Illinois Medicaid Launches Program Of All-Inclusive Care For The Elderly
The Illinois Department of Healthcare and Family Services (HFS) recently launched the Medicare-Medicaid Program of All-Inclusive Care for the Elderly (PACE) in five regions. As of July 1, 2024, three PACE organizations had launched operations; and two more are anticipated to begin operations during the first quarter of 2025. After 10 member months of enrollment among 3 operational PACE Organizations there are 16 PACE participants.
The PACE organizations were selected in a request for applications (RFA 11192021) process that began in late 2021. A letter of intent was due to HFS by November 29, 2021, and applications were due by December 23, 2021. On August 15, 2022, HFS announced it had selected eight organizations to serve the five regions. On December 28, 2022, HFS submitted a Medicaid state plan amendment (SPA) to implement PACE. The Centers for Medicare & Medicaid Services (CMS) approved the SPA on March 21, 2023, with an effective date of June 1, 2024. HFS and CMS awarded contracts to seven of the PACE applicants; one of the original awardees withdrew. Currently five of the awarded applicants have made application to CMS, and of those, three have received program agreements allowing them to begin enrolling participants.
HFS did not provide information about the anticipated launch dates for the remaining two selected PACE organizations. The initial awardees for each region, and their operational status are as follows:
- West Chicago had three awardees: Lawndale Christian Health Center launched operations as of July 1, 2024. Kinship PACE of Illinois, LLC will launch during the first quarter of 2025. PACE of Southwest Chicago, LLC withdrew.
- South Chicago had two awardees: Esperanza Health Centers launched operations as of July 1, 2024. Annie’s Place PACE has no anticipated launch date yet.
- Southern Cook County had one awardee: BoldAge PACE Illinois will launch during the first quarter of 2025.
- Peoria had one awardee: OSF Healthcare System launched operations as of July 1, 2024.
- East St. Louis had one awardee: Stella PACE at Home, LLC has no anticipated launch date yet.
Within the PACE service areas, enrollment is limited to adults aged 55 years and older who require nursing home level care but are still able to continue living safely in the community. Many PACE enrollees are eligible for both Medicaid and Medicare. PACE can also be covered by private insurers, or directly by consumers via a self-pay monthly premium.
According to a November 14, 2022, HFS presentation about PACE, the Illinois Department of Aging’s Community Care Units conduct a determination of need (DON). Individuals who score 29 on the DON and meet other eligibility criteria will be referred to the PACE organization, allowing the individual to decide if they would like to enroll in PACE.
After the assessments are completed, eligible individuals (and family caregivers) are invited to tour the PACE center and discuss the recommended care plan. Enrollment is open for the three of the seven PACE organizations. For the other PACE organizations, HFS advised interested residents in other PACE service areas to contact the PACE organization to ask when enrollment will open.
PACE combines all the services covered by Medicare and Medicaid and adds an element of integration for members. The PACE organization receives a capitated per member per month payment to cover all services needed by the member including holistic care planning and coordination, primary care, long-term services and supports, therapies, medications, mental health care, transportation, and hospital care, if necessary.
Nationwide, 31 other states have operational PACE programs. These existing programs serve an estimated 60,000 participants.
The RFA is available for download at no charge to OPEN MINDS Circle subscribers at https://rfp.openminds.com/rfp/illinois-seeks-program-of-all-inclusive-care-for-the-elderly-pace-services/. However, HFS is not accepting applications for new PACE organizations.
A link to the full text of “Illinois Medicaid State Plan Amendment To Implement The Program Of All-Inclusive Care For The Elderly (PACE)” is in the OPEN MINDS Circle Library at https://openminds.com/market-intelligence/resources/032123ilspapace/.
A link to the full text of “Illinois HFS Presentation: Program Of All-Inclusive Care For The Elderly” is in the OPEN MINDS Circle Library at https://openminds.com/market-intelligence/resources/111422ilagingpace/.
For more information, contact: Jamie Munks, Director of Communications, Illinois Department of Healthcare and Family Services, 201 South Grand Avenue East, Springfield, Illinois 62763; 217-670-3305; Email: Jamie.Munks@Illinois.gov; Website: https://www.illinois.gov/hfs/Pages/default.aspxily Services, 201 South Grand Avenue East, Springfield, Illinois 62763; 217-670-3305; Email: Jamie.Munks@Illinois.gov; Website: https://www.illinois.gov/hfs/Pages/default.aspx
Editor’s Note: This article was updated on September9 at the request of HFS.
