CareGrade™ OriginalQuick Answer
PACE (Program of All-inclusive Care for the Elderly) is a federal and state-funded program that helps older Californians with nursing-home-level care needs live safely at home — instead of moving into assisted living or a skilled nursing facility. In California, PACE is funded through Medi-Cal and Medicare, making it free or very low-cost for most participants.
Key Takeaways
- PACE serves adults 55+ who qualify for nursing-home-level care but want to remain at home
- California has more PACE sites than almost any other state, with programs across Los Angeles, San Diego, the Bay Area, Sacramento, and beyond
- Medi-Cal covers PACE at no cost for eligible participants; Medicare covers it for dual-eligible enrollees
- PACE includes medical care, physical therapy, adult day services, transportation, and caregiver support — all coordinated in one program
- PACE is not assisted living, but it is a powerful alternative that delays or prevents placement
- Enrollment requires a formal assessment and referral; waitlists vary by region
What Is PACE? A Plain-Language Definition
PACE stands for Program of All-inclusive Care for the Elderly. It is a managed care model that wraps all of a frail older adult's medical and social services into a single, coordinated program — typically centered around a PACE center the participant visits several days per week.
Think of PACE as a "care team in a building." Physicians, nurses, social workers, therapists, and dietitians all share one chart and one care plan. Nothing falls through the cracks.
What Services Does PACE Include?
PACE is one of the most comprehensive benefit packages available in the U.S. for older adults. Covered services typically include:
- Primary and specialty medical care
- Prescription drugs
- Physical, occupational, and speech therapy
- Adult day health services (structured activities, meals, socialization)
- Home health and personal care aides
- Respite care for family caregivers
- Dental, vision, and hearing care
- Transportation to and from the PACE center
- Mental health and social work services
- Nutritional counseling and meals
- Hospital and nursing facility care when medically necessary
How Is PACE Different from Assisted Living?
| Feature | PACE | Assisted Living |
|---|---|---|
| Where you live | Your own home or family's home | A licensed residential facility |
| Cost (Medi-Cal eligible) | Usually $0 | Typically $3,500–$7,000+/month |
| Medical oversight | Full primary care team on-site | Varies; often limited |
| Transportation | Included | Usually extra or not offered |
| Social activities | Daily at PACE center | On-site at facility |
| Caregiver support | Included | Not typically offered |
For families navigating how to pay for assisted living in Los Angeles, PACE can eliminate the cost question entirely — if the older adult qualifies and prefers to remain at home.
Who Qualifies for PACE in California?
To enroll in a California PACE program, an individual must meet all of the following criteria:
- Age 55 or older
- Live within the PACE organization's service area
- Meet the nursing-facility level of care as determined by the California Department of Health Care Services (DHCS)
- Be able to live safely in the community at the time of enrollment (with PACE support)
- Be enrolled in or eligible for Medi-Cal (Medicare-only beneficiaries may also enroll and pay a monthly premium)
What Does "Nursing-Facility Level of Care" Mean?
This does not mean someone must be bedridden or in crisis. It means the individual has complex, ongoing medical and functional needs that would typically require institutionalization — things like:
- Two or more chronic conditions (e.g., diabetes + heart failure + dementia)
- Needing help with three or more activities of daily living (ADLs)
- Frequent hospitalizations or ER visits
A formal assessment by the PACE interdisciplinary team determines eligibility. This is not a self-reported process.
The California PACE Landscape: Programs by Region
California is a national leader in PACE enrollment, with programs operating in major metros and some rural counties. Here is a regional snapshot:
Los Angeles County
Los Angeles has several active PACE organizations, including programs operated by Astrana Health PACE, InSight PACE, and community-based health systems. The density of programs in LA means many ZIP codes are served.
Families exploring options in LA should also review PACE Programs in Los Angeles: A Medi-Cal Alternative to Assisted Living Placement for a deeper local dive.
San Diego County
San Diego is home to established PACE programs including ElderCare PACE and programs affiliated with major health systems. For families also weighing memory care, see how to pay for memory care in San Diego for context on the broader funding landscape.
Bay Area (San Francisco, Oakland, San Jose)
The Bay Area has long been a stronghold for PACE innovation. On Lok, the organization that invented the PACE model in San Francisco's Chinatown in the 1970s, still operates multiple sites in the region. Bay Area programs often serve high concentrations of Asian American elders with culturally specific services.
Sacramento Region
Programs like Sutter SeniorCare PACE serve Sacramento-area residents. The Central Valley, historically underserved, has seen growth in PACE access through federally designated expansion efforts.
