility even if the elder exceeds the limit.
Elders also need to be mindful of "estate recovery" as the Division of Medical Assistance is entitled to recover against the probate estate of any individual for whom MassHealth benefits were paid when he or she was age 55 or over. In order to do so, the agency must file a timely claim against the estate. Typically, there is no probate estate when an elder is on MassHealth as the asset limit is $2,000. However, many elders on MassHealth own a home as the home is noncountable as long as the equity value does not exceed $750,000.
There are steps that can be taken to protect the home from an estate recovery claim. An elder law attorney can assist by providing legal guidance regarding the home and MassHealth estate recovery.
Nothing in this blog should be considered legal advice as this is a complicated area of the law.
The author Brigitte von Weiss of VON WEISS LAW OFFICE is an estate planning lawyer and elder law attorney serving clients in Easton, MA, as well as nearby towns and cities, including Abington, MA, Attleboro, MA, Avon, MA, Bridgewater, MA, Brockton, MA, Canton, MA, East Bridgewater, MA, Foxboro, MA, Mansfield, MA, North Attleboro, MA, Norwood, MA, Norton, MA, Plainville, MA, Randolph, MA, Raynham, MA, Rehoboth, MA, Rockland, MA, Sharon, MA, Stoughton, MA, Walpole, MA, West Bridgewater, MA, and Whitman, MA.
Brigitte, a graduate of Boston College School of Nursing and an honors graduate of Loyola University of Chicago Law School, stands out from other elder law and estate planning attorneys in that she worked as a registered nurse for four years and earned a Master of Science in Taxation with high distinction from Bentley College. This unique combination of legal, nursing and taxation backgrounds enables Brigitte to provide outstanding legal guidance to her clients in their time of need. Call (508) 238-3005 for a free phone conversation with Brigitte to learn if she can help. You also may reach her through her website at www.vonweisslaw.com.