San Francisco PACE Qualifications: Who Is Eligible and How to Enroll

To qualify for PACE (Program of All-Inclusive Care for the Elderly) in San Francisco, your parent must be 55 or older, live within a participating PACE organization's service area in the city, be certified as needing a nursing-facility level of care, and be able to live safely in the community with PACE support at the time of enrollment. If all four conditions are met, PACE bundles medical care, adult day services, personal care, prescriptions, and transportation into one coordinated plan and can reduce the need to coordinate separate providers.

Which PACE Organizations Serve San Francisco

Two PACE organizations currently serve San Francisco County: On Lok PACE and NEMS PACE (North East Medical Services). On Lok developed the PACE model in San Francisco in the 1970s in the city's Chinatown-North Beach community. On Lok operates multiple centers in San Francisco and also serves parts of Alameda and Santa Clara counties; NEMS operates a PACE center in San Francisco and also serves part of Santa Clara County.

Not every San Francisco address falls within every organization's approved service area. Coverage is defined by ZIP code, and ZIP-code boundaries can split a single neighborhood. Before investing time in an assessment, check the current DHCS list and call the PACE organization you are considering to confirm that your parent's specific address qualifies.

The California Department of Health Care Services (DHCS) maintains a directory of PACE plans and their service areas. DHCS paused applications for new PACE organizations and service-area expansions from November 20, 2025, through at least November 19, 2027. Use the current directory rather than assuming a new organization or expanded service area will become available soon.

The Four PACE Qualifications Explained

Each requirement must be satisfied — meeting three out of four is not enough.

1. Age 55 or Older

Despite the word "Elderly" in the program name, PACE enrollment starts at age 55, not 65. Medicare is often associated with age 65, but age alone is not the PACE test. A 57-year-old parent with Medi-Cal who needs daily help may still qualify if the other conditions are met.

2. Nursing-Facility Level of Care Certification

Your parent must be assessed as needing the kind of care a nursing facility provides. This does not mean they need to be in a nursing home — the level-of-care assessment considers functional limitations such as difficulty with bathing, dressing, transferring, managing medications, or similar daily tasks.

The PACE organization conducts this assessment, and DHCS certifies the determination. A diagnosis alone — even a dementia diagnosis — does not decide eligibility. The assessment looks at what your parent can and cannot do day to day and whether the full PACE eligibility standard is met.

3. Live Within the Service Area

Your parent's home address must fall within the PACE organization's approved service area. In San Francisco, that means the ZIP codes the organization is approved to serve. If your parent lives just outside the boundary, they are not eligible for that organization regardless of medical need.

4. Able to Live Safely in the Community

At the time of enrollment, the assessment must find that your parent can live at home (or in another community setting) with PACE support. If the organization determines that your parent cannot be safely supported in the community, they may not meet this criterion at that time. This is assessed case by case.

How San Francisco PACE Enrollment Works

The process typically looks like this:

1. Verify service-area eligibility. Check the current DHCS county-and-ZIP list, then call On Lok or NEMS and confirm your parent's address is within that organization's service area. Ask which center would serve them.

2. Request an assessment. The PACE organization will schedule a comprehensive evaluation, which may include a home visit, to determine whether your parent meets the nursing-facility level of care standard. The interdisciplinary team (physician, nurse, social worker, therapists) participates in this process.

3. Coordinate Medi-Cal enrollment if needed. PACE can serve someone with Medicare, Medi-Cal, or both, but the coverage arrangement affects premiums and enrollment. If your parent does not yet have Medi-Cal, apply through San Francisco's Human Services Agency while asking the PACE organization how the two processes should be coordinated.

4. Meet the care team and build the initial plan. Once enrollment is approved, the interdisciplinary team develops a care plan covering medical visits, day-center attendance, home care, therapies, prescriptions, and transportation. The plan adjusts as your parent's needs change.

Enrollment timing varies by plan. If your parent is being discharged from a hospital or their condition is changing quickly, tell the PACE organization when you call and ask what timeline is realistic.

What PACE Costs in San Francisco

For a parent who qualifies for both Medicare and Medi-Cal, the PACE plan generally has no additional monthly premium and no deductibles, copayments, or coinsurance for covered services approved by the care team. A Medi-Cal share of cost, if applicable, remains the participant's responsibility, and separate Medicare premiums may still apply. Medicare and Medi-Cal pay the PACE organization a fixed monthly capitation on your parent's behalf.

If your parent has Medicare but does not qualify for Medi-Cal, they may still enroll if they meet the PACE criteria, but they will generally pay a monthly premium for the long-term-care portion of the PACE benefit and a premium for Medicare Part D drugs. The amount depends on their Medicare coverage and the plan, so contact On Lok or NEMS for current figures. For families in this situation, compare the PACE premium against the cost of arranging equivalent services (home care, adult day, transportation, prescriptions, primary care) separately.

If your parent has Medi-Cal but not yet Medicare (for example, a 58-year-old on Medi-Cal), enrollment may still be possible if the other PACE conditions are met. Ask the organization how it would handle the coverage and whether any share of cost applies.

The Provider Lock-In Tradeoff

The single most important thing to understand before pursuing PACE enrollment is that your parent agrees to receive all covered care through the PACE organization's team and contracted providers, except in emergencies. This is what makes the model work — the same team that sees your parent at the day center also manages prescriptions, orders labs, and coordinates with home-care staff.

It also means your parent may need to leave their current primary care physician. For some families, especially those whose parent has a decades-long relationship with a doctor, this is a dealbreaker. For others — particularly those already exhausted from coordinating between specialists who do not communicate with each other — the integrated model is the entire point.

Ask On Lok or NEMS whether any of your parent's current providers are already in their network before assuming the switch is total.

PACE vs. Other Medi-Cal Options in San Francisco

San Francisco families exploring alternatives to PACE through Medi-Cal have several options:

• In-Home Supportive Services (IHSS) provides county-authorized help with personal care, meals, and protective supervision at home. It is an in-home services program rather than a comprehensive medical plan, so it does not itself coordinate medical care or cover prescriptions. It may fit families whose main need is authorized help at home and who already have a stable medical team.

• Community-Based Adult Services (CBAS) offers structured day programs with nursing, therapy, and social services at a licensed center. It adds center-based health services without replacing your parent's broader medical care.

• Multipurpose Senior Services Program (MSSP) provides case management and links to community services. It coordinates but does not directly provide medical or personal care.

PACE is the integrated option among these, rather than a stand-alone in-home or day-service benefit. Under current DHCS guidance, PACE participants receive Medicare and Medi-Cal benefits solely through PACE; concurrent enrollment in MSSP, HCBA, other fee-for-service Medi-Cal programs, or Medi-Cal managed care and associated CalAIM benefits such as Community Supports is not allowed. If your parent already receives one of these services, ask the PACE organization and your county office what would change before enrolling.

Next Steps

Start with the address check — everything else depends on whether your parent lives within the service area of On Lok or NEMS. If they do, request the assessment and begin the Medi-Cal application (if needed) while asking the PACE organization how to coordinate the two processes.

Our California Medi-Cal Long-Term Care & Asset Protection Guide walks through the financial eligibility side — organizing income and asset documentation, understanding transfer rules, and preparing for county review. PACE eligibility and Medi-Cal financial eligibility overlap but are not identical, so confirm current financial rules with the county and PACE organization before making a care or benefits decision.

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