PACE Resource Guide
In short
To join PACE in California, a person generally must be 55 or older, live in a PACE service area, be certified by the State as needing nursing-facility level of care, and be able to live safely in the community with PACE help. Enrollment is voluntary. Medicare or Medi-Cal is not required to qualify clinically. Final eligibility is decided by the PACE organization and the State—not this website.
When a California family begins exploring PACE — the Program of All-Inclusive Care for the Elderly — one of the first questions is whether their loved one actually qualifies. PACE is not available to every senior. Understanding the eligibility rules before you invest time in assessments helps families plan more effectively.
This guide walks through the four eligibility conditions used in federal PACE rules, how California’s assessment process typically works, how Leslie’s partner programs fit into the statewide landscape, and what to do if your parent does not qualify right away.
Also see: PACE Costs · How to Qualify · How to Enroll — then request a callback with Leslie.
CMS lists four conditions for joining PACE. You can join even if you do not have Medicare and/or Medicaid, if you meet these conditions (CMS Quick Facts; CMS PACE Manual, Chapter 4 — Enrollment and Disenrollment; 42 CFR § 460.150):
DHCS describes the same core criteria for California participants (DHCS PACE FAQ; DHCS PACE overview).
Joining PACE is voluntary (CMS Quick Facts).
PACE is designed for older adults with complex care needs. The minimum age is 55. There is no maximum age limit. Many participants are older than 55, but age alone does not qualify someone — nursing-facility level of care and community-safety determinations still apply.
Your loved one must live within the geographic service area of a specific PACE organization. Availability is defined by county and ZIP code, not by “California generally.”
Partner programs this agency works with: Leslie Kaz / Syndicated Insurance Agency works with three PACE partners — WelbeHealth, myPlace Health (SCAN), and InnovAge. Use the homepage ZIP checker to see whether one of these partners may serve your loved one’s ZIP. Partner service areas can include communities in parts of Los Angeles, San Bernardino, Riverside, Sacramento, Fresno, San Joaquin, Stanislaus, Santa Clara, and other counties those partners serve — always verify with the current ZIP tool and the PO.
Statewide landscape: California has additional PACE organizations beyond these three partners. For the official statewide list of plans and service-area ZIP documents, see:
If your ZIP is not served by a partner, Leslie will say so and can point you to official statewide directories. See also WelbeHealth, myPlace Health, and InnovAge — partners this agency works with.
This is often the most substantive criterion. The State Administering Agency (in California, DHCS) must determine that the person needs the level of care required under the Medicaid State plan for nursing facility services.
In plain language: the person’s health and functional needs are complex enough that they would medically qualify for a nursing facility, even if they currently live at home.
Assessments typically consider functional limitations (activities of daily living such as bathing, dressing, and eating), cognitive status, and medical complexity. A PACE organization conducts enrollment assessment activities; DHCS certifies nursing-facility level of care.
This website cannot certify NFLOC. Only the State (with the PACE organization’s assessment process) can.
At enrollment, the person must be able to live in a community setting without jeopardizing health or safety, based on criteria in the PACE program agreement developed with the State.
PACE is designed to support seniors who can remain at home (or in the community) with appropriate services. If needs are so acute that community living would be unsafe even with PACE, enrollment may be denied. CMS requires written notice and referrals to alternatives when denial is based on community-safety concerns.
A potential participant is not required to be a Medicare beneficiary or Medi-Cal recipient to meet PACE eligibility. Cost responsibility, however, depends heavily on Medicare/Medi-Cal status — see PACE Costs in California.
Once enrolled, a participant generally may not be concurrently enrolled in another Medicare Advantage plan, Part D plan, Medicaid prepayment plan, certain HCBS waivers, or the Medicare hospice benefit. That “sole source of care” design is why network lock-in questions come up during enrollment counseling — covered in PACE Enrollment in California.
CMS describes intake as an intensive process that includes one or more visits to the potential participant’s home and one or more visits to the PACE center. At a minimum, intake includes explaining the program and enrollment agreement, obtaining releases for medical/financial information, State assessment for nursing-facility level of care, and PACE organization assessment of whether the person can be cared for safely in the community.
DHCS’s consumer-oriented steps commonly include: checking service-area ZIP availability, contacting a PACE plan for a home visit, touring a PACE site, and completing a medical and social assessment by the interdisciplinary team.
Timeline: DHCS notes the application/assessment process can take a few weeks (DHCS Medi-Cal Managed Care FAQ — PACE). Exact timing varies by organization, documentation completeness, and scheduling.
If the prospective enrollee meets eligibility requirements and signs the enrollment agreement, CMS states the effective date of enrollment is the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement. Step-by-step enrollment detail: PACE Enrollment in California.
| Question | Answer |
|---|---|
| Who does Leslie work with? | WelbeHealth, myPlace Health (SCAN), and InnovAge — this agency’s PACE partners. |
| Are those the only PACE programs in California? | No. Other PACE organizations operate in California. See DHCS PACE Plans and CalPACE. |
| What should families do first? | Check ZIP → request a callback with Leslie when a partner may serve the area. |
| Who decides eligibility? | The PACE organization and the State of California — not this website and not the licensed agent alone. |
If the State does not certify nursing-facility level of care at the time of assessment, or if community-safety criteria are not met, the person may not enroll now. Needs can change; families sometimes revisit eligibility later. A licensed agent can help you stay oriented to options and timing.
In the meantime, other Medicare, Medi-Cal, or long-term services and supports pathways may be relevant depending on the situation. For comparisons that families often ask about, see PACE vs. Assisted Living in California and the Family Caregiver Guide.
Final eligibility is determined by the PACE organization and the State of California, not by this website.
Generally: age 55+, residence in a PACE service area, State certification of nursing-facility level of care, and ability to live safely in the community with PACE services.
No. Medicare/Medi-Cal enrollment is not required to meet clinical eligibility. Cost responsibility changes based on coverage.
It means the State determines the person needs the level of care that Medicaid would cover in a nursing facility — even if they still live at home. A home assessment and clinical review are part of the process.
DHCS indicates the process can take a few weeks. Timing varies. Ask the specific PACE organization for current expectations in your area.
No. Leslie guides families, helps with ZIP matching to partner programs, and coordinates introductions. Final eligibility is determined by the PACE organization and the State of California.
Leslie will say so. Check the full statewide directory at DHCS PACE Plans and CalPACE.
Official statewide references (secondary): DHCS PACE Plans · DHCS PACE FAQ · CMS Quick Facts (PDF)
Final eligibility is determined by the PACE organization and the State of California. This website does not guarantee eligibility or enrollment.
Related: PACE Costs in California · PACE Enrollment in California · What PACE Covers · PACE FAQ
Leslie Kaz, RHU is a licensed California insurance agent specializing in Medicare and PACE programs, operating through Syndicated Insurance Agency, LLC (CA License #0B32530). Leslie works as an independent advisor with three PACE partners — WelbeHealth, myPlace Health (SCAN), and InnovAge — and guides families through ZIP matching and enrollment coordination at no cost to the family.
Compensation. Guidance is at no cost to families. If enrollment occurs through this agency with a partner PACE organization, the agency may be compensated by that organization — not by the family.
Service area. Availability of PACE depends on ZIP code, program service area, and final eligibility as determined by the PACE organization and the State of California.
Ready to Learn More?
Check your ZIP, then request a callback with Leslie — at no cost to your family. DHCS and CalPACE remain secondary official references.
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