MACPAC, the Medicaid and CHIP Payment and Access Commission, on Thursday released an issue brief examining data on the Program of All-Inclusive Care for the Elderly (PACE) and had some useful information on long-stay enrollees.

PACE is a fully integrated care model that provides Medicare and Medicaid services to individuals age 55 or older who meet a nursing facility level of care and can live safely in the community at the time of enrollment.

In 2023, approximately 89,659 individuals were enrolled in PACE nationwide based on Medicare and Medicaid administrative data used in the MACPAC analysis.

The majority of enrollees were dually eligible for Medicare and Medicaid, while a smaller share were Medicaid-only enrollees.

MACPAC noted that PACE operates under a capitated payment model and provides comprehensive services without typical benefit limits, allowing providers to tailor care to participant needs. “As a result, differences in enrollee characteristics may influence patterns of service use and outcomes,” the brief said.

Long-Stay Enrollees

In the brief, MACPAC looked at long-stay nursing facility use among PACE enrollees by coverage group and demographic characteristics, including whether individuals remained enrolled in PACE during the entire stay or disenrolled during the episode.

For the purposes of its analysis, long-stay nursing facility use is defined as stays of 90 days or more.

What MACPAC found is that Medicare-covered PACE participants had higher rates of long-stay nursing facility use than Medicaid-only participants (7.1 percent compared to 1.7 percent).

“Among participants with long-stay nursing facility use, most remained enrolled in PACE during these episodes, and rates of continued enrollment were similar across coverage groups and demographic characteristics. Disenrollment rates were higher among rural participants and among Medicaid-only participants age 65 and older,” the brief said.

Overall, the report on PACE highlights important differences in the characteristics of PACE enrollees by coverage type, including variation in age and racial and ethnic composition. These differences are associated with variation in patterns of service use, including long-term nursing facility use, while PACE enrollment remains largely consistent during these episodes.

“As enrollment in PACE continues to grow, improved data on enrollee characteristics and service use may help policymakers and program administrators better understand how the program serves different populations,” MACPAC said.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.