Kentucky PACE Program: All-Inclusive Care for Seniors Who Want to Stay Home

What PACE Is

The Program of All-Inclusive Care for the Elderly (PACE) is a combined Medicare and Medicaid program that provides comprehensive medical and supportive services to people aged 55 and older who meet their state's nursing facility level of care but prefer to remain living at home or with family.

The defining feature of PACE is that a single interdisciplinary team — physician, nurse, social worker, physical therapist, dietitian, transportation coordinator — manages every aspect of the participant's care. There is no juggling separate Medicare and Medicaid benefits, no fighting with insurance over pre-authorizations, and no coordinating between multiple providers who do not talk to each other.

The PACE organization becomes the participant's sole source of covered services, but those services may be delivered at the PACE center, in the participant's home, or through contracted providers. Primary care visits, specialist referrals, prescription drugs, adult day health services, home care, hospital care, nursing facility care if temporarily needed, and transportation are all coordinated through one program.

How PACE Works in Kentucky

Kentucky's PACE programs operate through designated PACE organizations that contract with both Medicare and Medicaid. Each organization serves a defined geographic area — PACE is not available statewide. Current CHFS listings include service areas in central, western, southern, and eastern Kentucky, as well as Jefferson and northern Kentucky; check the current county list before assuming coverage.

Participants may attend the PACE day center; the frequency and services depend on the individual care plan. The center may provide:

• Primary and specialty medical care
• Nursing services
• Physical, occupational, and speech therapy
• Social work and care coordination
• Nutritional counseling and meals
• Recreational and therapeutic activities
• Personal care assistance

When services are provided outside the center, the PACE team may coordinate in-home services — personal care aides, home health visits, and medication management — to keep the participant safe at home.

Eligibility

To qualify for PACE in Kentucky, a person must:

• Be 55 years or older
• Live in the PACE organization's service area
• Meet Kentucky's nursing facility level of care criteria under 907 KAR 1:022 (the same clinical threshold required for the HCB waiver or institutional Medicaid)
• Be able to live safely in the community with PACE supports at the time of enrollment

The nursing facility level-of-care requirement is the Kentucky clinical standard under 907 KAR 1:022; it is not established solely by a simple two-ADL rule. PACE then coordinates that level of care in the community instead of in a facility.

Costs

For participants who qualify for both Medicare and Medicaid (dual-eligible), those programs pay for PACE services. Confirm the organization's current enrollment terms, including whether any participant-specific charges apply.

For participants who have Medicare but do not qualify for Medicaid, the PACE organization may charge a fee for the Medicaid portion of services. The amount varies by organization. Kentucky also permits private-pay PACE; ask the organization for the current amount before enrolling.

The all-inclusive model covers the services in the approved PACE plan, but ask the organization to explain the participant's premium, cost-sharing, and other charges before enrolling.

PACE vs the HCB Waiver

Both PACE and Kentucky's Home and Community Based (HCB) waiver serve the same population — people who meet nursing facility level of care but want to stay home. The key differences:

Service model: The HCB waiver pays for individual home care services (attendant care, home-delivered meals, respite care) but does not provide medical care. PACE covers everything — medical, behavioral, pharmaceutical, and supportive services — under one umbrella.

Provider choice: Under the HCB waiver, you choose your own providers. With Participant Directed Services (PDS), you can even hire family members. Under PACE, all care goes through the PACE center's team. You give up provider choice in exchange for complete care coordination.

Availability: The HCB waiver has a waiting list. PACE enrollment depends on capacity and the current enrollment process at the local PACE organization, so ask that organization about availability and timing.

Geographic availability: The HCB waiver is available statewide. PACE is limited to the areas served by a PACE organization. If your parent does not live in a PACE service area, the HCB waiver is the available option.

Is PACE Right for Your Parent?

PACE works best for seniors who benefit from structured social engagement, have complex medical needs requiring close coordination, and are willing to receive all their care through one team. The day center model provides daily social interaction that reduces isolation — a significant quality-of-life factor for homebound seniors.

It is not the right fit for seniors who have strong relationships with existing physicians and do not want to change providers, or who value the flexibility of choosing their own home care aides through the HCB waiver's PDS model.

The Choosing Care in Kentucky guide covers both PACE and the HCB waiver in its care comparison framework, helping families evaluate which model matches their parent's clinical needs, social preferences, and geographic location.

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