Older adults could get PACE care sooner in Ohio

Ohio lawmakers want older adults who qualify for the Program of All-Inclusive Care for the Elderly, or PACE, to start getting help before their Medicaid paperwork is finished. PACE serves people who need nursing-home-level care but can still live in the community, and the bill is designed to close the gap between applying and actually receiving services.

Under the proposal, a PACE organization could find an applicant presumptively eligible and begin services during a temporary period that starts immediately. It could also enroll someone on the first day of the month after the application date and start services before Medicaid approval, so long as the Department of Aging has already determined the person meets the other PACE requirements.

Who pays if the answer turns into no

The bill does not leave the financial risk hanging in the air. If an applicant is later found ineligible for PACE, the organization that made the presumptive finding would have to cover the cost of services provided during that temporary period.

If Medicaid eligibility is confirmed, the Department of Medicaid would reimburse the PACE organization for services starting on the enrollment date. The measure also lets the organization ask the participant to pay the private rate for PACE services, and if the person does not pay, the organization could move to involuntary disenrollment under existing state rules.