Medi-Cal PACE Program: How Medi-Cal Covers PACE and What Families Need to Know

The Medi-Cal PACE program is a long-term care option that bundles your parent's medical care, prescriptions, personal care, adult day services, and transportation into a single coordinated plan — paid for by Medi-Cal (and Medicare, if your parent has both). PACE stands for Program of All-Inclusive Care for the Elderly, and for families already navigating Medi-Cal, it replaces the patchwork of separate Medi-Cal benefits with one interdisciplinary team coordinating the covered care. If your parent qualifies, there is generally no PACE premium and no copay or deductible for PACE-approved services, although a Medi-Cal share of cost or another payment obligation can still matter.

Here is how PACE works specifically for Medi-Cal recipients, what it costs, and what changes when your parent enrolls.

How Medi-Cal Pays for PACE

PACE operates on a capitated model: Medicare and/or Medi-Cal pay the PACE organization a fixed monthly amount per enrollee, and in return the organization provides or arranges the covered care. For someone enrolled in both Medi-Cal and Medicare (a "dual eligible"), Medicare pays a portion and Medi-Cal pays the rest. For a person with Medi-Cal, there is generally no PACE premium and no copay or deductible for PACE-approved services, but a share of cost or another payment obligation can still apply.

For someone who has Medi-Cal but not Medicare — typically someone aged 55–64 who does not yet qualify for Medicare — Medi-Cal provides the Medicaid capitation payment to the PACE organization. A person with Medi-Cal generally has no PACE premium or copays for approved services, but any share-of-cost responsibility still needs to be addressed. This is one of the reasons PACE is worth investigating for younger adults who meet the other eligibility requirements.

The financial structure is fundamentally different from fee-for-service Medi-Cal, where each doctor visit, prescription, and home care hour is billed separately. Under PACE, the organization has a financial incentive to keep your parent healthy and out of the hospital, because it bears the cost of inpatient care from the same capitated payment.

Who Is Eligible for Medi-Cal PACE

Four requirements must all be met:

1. Age 55 or older. Despite the word "Elderly" in the name, California PACE serves adults starting at 55.
2. Certified as needing a nursing-facility level of care. The PACE organization conducts a medical and functional assessment, and the California Department of Health Care Services (DHCS) certifies the determination. A diagnosis alone does not decide this — the assessment looks at what your parent can and cannot do independently.
3. Live within a PACE organization's service area. PACE is not available statewide. Each organization covers specific ZIP codes, and even within a county that has a PACE provider, not every address is in-area.
4. Able to live safely in the community at the time of enrollment, with the services PACE provides.

Medi-Cal eligibility is a separate determination. If your parent is not yet enrolled in Medi-Cal, the PACE organization can often help coordinate the application. California's current Medi-Cal income rules for aged and disabled individuals vary by eligibility category and are updated periodically — contact the county eligibility office or the PACE organization for the rules that apply to your parent's household.

What Changes When a Medi-Cal Recipient Enrolls in PACE

Enrolling in PACE is not simply adding a benefit on top of existing Medi-Cal services. PACE generally becomes the sole source of the participant's Medicare and Medi-Cal benefits, subject to limited exceptions such as emergency care. Understanding what changes is as important as understanding what your parent gains.

If your parent is in Medi-Cal managed care, that enrollment ends. PACE participants cannot receive Medi-Cal managed care benefits at the same time. The PACE organization becomes the single point of coverage for all services that PACE covers. If your parent currently has a managed care plan that coordinates their doctors and specialists, those relationships will change.

Existing home- and community-based services end or change. PACE participants generally cannot receive other Medi-Cal program services at the same time. DHCS specifically identifies IHSS and MSSP, and its current guidance also bars Medi-Cal managed care and associated CalAIM benefits; CBAS and other waiver services outside PACE should be treated as part of the transition. Ask the PACE organization exactly which PACE services will replace current IHSS, CBAS, or waiver support, because providers and schedules can differ.

Your parent receives care through the PACE team. Covered medical care, including primary care, is generally delivered by the PACE organization's interdisciplinary team and its contracted providers, except in situations such as emergencies. Your parent may need to change a primary care physician or specialist they have seen for years unless the clinician also works with the PACE organization. For some families this is a significant drawback; for others — especially those already struggling to coordinate between multiple providers who do not communicate — it is the core benefit.

