PACE Resource Guide
In short
Enrolling in California PACE usually moves from ZIP check and inquiry, to home/center visits and assessments, to State nursing-facility-level-of-care certification, then a signed enrollment agreement. Coverage generally starts the first day of the next calendar month after the PACE organization receives the signed agreement. Leslie guides families; the PACE organization and DHCS decide eligibility.
Also see: PACE Costs · How to Qualify · How to Enroll — then request a callback with Leslie.
This page covers enrollment in the Program of All-Inclusive Care for the Elderly (PACE) — not Property Assessed Clean Energy financing.
PACE enrollment is more than filling out a web form. It is a regulated process involving:
Federal enrollment and disenrollment rules are summarized in CMS PACE Manual, Chapter 4. California consumer steps are outlined by DHCS. Eligibility basics: How to Qualify for PACE in California.
This website does not enroll anyone into PACE and does not guarantee acceptance. Final eligibility is determined by the PACE organization and the State of California.
Exact calendars vary by organization and by how quickly records, assessments, and signatures are completed. DHCS notes the process can take a few weeks (DHCS Medi-Cal Managed Care FAQ).
Family / Leslie
PACE organization: Receives a referral or direct inquiry and schedules intake activities.
CMS describes intake as an intensive process: PACE staff make one or more visits to the potential participant’s residence, and the potential participant may visit the PACE center. Staff explain the program using the enrollment agreement, including that the PACE organization would be the sole service provider (access to services is guaranteed, not a specific named doctor), provider lists, premiums if any, and Medicaid spenddown / post-eligibility income information where applicable.
DHCS commonly describes contacting the plan for a home visit and attending a tour of the PACE site with family or caregivers.
Leslie’s role: Prepare the family for what will be asked, help gather questions, and stay available — Leslie does not replace the PO’s intake staff.
Two determinations run through the enrollment path:
| Who | What they assess |
|---|---|
| DHCS (State Administering Agency) | Whether the person needs nursing-facility level of care under the State Medicaid plan |
| PACE organization | Whether the person can be cared for appropriately and live safely in the community with PACE support; whether all program eligibility conditions are met |
The potential participant (or representative) signs releases so the PO can obtain medical and financial information and Medicare/Medi-Cal eligibility status.
DHCS notes the plan schedules a complete medical and social assessment by the interdisciplinary team.
If enrollment is denied because community living would jeopardize health or safety, CMS requires written notice of the reason, referral to alternative services as appropriate, documentation, and notice to CMS and the State.
If the person meets eligibility requirements, they (or a legal representative) must sign the PACE enrollment agreement. CMS requires the agreement to cover identity and coverage status, conditions of enrollment/disenrollment, premiums or spenddown obligations, the sole-provider requirement, emergency procedures, Participant Bill of Rights, grievance/appeals information, and more.
After signing, the PO must give the participant a copy of the agreement, a PACE membership card, and emergency information to post at home.
Leslie’s role: Help the family understand what they are signing and which questions to ask the PO. Leslie does not sign the enrollment agreement for the participant and does not override PO/State decisions.
Per CMS: if the prospective enrollee meets eligibility requirements and signs the enrollment agreement, the effective date of enrollment is the first day of the calendar month following the date the PACE organization receives the participant’s signed enrollment agreement.
Example (illustrative only): If the PO receives a valid signed agreement on March 12, enrollment generally becomes effective April 1, subject to successful processing with CMS/State systems.
After enrollment, the interdisciplinary team completes an initial comprehensive assessment and plan of care on a CMS-defined timeline (promptly following enrollment; consolidated plan within 30 days). That post-enrollment care planning is separate from the pre-enrollment eligibility decision.
| Task | Leslie (licensed advisor) | PACE organization (PO) | DHCS / State |
|---|---|---|---|
| Explain PACE in plain language | Yes | Yes | Publishes official program info |
| Check partner ZIP availability | Yes (site ZIP tool + callback) | Confirms service area | Publishes statewide ZIP/plan lists |
| Clinical / NFLOC determination | No | Assesses; coordinates | Certifies NFLOC |
| Community-safety determination | No | Yes (per State-approved criteria) | Oversight |
| Sign enrollment agreement | No | Receives / processes agreement | State enrollment processes as applicable |
| Decide final eligibility | No | Yes (with State) | Yes (with PO) |
| Coordinate partner referral | Yes | Accepts referrals / runs intake | — |
| Ongoing care after enrollment | No | Yes (IDT / network) | Oversight / recertification rules |
Guidance from Leslie is at no cost to the family. If enrollment occurs through this agency with a partner PO, the agency may be compensated by that organization — not by the family.
PACE participants must use providers in the PACE organization’s network for needed services (other than emergency / urgently needed out-of-network rules described in the enrollment agreement). CMS is explicit that the PO guarantees access to services, not to a specific provider.
If keeping a particular physician is non-negotiable, ask the PO during intake whether that clinician is contracted. Do not assume continuity.
PACE is designed as the participant’s sole source of Medicare- and Medicaid-covered services through the PO’s network. Electing certain other Medicare/Medicaid products after enrollment can be treated as voluntary disenrollment from PACE.
However, a participant may voluntarily disenroll at any time without cause. Voluntary disenrollment is effective the first day of the month following the date the PO receives the participant’s notice.
After leaving PACE, special election / Medigap guaranteed-issue rules may apply on timelines set in CMS guidance. Families should confirm current rights with the PO, Medicare, or a licensed advisor at the time of disenrollment.
PACE is intended to help people remain in the community; if nursing facility care becomes necessary, PACE organizations remain responsible for covered care under program rules. See also What Does PACE Cover? and CalPACE/DHCS consumer materials. Individual situations vary — ask the PO during intake.
Cost depends on Medicare/Medi-Cal status (often $0 premium or share of cost for dual-eligible participants; premiums for Medicare-only or private pay). Details: PACE Costs in California. No dollar amount on this page is a personal quote.
Leslie works with WelbeHealth, myPlace Health (SCAN), and InnovAge. Those partners are the primary path this agency supports for callbacks and enrollment coordination.
California also has other PACE organizations. For statewide plan and ZIP listings, use DHCS PACE Plans and CalPACE as secondary official references — after you check partner availability on this site.
Related: PACE Costs · How to Qualify · How to Enroll · Partners · Caregiver Guide
Check service-area ZIP availability, contact a PACE organization (or request a callback with Leslie for partner ZIPs), complete intake visits and assessments, obtain State NFLOC certification, and sign the enrollment agreement. Coverage generally starts the first of the month after the PO receives the signed agreement.
DHCS indicates the process can take a few weeks. Scheduling, records, and assessments affect timing.
Generally the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement.
Yes. Voluntary disenrollment is allowed at any time without cause; it is effective the first of the month after the PO receives notice.
Leslie guides and coordinates with partner organizations. The PACE organization and the State determine eligibility and complete enrollment. This site does not guarantee enrollment.
Official statewide references (secondary): DHCS PACE Plans · DHCS PACE FAQ · CMS Chapter 4 (PDF) · Medicare.gov PACE
Final eligibility is determined by the PACE organization and the State of California. This website does not guarantee eligibility, start dates, or enrollment.
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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