Tag Archive for: policy

Stricter Medicaid work requirement test catches states off guard

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This article was originally published on State House News Service.

States are scrambling to overhaul their Medicaid work requirement plans in response to a new federal rule that would require stricter limitations than many policymakers and advocacy groups had anticipated.

“It will be a significant burden to implement,” said Kody Kinsley, the former secretary of the North Carolina Department of Health and Human Services.

The Interim Final Rule, released by the federal Centers for Medicare and Medicaid Services on Monday…

Read the full article on State House News Service.

Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care for the Elderly: Recommendations and Updated Implications

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This article was originally published on Medicaid and CHIP Payment and Access Commision (MACPAC).

The Program of All-Inclusive Care for the Elderly (PACE) model provides integrated care to adults ages 55 and older who meet nursing facility level-of-care criteria and can live safely in the community. Findings from the June 2025 report to Congress identified questions related to transparency in state and federal oversight of PACE compliance and quality.

At the April 2026 Commission meeting, staff presented three policy options to the Commission that address two challenges identified during the document review and stakeholder interviews: (1) overlap and lack of coordination in federal and state audit activities, and (2) the limited availability of information on PACE program quality and performance. At this meeting, staff presented final recommendation language, as well as updated estimates of the recommendations’ effect on federal direct spending from the Congressional Budget Office.

Read the full article online.

Advocates applaud PACE recommendations to strengthen audit coordination, transparency

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This article was originally published on McKnights Home Care.

The National PACE Association hailed three new recommendations put forth by the Medicaid and CHIP Payment and Access Commission (MACPAC) to strengthen federal-state audit coordination, improve transparency and develop a standardized national quality measure for the Program of All-inclusive Care for the Elderly (PACE).

“It’s a reflection of a growing recognition that as PACE expands, the oversight framework needs to evolve with it, especially to reduce duplication and better demonstrate program value,” Tonya Saffer, chief policy and advocacy officer at NPA, told McKnight’s Home Care Daily Pulse on Monday. “So I think it’s really a timely set of recommendations as the PACE community has been growing.”

A total of 202 nonprofit and for-profit PACE organizations are operating in 33 states today, Saffer said. The recommendations, which will be published in the June report to Congress, are an outgrowth of two years of knowledge-gathering on the PACE program and conversations with NPA and others, Saffer said.

In its research, MACPAC found some consistent challenges and variation in state approaches to PACE, she said. One of the problems uncovered was the lack of coordination between federal and state audits of PACE organizations. To this,  MACPAC recommended the Centers for Medicare & Medicaid Services update audit protocols and three-way program agreements to facilitate joint audits of PACE organizations with state administering agencies.

“I think this piece is really meaningful because the recommendations could translate fairly quickly into less administrative burden and more streamlined oversight for the PACE organizations,” Saffer said.

MACPAC also sought to respond to the issue of limited availability of accessible information on PACE program quality and performance. On this, it offered two recommendations to CMS: Aggregate and publicly release, in a user-friendly format on the CMS website, existing PACE program performance data; and develop a standardized, national quality measure set for PACE organizations.

These two recommendations, which likely will take longer to implement, are “more foundational,” Saffer said.

Ultimately, the three recommendations will help drive quality improvement and help shed light on the value that PACE provides, Saffer said.

“I think this is really going to help position PACE for responsible growth and stronger visibility both with policy makers and the public,” Saffer said.

NPA hopes to play a role in is helping shape the recommendations for CMS, Saffer noted.

From PACE validation to expansion: Why bipartisan support and federal funding mark a new era for PACE

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This article was originally published on Healthcare Business Today.

Unequivocally, PACE is the most effective solution for the U.S. senior population’s most complex needs. It is rare for a care model to earn unanimous praise across the aisle, yet the Program of All-Inclusive Care for the Elderly has done exactly that, gaining rare bipartisan backing at the federal level.

The recent signing of H.R. 7148 saw Congress call on CMS to “move forward expeditiously on PACE-specific model tests.” This policy momentum follows the passage of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act in early 2025, which opened a significant new bridge between the PACE model and the millions of veterans who will need it.

