Is PACE available everywhere in Florida?

No. PACE is organized county by county through individual PACE organizations, and as of early 2026 it covers parts of roughly two dozen Florida counties, not the whole state. A client has to live in an active service area to enroll, and availability can be limited by the PACE organization's capacity even within a covered county.

Does PACE replace Medicare and Medicaid, or work alongside them?

Once enrolled, PACE becomes the participant's sole source of Medicare and Medicaid benefits. The PACE organization receives the capitated payment and takes over responsibility for arranging and paying for the covered services directly, rather than the participant continuing to use Medicare and Medicaid through separate providers.

Can someone on a SMMC Long-Term Care waiver switch to PACE instead?

Yes, if they meet the age, level-of-care, and service-area requirements and an opening exists with a local PACE organization. The underlying Medicaid financial eligibility doesn't change; switching to PACE changes how the approved services are organized and delivered, not whether the person qualifies for Medicaid long-term care in the first place.

What happens if a PACE participant eventually needs full-time nursing home care?

Nursing facility care is one of the services included in PACE's capitated benefit, so the PACE organization remains responsible for the participant's care even if a nursing home placement becomes necessary. The participant doesn't have to separately re-qualify for nursing home Medicaid or switch programs at that point.

Is there a cost to enroll in PACE?

For someone eligible for both Medicare and Medicaid, there's no premium, deductible, or coinsurance. Someone eligible for Medicare only, without Medicaid, pays a monthly premium covering the Medicaid portion of the capitation rate plus a Part D premium, but still has no deductibles or coinsurance under the program.

PACE in Florida: An Alternative to Nursing Home Medicaid for People 55 and Older

PACE is a Medicaid and Medicare program that lets someone who would otherwise qualify for nursing home care stay in the community instead, with one provider responsible for everything: doctors, therapy, medication, transportation, meals, and a day center, all under one roof. It's not well known outside the counties where it operates, but where it's available, it's often a better fit than the nursing-home Medicaid track for someone who wants to stay out of a facility.

Who Qualifies

Federal law sets three requirements for PACE, and Florida hasn't added others on top of them (42 U.S.C. § 1396u-4):

Age 55 or older.
Nursing facility level of care, the same clinical threshold used for Florida's Institutional Care Program and the SMMC Long-Term Care waiver. Florida's Department of Elder Affairs makes this determination.
Residence in a PACE service area. PACE is organization-by-organization and county-by-county. Someone living outside an active service area can't enroll, no matter how well they'd otherwise qualify.

There's a fourth practical requirement that isn't in the statute but matters in practice: the applicant has to be able to live safely in the community, with PACE's help, at the time of enrollment. PACE isn't a substitute for a nursing home placement that's already medically necessary and can't be managed at home or in assisted living.

Where PACE Operates in Florida

As of Florida's Agency for Health Care Administration's February 2026 PACE report, sixteen providers serve parts of Miami-Dade, Palm Beach, Broward, Lee, Pinellas, Charlotte, Collier, Duval, Clay, Hillsborough, Hernando, Pasco, Orange, Osceola, Lake, Sumter, Seminole, Manatee, Sarasota, DeSoto, Escambia, Okaloosa, Santa Rosa, and Martin counties, with combined enrollment of roughly 4,600 participants. Hope PACE serves Lee County, which covers our Bonita Springs clients directly; Hope PACE also has a Charlotte County and a Collier County site. Service areas expand over time, so if a client isn't currently covered, it's worth checking again later rather than ruling PACE out permanently.

What PACE Covers and How It's Paid For

PACE runs on a capitated model: the PACE organization receives a fixed monthly payment and, in exchange, takes on responsibility for the full range of care the participant needs, not just what a fee-for-service plan would separately reimburse. That includes primary and specialist medical care, hospital care when needed, prescription drugs, physical and occupational therapy, home health, transportation to and from the PACE center, meals, social work, and nursing facility care if it ever becomes necessary. An interdisciplinary team, not a single physician working alone, manages the plan of care.

Cost to the participant depends on coverage status, per Medicaid.gov's description of the benefit:

Dual-eligible participants (Medicare and Medicaid both) pay nothing. No deductibles, no coinsurance, no premium.
Medicare-only participants who don't qualify for Medicaid pay a monthly premium equal to the Medicaid capitation rate, plus a Part D premium, but still no deductibles or coinsurance.
Private-pay participants without Medicare or Medicaid can enroll and pay out of pocket, where a PACE organization offers that option.

Florida's Medicaid statute lists PACE organizations among the plan types that can serve as a Medicaid managed care plan for long-term care (Fla. Stat. § 409.962(7)).

PACE vs. the Nursing Home Medicaid Track

For a client who qualifies for both, the choice between PACE and the traditional ICP or SMMC Long-Term Care waiver track usually comes down to a few things. PACE bundles everything through one organization and one care team, centered on its day center, and it includes acute medical care and hospital coverage in that same bundle, not just long-term-care services. The waiver programs instead layer home and community-based services on top of Florida's regular Medicaid medical coverage, coordinated through a managed care plan but without PACE's single-point-of-responsibility structure.

The asset and income rules for Medicaid eligibility are the same either way; PACE doesn't relax the underlying Medicaid financial requirements. See Florida's Medicaid eligibility framework for how those rules apply to nursing-home-level applicants generally. What changes is how the approved services get organized and delivered once someone qualifies.

Leaving PACE Is Always an Option

A participant can voluntarily disenroll from PACE at any time and for any reason, without having to show cause. Federal regulation makes the disenrollment effective the first day of the month after the PACE organization receives notice, and it specifically bars PACE staff from discouraging disenrollment based on a participant's declining health (42 C.F.R. § 460.162). That protection matters: a family considering PACE isn't locking a parent into a structure that's hard to undo if it isn't working out.

The Practical Takeaway

PACE is worth raising with any client 55 or older who meets a nursing-home level of care, lives in an active service area, and wants to avoid a facility if at all possible. It isn't available everywhere in Florida yet, and it isn't the right fit for everyone even where it is, but where both conditions are met, it's often a stronger option than assembling waiver services piecemeal. Confirm service-area coverage and current availability directly with the PACE organization before counting on it, since enrollment can be capped by provider capacity.