Can PACE Help Pay for In-Home Care?
Need Home Care?
Contact Us Today
Can PACE Help Pay for In-Home Care in San Diego?
Short answer: PACE may arrange and pay for in-home care when an eligible older adult enrolls and the PACE interdisciplinary team determines that the service is needed as part of the participant’s care plan. PACE is not a reimbursement benefit that families can use with any agency they hire on their own.
PACE stands for Program of All-Inclusive Care for the Elderly. It combines medical care, long-term services and supports, medications, transportation and social services in one coordinated program. Its purpose is to help people who meet a nursing-home level of care remain safely in their homes or communities when that is possible.
In San Diego County, PACE availability is based on the person’s home ZIP code and the service area of an approved PACE organization. Enrollment, covered services, authorized hours and the provider used for home care are decided through the PACE program—not by the home-care agency.
What Is PACE?
PACE is a comprehensive Medicare and/or Medicaid program for eligible adults age 55 and older. After enrollment, an interdisciplinary team assesses the participant and coordinates the services needed across settings, including the home, PACE center, physician offices, hospitals and nursing facilities.
The care team commonly includes professionals such as:
A primary care provider and registered nurse
A social worker and dietitian
Physical, occupational and recreational therapy professionals
A home-care coordinator or liaison
A PACE center representative and transportation staff
Other clinicians or specialists involved in the participant’s care
The team creates and updates one care plan based on the participant’s medical, physical, functional, emotional and social needs. PACE covers Medicare- and Medi-Cal-covered services and may cover additional services the team decides are necessary to maintain or improve the participant’s health.
Who May Qualify for PACE in San Diego?
A person generally must meet all four federal and California eligibility requirements:
Be age 55 or older
Live in the service area of a PACE organization
Need a nursing-home level of care, as determined by the California Department of Health Care Services
Be able to live safely in the community with help from PACE at the time of enrollment
Needing a nursing-home level of care does not mean the person must already live in a nursing home. It is an assessment standard. The review may consider health conditions, cognition, mobility, safety risks and the amount of help needed with activities of daily living. The state and PACE organization—not a home-care company—make the eligibility decision.
San Diego County has multiple approved PACE organizations, but each serves particular areas. A nearby PACE center does not by itself confirm eligibility; the participant’s residential ZIP code must be within that organization’s current service area.
What In-Home Services May PACE Provide?
PACE can provide care in the participant’s home when the interdisciplinary team authorizes it. The exact mix of services and frequency is individualized. Depending on the care plan, PACE services at home may include:
Personal care, such as help with bathing, dressing, grooming, toileting or mobility
Home-care assistance and safety supervision
Skilled nursing or home health services
Physical, occupational or speech therapy
Medication delivery, management or support
Meals, nutrition support or medically appropriate food assistance
Light housekeeping related to the participant’s care and safe living environment
Medical equipment or supplies included in the care plan
Transportation to the PACE center and approved medical appointments
Social work, caregiver support and respite-related services
PACE does not promise a particular number of home-care hours, round-the-clock care or a specific caregiver. The team decides what is medically and functionally necessary, where the service should be delivered and whether it will be provided by PACE staff or an approved contracted provider.
How PACE Authorizes Home Care
A typical process looks like this:
- Complete an enrollment screening. The PACE organization reviews age, address, basic care needs and potential eligibility.
- Complete the required assessments. The organization and state determine nursing-home level of care and whether the person can live safely in the community with PACE support.
- Enroll in the PACE program. The participant signs an enrollment agreement after reviewing how PACE will coordinate health care, medications, providers and long-term supports.
- Meet with the interdisciplinary team. The team evaluates medical, functional, home-safety, transportation and social needs.
- Receive an individualized care plan. The team specifies approved services, frequency, schedule and provider arrangement.
- Request reassessment when needs change. The participant or family should promptly tell the team about falls, hospitalizations, caregiver breakdown, new confusion or increased difficulty with daily activities.
Do not hire a private home-care agency with the expectation that PACE will reimburse the cost later. Ask the PACE team to confirm the authorization, dates, tasks, approved hours and provider in writing before covered services begin.
PACE Is More Than a Home-Care Benefit
Families sometimes contact PACE because they need only bathing help, meals or transportation. California explains that participants enroll in the entire coordinated program rather than selecting a single service. PACE becomes responsible for arranging the participant’s covered health care and long-term services through its team and approved providers.