Shawn Bloom, president and CEO of the National PACE Association (NPA), offered a clear explanation: “further expansion of PACE enjoys bipartisan support because it is a model of care that works economically and toward the benefit of the health of our seniors.”

These policy advancements mark a fundamental shift in federal confidence in the program. PACE has long delivered exceptional results but has scaled incrementally, making this level of validation particularly significant. These policy tailwinds signal that PACE is moving beyond a niche alternative and is increasingly viewed as a credible, policy-endorsed cornerstone of preventative value-based care models.

I believe, as a result of these tailwinds and other accelerating market forces, the national PACE census will grow to 250,000 members by year-end 2030.

Why this recognition matters now

PACE has demonstrated value for decades, but adoption has been measured relative to the size of a growing eligible population. As of December 2025, more than 90,000 participants across 33 states were enrolled in the program: representing less than 5% of the estimated two million eligible participants.

As healthcare systems continue to face rising complexity, labor shortages, and an aging population with higher acuity needs, PACE emerges as an underutilized solution with immense runway for expansion. The model’s fully capitated structure and interdisciplinary design align with policymakers’ prioritization of models that connect quality with financial accountability.

Funding follows confidence

Importantly, we see PACE momentum extending beyond model validation with recent state-level expansion efforts. Recent reports outline that the $50 billion Rural Healthcare Transformation Program is being leveraged by states to ease Medicaid pressures and strengthen care delivery in historically underserved communities. Nine states are already moving to use these funds to either launch new PACE programs or scale existing ones. Bipartisan validation and significant state-level budget allocations signal that the conversation has moved beyond recognition and should now focus on how the model can best succeed and meet these expectations.

The leadership challenge: Scaling without fragmenting

With expansion, however, comes heightened execution risk. As programs scale, particularly into rural or resource-constrained settings, their operational complexity increases exponentially.

The PACE model works because its fully integrated design is built around the principle that better patient outcomes and disciplined utilization control are mutually reinforcing. Interdisciplinary coordination, proactive care planning, and rigorous documentation are the engines of its success, enabling teams to manage risk longitudinally rather than episodically. As we move into this new era, leadership’s primary responsibility is to ensure that “growth” does not result in the dilution of the model’s core strengths.

Without the right systems in place, rapid expansion risks introducing fragmentation—the very problem PACE was designed to solve.

Infrastructure: The “force multiplier” for growth

To ensure expansion readiness, modern technology must function as the core infrastructure necessary to scale the impact of PACE, while reinforcing the integrity of the IDT model. Simple and legacy tools to alleviate administrative burdens will inhibit PACE from pulling into the future.

Core infrastructure should perform as the fabric that streamlines care coordination and provides visibility into the care journey, keeping teams laser-focused on participants while keeping operations sustainable. As smaller programs seek to meet this policy opportunity and scale across multiple geographies and larger populations, that infrastructure must amplify the model in its fullest form while navigating potential growing pains.

Clinical teams need clear, real-time visibility into participant risk to deliver proactive, participant-centered care. As programs scale, purpose-built platforms must continue to preserve the synchronization of the IDT plan to ensure care plans, documentation and decisions remain aligned when care is delivered. Enrollment increases bring greater clinical complexity, and revenue capture must accurately reflect that complexity while cost controls limit unnecessary utilization. At the same time, embedded workflows and defensible documentation will be essential in preserving the program’s integrity and safeguarding against regulatory risk.

From validation to responsible scale

As the national dialogue reaches a defining moment, the evidence, outcomes, and policy signals all point in the same direction: PACE is the path forward for complex senior care.

Through this lens, technology and services can provide the operational foundation that allows programs to grow without sacrificing the coordinated, high-accountability care that defines the model. When implemented effectively, these capabilities reinforce clinical excellence, care alignment, financial sustainability, and regulatory compliance that programs need at every stage of growth.

By reinforcing interdisciplinary teams with the right infrastructure, we can ensure that this era of expansion leads to a permanent, sustainable shift in how we care for our most vulnerable populations.

