PACE Programs in California: What They Are and How They Fit With Assisted Living

Medicare describes PACE as a Medicare and Medicaid program that helps eligible older adults who need nursing home-level care meet their health care needs in the community. Medi-Cal is California's Medicaid program, and the Department of Health Care Services (DHCS) oversees PACE in the state.

DHCS explains the model. An interdisciplinary team, working from a PACE center, provides and coordinates all needed preventive, primary, acute and long-term care for older adults who would otherwise reside in nursing facilities. The team usually includes a physician, nurses, a social worker, therapists and a transportation coordinator.

The center is the hub. Participants come in for medical visits, therapy, meals and activities, and the program drives them there and back. According to DHCS, participants attend about three times a week on average, and the schedule is set by need.

DHCS and Medicare give the same four conditions. A person qualifies if he or she:

• Is 55 or older.
• Lives in the service area of a PACE organization. In California, service areas are set by county and zip code.
• Meets the requirement for a nursing home level of care, as assessed by the PACE team and certified by DHCS.
• Can live in the community without jeopardizing his or her health or safety at the time of enrollment.
• The National PACE Association adds two points. No financial criteria are considered in deciding eligibility, and a person does not need to be enrolled in Medicare or Medicaid to join. A PACE participant cannot also be enrolled in a Medicare Advantage plan, a separate Medicare drug plan or hospice services.

Medicare says PACE covers all Medicare- and Medicaid-covered care and services, and anything else the team decides you need. Its list includes primary care, hospital care, prescription drugs, dentistry, physical and occupational therapy, home care, personal care, meals, social services, and transportation to the center and to medical appointments. Nursing home care is covered when it is medically necessary.

The trade is choice. DHCS's answers to common questions are direct about it:

You cannot keep your own doctor. A participant is assigned a primary care physician on the PACE team and agrees to receive all health care services through the program.

You cannot pick single services. DHCS says a person cannot enroll only for home care, meals, transportation or the day center.

You leave your other plan. Enrolling in PACE automatically ends enrollment in a Medicare HMO, and Medicare says that joining a separate Medicare drug plan while in PACE ends PACE enrollment. The National PACE Association warns that a participant may be held financially responsible for care received outside the program that the team did not approve.

You can leave. DHCS says a participant is free to disenroll at any time and go back to regular Medicare and Medi-Cal benefits. For what Medicare covers on its own, see does Medicare pay for assisted living.

Medicare states the rule in three parts. A person with Medicaid pays no monthly premium for PACE. A person with Medicare but not Medicaid pays a monthly premium for the long-term care part of the benefit and a premium for Medicare Part D drugs. A person with neither can pay the premium privately. In every case, Medicare says there is no deductible, copayment or coinsurance for any drug, service or care the PACE team approves.

The public pages we read do not list premium amounts, so this guide gives none. Ask the PACE organization for its current figure in writing.

Two Medi-Cal details matter here. California Advocates for Nursing Home Reform (CANHR), a nonprofit that publishes consumer fact sheets, says in its PACE fact sheet updated August 21, 2026 that Medi-Cal members who have a share of cost must still pay it. It also says that when one spouse needs PACE and the other does not, the Medi-Cal spousal impoverishment provisions apply. We explain both in Medi-Cal share of cost explained and Medi-Cal spousal protection in California.

Yes, with a limit. CANHR's fact sheet says a resident of a residential care facility for the elderly (RCFE), the California license for both assisted living communities and board and care homes, can be a PACE participant at the same time. PACE will not cover the cost of room and board in the home. It may pay for medical costs.

CANHR describes this as an option for people who want to keep living in an RCFE and not move to a skilled nursing facility, but who need additional care and have high medical bills. The monthly charge from the home remains the family's to pay.

Practical questions follow, and the answers differ by organization and by home. Ask the PACE organization whether it serves residents in the home you are considering, which services it would bring in, and how it works with the home's staff. Ask the home whether it has residents in PACE now.

PACE is not the only program in this space. See our guides to the Medi-Cal Assisted Living Waiver and to IHSS and assisted living. A person may not be able to use more than one at the same time, so ask the county and each program.

PACE is not statewide. DHCS publishes a list of California PACE plans with the counties and zip codes each one serves. The list dated July 2026 shows several plans in Los Angeles County, with zip codes in the Torrance, San Pedro, Carson, Gardena and Long Beach areas among them. Check your relative's own zip code on the current list.

Service areas are not likely to grow soon. DHCS announced that, effective November 20, 2025, it paused new PACE applications for at least two years, both for new organizations and for existing ones asking to expand their service areas. The steps DHCS gives for joining are:

1. 1

   Check the zip code list

   Use the DHCS list of PACE plans to see whether a plan serves the address where your relative lives.

2. 2

   Call the PACE plan

   The plan schedules a home visit with the person and the caregiver to explain how it works.

3. 3

   Tour the PACE center

   Go with your relative and see the clinic, the day room and the transportation.

4. 4

   Complete the assessment

   The plan's interdisciplinary team does a full medical and social assessment, and the state certifies the level of care. CANHR adds that a person who is not yet on Medi-Cal can apply at the county social services office.

Hamssa Benrekia is a senior living placement specialist in Torrance who works with families in the South Bay and Harbor area of Los Angeles County. She does not enroll anyone in PACE or Medi-Cal and does not decide who qualifies: the PACE organization, the county and the state do. She can talk through your relative's care needs and budget and help you look at licensed homes, including a board and care home, and you can ask each one about PACE. To talk it through, contact Hamssa. The full series is in the California Assisted Living Placement Guide.