This integrated approach can be helpful for a person with several medical and daily-living needs, but it also changes how care is obtained. A participant generally receives covered care through the PACE organization. Families should review provider choice, current specialists, medication coverage, transportation, emergency procedures and service-request rights before enrolling.
PACE Compared With Other Ways to Pay for Care
PACE and Medicare Advantage
PACE is a Medicare health plan as well as a long-term care program. A person cannot remain enrolled in a separate Medicare Advantage plan at the same time. Enrollment in PACE generally triggers disenrollment from the current Medicare Advantage plan. Coordinate effective dates with the PACE enrollment specialist before making any coverage change.
PACE and Original Medicare
Original Medicare generally does not pay for ongoing custodial care when help with daily activities is the only service needed. PACE can authorize a broader range of health and support services for eligible participants because it coordinates Medicare, Medi-Cal and long-term care resources under one program.
PACE and IHSS
In-Home Supportive Services, or IHSS, is a separate Medi-Cal program that can authorize help with activities needed to remain safely at home. The eligibility, assessment, provider and payment rules differ from PACE. Ask the PACE enrollment specialist and the appropriate county office how current IHSS services would be affected before enrolling; do not assume both programs will pay for the same hours or tasks.
PACE and Private-Pay Home Care
A family may consider paying privately for additional non-medical support that PACE has not authorized, but the PACE team should be informed first. Outside services will not be reimbursed by PACE unless PACE approved and arranged them, and the schedule should be coordinated to avoid duplicated tasks, conflicting instructions or safety concerns.
For a broader overview of funding options, see How to Pay for Home Care in San Diego.
What Does PACE Cost?
Cost depends on Medicare and Medi-Cal status. According to Medicare, a participant who has Medicaid/Medi-Cal does not pay a monthly premium for PACE. A person who has Medicare but not Medicaid/Medi-Cal pays a monthly premium for the long-term care portion of the PACE benefit and a premium for Medicare drug coverage. A person who has neither Medicare nor Medicaid may be able to pay the PACE premium privately.
There is no deductible, copayment or coinsurance for a drug, service or other care approved by the PACE team. Care obtained outside the program without authorization can become the participant’s financial responsibility except in situations protected by PACE rules, such as emergency care. Ask for the current premium and enrollment terms in writing.
How to Explore PACE in San Diego
- Check the current service-area directory. Use the California Department of Health Care Services directory to identify PACE organizations serving the participant’s residential ZIP code.
- Call a PACE enrollment department. Explain the person’s age, address, living situation, diagnoses and help needed with daily activities.
- Describe current risks clearly. Mention recent falls, wandering, missed medications, unsafe transfers, caregiver exhaustion or repeated hospital visits.
- Complete the clinical and state reviews. The PACE organization will explain records, assessments and the nursing-home-level-of-care determination.
- Review the enrollment agreement. Confirm providers, medications, specialist access, transportation, home-care request procedures and the effective date.
- Keep current coverage in place until enrollment is confirmed. Do not cancel a Medicare Advantage, prescription drug or other health plan based only on a preliminary screening.
California’s Medi-Cal Health Care Options line may also help with plan questions at 800-430-4263 (TTY 800-430-7077). Current PACE organizations and service areas can change, so use the state directory rather than relying on an old list or brochure.
Questions to Ask a PACE Enrollment Specialist
Does this exact home address fall within your current PACE service area?
What information is used to determine nursing-home level of care?
How long does screening and enrollment usually take, and when would coverage begin?
Which current doctors, specialists, pharmacies and medications would change after enrollment?
How does the team decide whether in-home personal care is needed?
Who provides home care, and may the participant request a different caregiver or agency?
How are authorized home-care hours, tasks and schedules documented?
What happens if the participant needs more help at night, on weekends or after a hospital stay?
How can the participant request a service, obtain a reassessment or appeal a denial?
How would current IHSS, Medicare Advantage, Part D or other coverage be affected?
What monthly premium, if any, would apply based on the participant’s coverage and financial eligibility?
Can Home Helpers Home Care of Mission Valley Work With PACE?
Home Helpers Home Care of Mission Valley provides non-medical in-home care through W-2 employee caregivers and is licensed by the California Department of Social Services as a Home Care Organization, HCO No. 374700432.
If a PACE organization authorizes Home Helpers through an approved provider arrangement, our team can coordinate services within the written authorization and provide required visit documentation. Provider participation, authorization and payment must be confirmed by the PACE organization before service begins.
