Healthcare
Older adults could get PACE care sooner in Ohio
The bill would let a PACE organization start services right after a presumptive finding, and it gives the state a backup plan if a later review disqualifies the applicant.
For some older adults, the wait for paperwork could no longer stand between applying and getting care. The change would let PACE services begin before Medicaid approval, with payment rules that shift to the organization if the person is later found ineligible.
- PACE could begin before Medicaid approval.
- Aging officials would still have to confirm the other eligibility rules.
- If a person later is not eligible, the PACE organization pays for the temporary care.
- If Medicaid is approved, the state would reimburse the organization.
- 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
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.