Other Regions
- Inland Empire: Growing PACE presence through federally qualified health centers (FQHCs)
- Central Coast: Limited but emerging options
- Rural Counties: Access remains a challenge; telehealth-enhanced PACE models are expanding
Pro tip: The National PACE Association maintains a locator tool at pace4you.org. California's DHCS also publishes a current list of licensed PACE organizations.
Costs & Pricing: What Does PACE Cost in California?
For Medi-Cal Beneficiaries
If a participant is enrolled in full-scope Medi-Cal, PACE costs nothing out-of-pocket. Medi-Cal pays a capitated monthly rate directly to the PACE organization to cover all services.
For Medicare + Medi-Cal (Dual-Eligible) Beneficiaries
Participants who have both Medicare and Medi-Cal are "dual eligible." PACE becomes their combined Medicare and Medi-Cal plan — again, typically $0 out-of-pocket.
For Medicare-Only Beneficiaries (No Medi-Cal)
If someone has Medicare but does not qualify for Medi-Cal, they can still enroll in PACE but will pay a monthly premium. This premium is set by the PACE organization and reflects the Medicaid rate in the region. It is substantial — often $4,000–$6,000+ per month — though it still replaces all other Medicare premiums, copays, and out-of-pocket costs.
Cost Comparison at a Glance
| Payer Situation | Monthly PACE Cost |
|---|---|
| Medi-Cal only | $0 |
| Medicare + Medi-Cal | $0 |
| Medicare only (no Medi-Cal) | $4,000–$6,500+ (program-set) |
| Private pay (no Medicare/Medi-Cal) | Not typically available |
Families who are unsure whether their loved one qualifies for Medi-Cal should review the California Assisted Living Waiver (ALW) — another Medi-Cal program that covers assisted living costs and is often compared to PACE when families are deciding between home-based and residential care.
For a broader comparison of Medicaid-funded options nationally, the Medicaid Waivers for Assisted Living: A State-by-State Guide is a useful reference.
PACE vs. Other Medi-Cal Options: How to Choose
PACE is not the right fit for everyone. Here is a simple decision framework:
PACE may be the right choice if:
- Your loved one strongly prefers to remain at home
- They have complex medical needs requiring coordinated care
- A family caregiver is available to support home safety overnight and on weekends
- They live within a PACE service area
- They are socially isolated and would benefit from the day center community
PACE may NOT be the right choice if:
- Your loved one needs 24/7 supervised residential care that cannot be safely managed at home
- They live in a rural area without a nearby PACE center
- They are resistant to attending a day program multiple times per week
- Cognitive decline makes community-based management unsafe without full-time supervision
In cases where home-based care is not feasible, the California Assisted Living Waiver or a Medi-Cal-certified memory care facility may be more appropriate paths.
Next Steps: How to Enroll in a California PACE Program
Enrollment in PACE follows a defined process. Here is what to expect:
Step 1: Confirm Geographic Eligibility
Use the National PACE Association locator (pace4you.org) or contact California DHCS to find PACE organizations in your loved one's ZIP code.
Step 2: Request an Assessment
Contact the PACE organization directly. They will schedule an in-person assessment by an interdisciplinary team to confirm nursing-facility level of care.
Step 3: Verify Medi-Cal Status
If your loved one is not yet enrolled in Medi-Cal, work with a county social worker or benefits counselor to apply. This can often happen concurrently with the PACE intake process.
Step 4: Complete Enrollment Paperwork
PACE replaces existing Medicare and/or Medi-Cal managed care plans. Enrollment documents must be completed and submitted to DHCS.
Step 5: Attend Orientation and Begin Services
Once enrolled, a care plan is developed with the PACE interdisciplinary team. Transportation to the day center typically begins within the first week.
Average timeline: 2–6 weeks from first contact to active enrollment, depending on assessment availability and Medi-Cal verification.
Find and Compare PACE Programs with CareGrade™
Navigating PACE enrollment, Medi-Cal eligibility, and regional availability is complex. CareGrade™ builds tools specifically to help families make faster, more confident decisions.
- SeniorTrust™ — Verified ratings and real family reviews for PACE programs and care facilities across California
- CompareWhy™ — Side-by-side comparison of PACE vs. assisted living vs. home care options based on your loved one's needs and location
- CareCircle™ — Coordinate your family's research and next steps in one shared workspace
- Clara™ — CareGrade™'s AI care advisor, available 24/7 to answer your PACE questions, explain Medi-Cal eligibility, and walk you through next steps in plain language
Start with Clara™ today — describe your situation, and get a personalized roadmap for PACE enrollment or alternative care options in your area.