We can also discuss private-pay care when a family wants support outside a PACE authorization. Home Helpers cannot determine PACE eligibility, promise approval, select covered hours or guarantee that a PACE organization will authorize our agency.
Frequently Asked Questions
Do you have to live in a nursing home to qualify for PACE?
No. PACE is designed to help eligible people who meet a nursing-home level of care remain in the community. The person must be able to live safely in the community with PACE support at enrollment.
Is PACE only for people who have both Medicare and Medi-Cal?
No. People who meet the program’s eligibility rules may enroll without having both, but their monthly premium responsibilities can be different.
Does PACE automatically provide 24-hour home care?
No. The interdisciplinary team authorizes an individualized set of services. PACE may also use a PACE center, transportation, clinical services, respite, facility care or other supports when appropriate.
Can a family choose any home-care agency?
Not automatically. PACE generally arranges covered services through its staff or contracted providers. Ask whether a preferred agency is approved before scheduling care.
Can PACE pay a family caregiver?
Do not assume that it will. Payment arrangements and provider requirements are program-specific and must be authorized. Ask the local PACE organization how it handles family-provided care.
Can someone with Medicare Advantage join PACE?
A qualifying person may apply, but PACE and a separate Medicare Advantage plan cannot be active together. Coordinate the transition and effective dates with the PACE organization.
What if the participant’s needs increase after enrollment?
Contact the PACE team immediately and request reassessment. Explain the new condition or safety concern and ask for the decision and appeal information in writing.
Talk With a Local Home-Care Team
If your family is comparing PACE, other public benefits and private-pay support, Home Helpers Home Care of Mission Valley can explain our non-medical services, scheduling options and the information we would need from an authorizing organization.
Call 619-292-8001 to discuss care needs or request a free in-home assessment.
Coverage and eligibility disclaimer: This page provides general educational information and is not legal, financial, insurance or medical advice. PACE eligibility, enrollment, premiums, covered services, provider participation and authorized hours are determined by the applicable PACE organization, Medicare, Medi-Cal and the California Department of Health Care Services. Program rules and service areas can change. Verify current information before making coverage or care decisions.
Information reviewed August 20, 2026.
How to Pay for Home Care in San Diego — https://homehelpershomecare.com/mission-valley-ca/resources/how-to-pay-for-home-care-san-diego/
Home Care Services — https://homehelpershomecare.com/mission-valley-ca/services/
About Home Helpers Home Care of Mission Valley — https://homehelpershomecare.com/mission-valley-ca/about-us/
Contact Home Helpers Home Care of Mission Valley — https://homehelpershomecare.com/mission-valley-ca/contact-us/
Medicare — Program of All-Inclusive Care for the Elderly (PACE): https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-medicare-health-plans/PACE
Centers for Medicare & Medicaid Services — PACE: https://www.cms.gov/medicare/medicaid-coordination/about/pace
California DHCS — Program of All-Inclusive Care for the Elderly: https://www.dhcs.ca.gov/services/long-term-care-alternatives-home-and-community-based-service-options/program-of-all-inclusive-care-for-the-elderly/
California DHCS — PACE Provider and Participant Questions: https://www.dhcs.ca.gov/providers-partners/program-for-all-inclusive-care-for-the-elderly/
California DHCS — California PACE Plans and Service Areas: https://www.dhcs.ca.gov/individuals/california-program-of-all-inclusive-care-for-the-elderly-plans/
California DHCS — San Diego County Health Plan Directory: https://www.dhcs.ca.gov/individuals/medi-cal-managed-care-health-plan-directory/san-diego-county/
Call 619-292-8001 | Schedule a Free In-Home Assessment | Read What Families Say
Your Questions, Answered
Home Helpers Home Care offers a wide range of in-home care services, including personal care, companionship, nutrition support, wellness monitoring, and specialized care for chronic conditions, dementia, and recovery.
Our services are designed for seniors, individuals with disabilities, those recovering from illness or surgery, and anyone who needs extra support to live safely and comfortably at home.
Yes, every care plan is fully personalized based on each client’s unique needs, preferences, and schedule, whether they require a few hours of support or 24/7 care.
Yes, our caregivers are carefully screened, trained, and insured to provide compassionate, high-quality care you can trust.
Getting started is easy—simply contact your local Home Helpers location to schedule a free in-home assessment and create a care plan tailored to your needs.