Prescription drugs go through PACE. The PACE pharmacy manages medications. If your parent has Medicare, PACE supplies Part D-covered drugs and other necessary medications, and a separate Medicare Part D plan cannot be used alongside PACE. The PACE plan's drug list may differ from their current Part D plan's formulary. Ask the PACE organization whether your parent's current medications are covered before enrolling.

Where Medi-Cal PACE Is Available

California has multiple PACE organizations, but geographic coverage is limited. DHCS's July 2026 directory shows PACE service areas in parts of the following counties (among others): Alameda, Contra Costa, Los Angeles, Marin, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, Santa Clara, and Sonoma. Each plan serves a defined set of ZIP codes — county-level coverage does not mean universal coverage within that county.

DHCS paused accepting new PACE applications, including applications for new organizations and existing-organization service-area expansions, effective November 20, 2025, through at least November 19, 2027. Applications already received and in process can continue; the pause limits new application submissions. If your parent's address is not currently within a PACE service area, do not assume an expansion is available — verify the current directory and provider directly.

Confirm directly with the PACE organization whether your parent's specific address qualifies before building a care plan around PACE enrollment.

Medi-Cal PACE vs. Staying on Fee-for-Service or Managed Care Medi-Cal

The decision comes down to how much coordination your family needs.

PACE is strongest when your parent has complex, overlapping needs. Multiple chronic conditions, cognitive decline, need for daily personal care, frequent medical appointments, and transportation barriers — PACE wraps all of these into one team. It can reduce the need for the adult child to be the de facto care coordinator calling between the doctor's office, the pharmacy, the home care agency, and the county IHSS office.

Fee-for-service or managed care Medi-Cal may preserve more flexibility. Your parent may be able to keep current doctors or continue IHSS, depending on the coverage and provider arrangements; managed care itself has a provider network. If your parent has a stable care situation — a trusted primary care physician, adequate IHSS hours, a manageable medication regimen — there may be no reason to switch.

Managed care plans are expanding long-term care coordination. Some Medi-Cal managed care plans offer Enhanced Care Management and Community Supports under CalAIM, which can provide care coordination and some home-based services without the all-or-nothing enrollment switch that PACE requires. Eligibility and availability vary, so ask your parent's current managed care plan what it offers before assuming PACE is the only integrated option.

How to Start the Medi-Cal PACE Enrollment Process

1. Check whether a PACE organization serves your parent's address. Call the provider directly or check the DHCS PACE directory. Do not assume based on county alone.
2. Confirm Medi-Cal eligibility. If your parent is not currently enrolled in Medi-Cal, begin the application through the county or through Covered California. The PACE organization may assist with this process.
3. Request an assessment. The PACE organization will arrange a medical and functional evaluation — often starting with a home visit — to determine whether your parent meets the nursing-facility level of care standard.
4. Review what changes. Before signing enrollment paperwork, get a clear answer on which current services may end or change (IHSS hours, managed care plan, Part D coverage, existing providers) and what PACE will provide in their place.
5. Ask about the initial care plan. Once approved, the interdisciplinary team builds a care plan covering medical visits, adult day attendance, home care, therapies, and transportation. Understand the plan before your parent's first day.

Enrollment timing varies between PACE organizations. If your parent is being discharged from a hospital or their care needs are escalating, tell the organization when you first call and ask what assessment timeline is realistic.

Getting the Financial Details Right Before Enrolling

PACE enrollment and Medi-Cal financial eligibility are related but involve separate determinations. California's transfer look-back rules are a separate planning question from the PACE clinical assessment and enrollment process. Do not assume that a rule applying to institutional Medi-Cal (nursing facility coverage) applies in the same way to PACE; confirm with the PACE organization and county eligibility office before making any asset transfers or joint-account changes.

If your parent has a Medi-Cal share of cost, ask the PACE organization how that obligation will be handled. California's PACE enrollment materials say that Medi-Cal-only and dual-eligible participants may have a premium or share-of-cost responsibility even though there are no copays or deductibles for authorized services. Getting a clear answer before enrollment prevents surprises on the first month's bill.

Our California Medi-Cal Long-Term Care & Asset Protection Guide walks through the eligibility documentation, asset inventory, and county application process that runs alongside PACE enrollment — so you can prepare the financial side while the PACE assessment is underway.

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