Tip for PACE-org-specific

PACE eligibility requires: age 55+, living in a PACE service area, certified to need nursing facility level of care, and able to live safely in the community with PACE services

Tip for PACE-org-specific

PACE is available to Medicare, Medicaid, and dually eligible individuals. Private pay options exist for those without Medicaid.

Tip for PACE-org-specific

Enrolling in PACE means ALL care must go through the PACE program — you give up your choice of outside doctors and hospitals (except emergencies)

Long-Term Caremoderate

PACE Enrollment Application

PACE-org-specific · PACE organizations (CMS-certified)

Enrollment in the Program of All-Inclusive Care for the Elderly. Provides comprehensive medical and social services for individuals age 55+ who qualify for nursing home level of care but can live safely in the community. Covers all Medicare and Medicaid services.

Form Details

Total fields: 50
Auto-fillable: 30 (60%)
Time without BeneFill: 45 minutes
Time with BeneFill: 12 minutes
Time saved: 33 minutes
Filled by: patient
Frequency: one time
State-specific: Yes — form may vary by state

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Where to Submit This Form

🏢

Apply at your local PACE program

https://www.medicare.gov/care-compare/?providerType=pace

PACE (Program of All-Inclusive Care for the Elderly) requires an in-person assessment at the PACE center.

🏢

Contact your local PACE program to begin the enrollment process

Filing Deadline

Apply at any time. Enrollment is effective the first day of the month after the PACE program and the applicant agree to enrollment.

Required Attachments

📎 PACE enrollment agreement signed by the participant
📎 Medicare and/or Medicaid documentation
📎 Medical records and medication list
📎 Level of care assessment (PACE conducts its own, but prior assessments are helpful)
📎 Financial information (for Medicaid eligibility if not already enrolled)

Processing Time

Assessment and enrollment process: 2-4 weeks. The PACE team conducts a comprehensive assessment including medical, functional, and social needs.

What Happens Next

PACE provides ALL medical, social, and long-term care services through the PACE center and home-based care. Participants receive coordinated care from an interdisciplinary team. PACE replaces Medicare and Medicaid benefits — all care must go through PACE except emergency services.

Tips for This Form

✓ PACE eligibility requires: age 55+, living in a PACE service area, certified to need nursing facility level of care, and able to live safely in the community with PACE services
✓ PACE is available to Medicare, Medicaid, and dually eligible individuals. Private pay options exist for those without Medicaid.
✓ Enrolling in PACE means ALL care must go through the PACE program — you give up your choice of outside doctors and hospitals (except emergencies)
✓ PACE provides comprehensive services including adult day care, home care, transportation, medications, hospital care, and nursing facility care when needed

More Long-Term Care Forms

MDS 3.0 (Minimum Data Set)

MDS 3.0 · CMS

Standardized health status screening and assessment tool required for all residents of Medicare/Medicaid-certified nursing facilities. Used for care planning and Medicare payment calculation. Must be completed within 14 days of admission and periodically thereafter.

PASRR Level 1 Screening

State-specific · CMS / State Medicaid agencies

Federally mandated preadmission screening for all individuals entering Medicaid-certified nursing facilities to identify those with mental illness, intellectual disability, or related conditions who may need specialized services.

PASRR Level 2 Evaluation

State-specific · State mental health / developmental disability agencies

Comprehensive evaluation for individuals identified in Level 1 screening. Determines if nursing facility placement is appropriate and what specialized services are needed.

Long-Term Care Medicaid Application

State-specific · State Medicaid agencies

Application for Medicaid coverage of nursing facility care. Includes detailed financial disclosure of income, assets, and transfers. A five-year look-back period for asset transfers applies.

Asset Transfer / Look-Back Documentation

State-specific · State Medicaid agencies

Documentation of all asset transfers in the 60 months (5 years) before Medicaid application. Uncompensated transfers may result in a penalty period of Medicaid ineligibility.

Spousal Impoverishment Protection Forms

State-specific · State Medicaid agencies

Documentation establishing the Community Spouse Resource Allowance (CSRA) and Monthly Maintenance Needs Allowance (MMNA) protecting the non-institutionalized spouse's assets and income.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the PACE organizations (CMS-certified) or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.