Program of All-Inclusive Care for the Elderly (PACE) in Ohio
The Ohio Program of All-Inclusive Care for the Elderly (PACE) is a comprehensive health and medical coverage plan designed to provide elderly patients with services within their communities. The PACE program is largely based on coverage within Medicare and Medicaid, and its participants are often dually-eligible. However, PACE services differ from those offered within either Medicare or Medicaid, in that patients who qualify for PACE can receive services in their communities, rather than at nursing facilities. As such, those who meet PACE eligibility are typically seniors that are often facing chronic, long-term medical conditions. Learn more about the PACE program, including how to qualify for PACE in Ohio, in the sections below.
Ohio PACE Program Eligibility Requirements
PACE services in Ohio are meant to assist elderly patients over the age of 55. Note that the age requirement is determined by the federal government, and cannot be altered by organizations providing PACE services in the state of Ohio. As such, the age requirement, along with other core criteria, will remain standard across organizations. However, some organizations might be able to impose additional restrictions, so long as they do not alter these core aspects.
Although many patients who enroll in PACE are often dually-eligible for Medicare coverage as well as Medicaid, this is not a rule. Organizations participating in the PACE program are prohibited from discriminating on the basis of coverage. Applicants eligible for PACE do not need to be current recipients of either Medicare or Medicaid coverage. However, those recipients who are currently enrolled in some programs such as Medicare Part A, B or Medicaid may already be pre-qualified for enrollment in PACE, should they fulfill the other criteria.
Note that due to the structure of PACE program networks, the applicant’s eligibility for PACE will be affected by his or her place of residence. Recipients of PACE services must live within communities that are serviced by a network of doctors specifically caring for OH PACE participants. Although this may limit the availability of services, it remains one of the benefits that the Ohio PACE program provides patients who face debilitating illnesses, as it allows them to receive health and medical care services within their communities, rather than at isolated facilities. Learn more about PACE services in Ohio by downloading our free, informative guide.
How to Enroll in the Ohio PACE Program
In the state of Ohio, the PACE application process can be lengthy. Applications for PACE can be submitted directly to the local PACE organization. As such, applicants should check for PACE programs in their areas, either online or by calling a local Medicare office. Once the applicant has found an organization in his or her community, reaching out via phone about enrolling in PACE will begin the process.The PACE application process will require multiple visits between the applicant and the caretaker(s) at his or her selected organization in order to certify the applicant’s medical condition. Caretakers must gauge whether the patient is in a condition to travel within the community, or if he or she will require care at an isolated treatment facility. The certification process will begin promptly after the applicant has enrolled in PACE.If the PACE organization approves an applicant for enrollment in PACE, care will begin on the first day of the next month after receiving the signed enrollment agreement. No services performed before this time will be considered PACE services, as the first of the month will serve as the applicant’s effective date. Typically, during the application process for PACE, the initial health assessment will also allow the caretakers to begin formulating treatment to begin on the effective date.
Should the PACE organization deny an applicant, this will be on the basis of his or her medical condition. The Ohio PACE program is designed for patients capable of living within their communities, while also receiving care. Some patients may be experiencing conditions that can be worsened by traveling for PACE services within their communities, so caretakers will recommend qualified treatment facilities, instead. Learn more about PACE enrollment by downloading our complimentary guide.
Ohio PACE Program Coverage and Services
When you enroll in PACE, it will provide many of the same benefits as Medicare and Medicaid. PACE services in OH also allow participants to receive treatment for services that might not be covered under some of these plans. More specifically, considering that some plans, like those within Medicare Part A, do not always cover home health services such as custodial care, PACE programming offers an alternative to assist those patients who may also need limited home services.
The Ohio PACE program will provide all of the same coverage offered within Medicare, from inpatient hospital treatment to medical procedures, and even prescription drug coverage. In no way does a patient’s ability to pay for these services affect what treatment he or she receives. This is because when patients apply for PACE, they are often already qualified to receive Medicare and Medicaid. As such, services in PACE can be considered extensions of what benefits these patients may already receive. Additionally, Ohio PACE services also include ancillary benefits, such as coverage for dentistry, preventive care and social services. These are benefits that might be optional for most Medicare applicants choosing Original Medicare over Medicare Advantage or other plans. Within PACE, however, these services are included. Learn more about PACE coverage by downloading our comprehensive guide.