OPINION:
Long-term health care awareness and conversation are rising in America, but most have not heard of the Program of All-Inclusive Care for the Elderly. For the nation’s most vulnerable seniors, particularly in Ohio, where officials are trying to get the program off the ground, PACE could be life-changing if properly implemented and managed.
PACE is designed to deliver wraparound medical and social services to low-income seniors who qualify for nursing home care. It is a thoughtful model that works for the patient and the taxpayer, allowing seniors to receive care in their homes and communities, not in an institutional setting such as a nursing home. Though a small percentage of participants qualify through private insurance, most PACE participants are enrolled in Medicare and Medicaid. The results speak for themselves: This safety net program has improved quality of life, reduced hospitalizations and kept vulnerable seniors out of costly long-term care facilities.
Best of all, it saves states money. Under PACE, providers receive a fixed payment to manage all care needs for participants, incentivizing preventive care that keeps participants out of the nursing home setting. As a result, the program saves state governments an average of $6,000 per person annually in Medicaid spending compared with nursing home care. It’s no wonder that Centers for Medicare & Medicaid Services Administrator Mehmet Oz said the program is a “miracle” for older adults.
PACE has long been overlooked as an eldercare option, but states such as Ohio have recently targeted it for expansion.
Ohio’s adoption of PACE through a competitive request-for-proposal process was a forward-thinking policy decision. Still, the program’s future is at risk because of what seems like typical bureaucratic meddling, well-intentioned or not. It is becoming a bit of a cautionary tale, but it’s not too late for the reliably commonsense Gov. Mike DeWine to step in and right the ship.
When Ohio launched the PACE RFP, applicants relied on the Medicaid rate offered to the only operating PACE provider in the state, located in the Cleveland area, as the baseline. Applicants for the PACE expansion built financial plans, secured funding, hired staff and began laying the groundwork for new programs. After the awards were issued and millions of dollars were invested, the state returned with a shock: Rates would be set nearly 20% lower than those offered in Cleveland. The state failed to account for national guidelines when devising these payment rates. As a result, they rank among the lowest in the nation.
This isn’t about profitability; it’s about whether programs can sustain operations long enough to deliver strong results. Unfortunately, PACE programs are quietly reconsidering whether they can move forward and open their doors. If they can’t, the dollars provided by the American Rescue Plan Act to cover startup costs would be wasted.
Without a clear path to sustainability, PACE programs are unlikely to expand. Instead, they will be confined to a few areas in the state, falling far short of their potential. Further, without access to the program, thousands of eligible participants will be forced to receive care in higher-cost nursing homes and hospitals.
Again, there is still time to correct the course. Mr. DeWine’s administration deserves credit for taking the promising step to expand PACE in Ohio. State leaders must establish a fair and stable rate structure that empowers providers to grow. With the right support, PACE can transform aging in Ohio, allowing older adults to live with dignity, independence and better health.
PACE could and should be one of Ohio’s proudest innovations, part of Mr. DeWine’s legacy and a model for other states. Ensuring that PACE lives up to its promise for today’s seniors and generations to come would be a long-term health care policy win for all.
Correction: A previous version of this column misidentified the American Rescue Plan Act.
• Terry Wilcox is the co-founder and chief mission officer of Patients Rising.
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