Virginia PACE Program: All-Inclusive Elder Care Without Nursing Home Placement

What PACE Actually Does

Your parent qualifies for nursing home placement but wants to stay at home. That tension is exactly what the Program of All-Inclusive Care for the Elderly (PACE) was designed to resolve.

PACE bundles every medical and social service a nursing-facility-eligible senior needs into a single coordinated package — primary care, specialist visits, prescription drugs, hospital stays, physical therapy, adult day health, personal care, meals, transportation, and social activities. Participants attend a PACE day center several times a week, where an interdisciplinary team of physicians, nurses, social workers, therapists, and dietitians manages their total care plan. Between day-center visits, home care aides and nurses provide whatever support the participant needs at home.

The model eliminates the fragmentation that makes Virginia's eldercare system so difficult to navigate. Instead of juggling separate Medicare claims, Medicaid waiver applications, and out-of-pocket home care bills, PACE handles everything under one roof.

Who Qualifies in Virginia

PACE eligibility requires meeting four criteria simultaneously:

• Age 55 or older (the federal minimum)
• Live within a PACE organization's approved service area in the Commonwealth
• Meet nursing facility level of care as determined through the Uniform Assessment Instrument (UAI) — the same clinical threshold required for CCC Plus waiver enrollment or nursing home Medicaid
• Able to live safely in the community at the time of enrollment, with PACE supports in place

The UAI screening evaluates dependencies in activities of daily living (bathing, dressing, toileting, transferring, eating) and instrumental activities (medication management, meal preparation, financial tasks). If the screening determines your parent needs the level of care a nursing facility provides, they meet the clinical bar for PACE.

How PACE Is Paid For

The payment structure depends on your parent's insurance coverage:

Dual-eligible participants (Medicare + Medicaid): Medicare and Medicaid jointly fund PACE services, including prescriptions. Ask the PACE organization whether any premium or cost-sharing applies to your parent's specific enrollment.

Medicare-only participants: Pay a monthly premium for the Medicaid-equivalent portion of services. The amount varies by program, so ask the PACE organization for the current premium before enrollment.

Private-pay participants: Individuals who meet the clinical and geographic criteria but don't qualify for either Medicare or Medicaid may be able to enroll by paying the program's full rate. Confirm availability and the current amount directly with the PACE organization.

What Makes PACE Different from the CCC Plus Waiver

Both PACE and Virginia's CCC Plus (Cardinal Care) waiver fund home and community-based services for people who qualify for nursing-facility-level care. The differences matter:

CCC Plus operates through managed care organizations (MCOs). Five MCOs coordinate services, but participants still see their own primary care physicians and navigate the broader healthcare system. Services are authorized individually and may have soft caps (56 hours per week for personal care, 480 hours per year for respite).

PACE replaces much of that fragmentation with a single provider. The PACE organization employs or contracts its own medical team and uses an interdisciplinary team to authorize services. Ask the organization which outside providers remain available and what service limits apply to the specific program.

The tradeoff is provider choice. With CCC Plus, your parent keeps their existing doctors. With PACE, they switch to the PACE medical team. For families managing complex medical situations across multiple specialists, that switch can be either a relief (one team coordinates everything) or a concern (losing established provider relationships).

How to Explore PACE for Your Parent

Start by confirming your parent lives within a PACE service area. Virginia's PACE organizations operate in specific regions — not every part of the Commonwealth is covered. Contact the nearest Area Agency on Aging (AAA) or call Virginia's No Wrong Door system to check service area availability and get connected to the local PACE intake team.

If your parent is already enrolled in a CCC Plus managed care plan, switching to PACE is possible but requires disenrollment from the MCO. The PACE organization's enrollment coordinator can walk you through the transition timeline.

For families weighing the full range of Virginia care options — from home care trials to facility placement to programs like PACE — the Virginia Care Decision Guide maps every pathway side by side, including the financial eligibility thresholds and agency contacts you need to act on any of them.

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