Integrating Care for Aging Populations: Dual-Framework Policy Analysis of the United States Program of All-Inclusive Care for the Elderly (PACE)

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This article was originally published on Journal of Advanced Nursing.

Aim

To critically analyse the federal Program of All-Inclusive Care for the Elderly (PACE) using the Integration Continuum Framework and the Conceptual Model for Nursing and Health Policy, identifying system-level strengths, equity gaps and nursing implications for long-term care reform.

Background

The U.S. long-term care system remains fragmented and institutionally biased, disproportionately affecting dual-eligible older adults who account for outsized healthcare expenditures despite comprising just 17% of Medicare beneficiaries. Permanently authorised under the Balanced Budget Act of 1997, PACE delivers fully integrated, community-based care for individuals aged 55 and older who qualify for nursing home-level services but prefer to remain in their communities.

Design

A policy analysis guided by dual conceptual frameworks assessing PACE structure, implementation and impact across four policy outcome levels: efficacy, effectiveness, equity and justice.

Methods

This policy analysis was conducted between May and July 2025. Two conceptual frameworks were applied to examine PACE structure, implementation and outcomes. Data sources included peer-reviewed studies, federal legislation, policy documents and grey literature published between 2020 and 2025, supplemented by international integrated care literature.

Findings

PACE demonstrates strong efficacy and effectiveness, with fully integrated interdisciplinary teams and reduced institutionalisation for enrolled older adults. However, the program falls short on equity and justice due to limited geographic reach, racial and ethnic disparities in enrollment, exclusion of Medicare-only populations and persistent nursing workforce challenges.

Conclusion

PACE exemplifies a high-functioning integrated model of community-based long-term care, but current policy constraints prevent it from achieving scale and equity. Without eligibility expansion, financing reform and workforce investment, its transformative potential will remain unrealised. Nurses are central to this vision and must be empowered as clinical leaders and policy advocates to sustain care coordination and advance health equity in aging populations.

Read the full publication online.

What Older Americans Want Policymakers To Know

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This article was originally published on Bipartisan Policy Center.

Older Americans are often the focus of health care debate, but their voices are missing. BPC’s toolkit highlights their experiences and bipartisan reforms to improve affordability, access, caregiving, behavioral health, and financial security.

While older Americans are often the subject of health care debate, their voices are often missing from health policy conversations. To help center their voices, BPC drew on interviews conducted by The People Say initiative to highlight key challenges older adults experience in today’s health care system.1 Informed by older adults’ experiences, the following are bipartisan policy reforms Congress should take to strengthen services and make care more affordable for a growing aging population. This includes opportunities to strengthen caregiver support for cost-effective home-based care, increase access to behavioral health services, improve financial security, and reduce system complexities.

Strengthen Caregiver Support For Cost-Effective Home-Based Care

“Anna” is a 65-70-year-old adult enrolled in traditional Medicare and private insurance who lives in suburban Louisiana.

“…being a caregiver is a lot… I have to take care of myself and also take care of [my husband]. And taking care of him is a job by itself… and it’s hard… but I have to hire someone to come and take care of him, and… it costs a lot. And we can’t get the long-term personal care or anything, because if you own a house or your own property, then that’s out. You can’t get any assistance from the state, and that’s hard.”
– “Anna”

“Anna” is not alone. Nearly 38 million working Americans provide care for an adult or child with disabilities, and many are forced to reduce work hours or leave the workforce to provide care.2 Medicare does not cover long-term care, and many older adults cannot afford needed services, which often leaves family members to step in to provide care. A shortage of paid direct care workers adds to this challenge.

  • Congress should support unpaid family caregivers by establishing a modest Medicare respite benefit and a refundable caregiver tax credit.
  • Congress should address the direct care workforce shortage by strengthening registered apprenticeship programs and ensuring adequate Medicaid payment rates and compensations for direct care services.

For more information, see reports “A Practical Framework for Addressing the Long-Term care Financing Challenges” and “Addressing the Direct Care Workforce Shortage.”