PACE in New York: 2026 Senior Guide to All-Inclusive Care

In New York in 2026, PACE serves roughly 10,500 older adults across 10 active programs, and it has quietly become one of the most consequential paths to integrated dual-eligible care in the state. Short for Programs of All-Inclusive Care for the Elderly, PACE wraps a senior's primary care, specialty care, prescription drugs, long-term services and supports, transportation, meals, and family caregiver respite into one fully capitated plan built around a community day center.

The reason PACE matters in 2026 New York is not just the day-center model. It is that PACE is the only major NY long-term-care managed-care product that is exempt from the September 1, 2025 Minimum Needs Requirement, the new ADL-based eligibility floor that now governs MLTC Partial Capitation and Medicaid Advantage Plus enrollment under MLTC Policy 25.04. For a senior who clears nursing-home level of care but does not clear the new floor, PACE is the operative integrated-care option.

This guide walks through who qualifies for PACE in New York, how the 10 active 2026 plans are organized by service area, how PACE differs from MLTC Partial Capitation and from Medicaid Advantage Plus, the costs a member pays, how appeals work, and the misconceptions that are common in older directories.

What PACE Is

PACE is a fully capitated dual-eligible program that combines all Medicare benefits, all Medicaid benefits including long-term services and supports, prescription drug coverage, day-center primary care, specialty care, transportation, meals, and caregiver support into a single plan. The PACE organization is both the payer and the provider of most services, which puts PACE structurally closer to a staff-model HMO than to a conventional health plan with a contracted network.

The federal authority is unusual in that it lives in two parallel statutes that were enacted simultaneously. Section 1894 of the Social Security Act, codified at 42 USC § 1395eee, establishes the Medicare side. Section 1934, codified at 42 USC § 1396u-4, establishes the Medicaid side. Both were made permanent by the Balanced Budget Act of 1997 (Public Law 105-33, Title IV, § 4801). The implementing regulations live at 42 CFR Part 460, with subparts covering applications, the three-way program agreement, services, participant rights, quality, enrollment and disenrollment, and payment.

The state-side framework in New York rests on Public Health Law Article 44 and the broader Managed Long Term Care architecture under PHL § 4403-f. PACE plans are authorized as a category of MLTC plan in New York, but the operative federal authority and federal regulations are independent of New York's 1115 demonstration. That is why families anxious about NYHER renewal sometimes prefer PACE: the foundation underneath PACE is statutory and not waiver-dependent.

Who Qualifies for PACE in 2026

Federal regulations at 42 CFR § 460.150 set out four eligibility tests that every PACE applicant in New York must meet:

1. Age 55 or older. This is older than the 21-or-older floor for Medicaid Advantage Plus and the 18-or-older floor for MLTC Partial Capitation. PACE is structurally an aging-services program.
2. Nursing-facility level of care (NF-LOC) certification. The state administering agency, in this case the New York State Department of Health, determines whether the applicant needs the level of care that a nursing facility provides. NF-LOC is operationalized through the PACE plan's clinical assessment, with NYSDOH verification.
3. Residence within the PACE organization's service area. Service areas are designated by ZIP code or county in the three-way program agreement. A senior outside the service area cannot enroll, even if every other test is met.
4. Ability to live safely in the community with PACE support. Per 42 CFR § 460.150(c), the applicant must be able to live in a community setting at the time of enrollment without jeopardizing their health or safety. This is a clinical judgment by the interdisciplinary team, not a categorical floor.

Insurance status is not a precondition. PACE accepts dual-eligibles, Medicaid-only participants, and Medicare-only or private-pay participants. The vast majority of New York PACE participants are full-benefit dual-eligibles, but the regulation does not require dual eligibility.

PACE is also voluntary. A senior cannot be auto-assigned into PACE the way a dual-eligible can be auto-assigned into an MLTC plan. The senior must affirmatively elect enrollment, which is part of why PACE penetration in New York has plateaued at roughly 10,500 enrollees despite strong outcomes.

The September 1, 2025 ADL-Floor Exemption

This is the lead 2026 fact. Under MLTC Policy 25.04 (issued June 30, 2025; revised August 22, 2025) and the parallel state plan amendment notice 25 OHIP/ADM-03, NYSDOH implemented a new Minimum Needs Requirement floor for MLTC Partial Capitation and Medicaid Advantage Plus enrollments effective September 1, 2025. Applicants assessed on or after that date must show either limited assistance with three or more activities of daily living, or supervisory assistance with two or more ADLs if a documented Alzheimer's or dementia diagnosis is on file.

PACE is explicitly carved out. The policy text states that the new program eligibility criteria are referred to as Minimum Needs Requirements and do not apply to enrollment in Programs of All-Inclusive Care for the Elderly. The policy logic is straightforward: PACE eligibility has always been gated by NF-LOC, which is a deeper clinical test than any ADL count. A senior who clears NF-LOC has, by definition, been deemed appropriate for institutional placement, and the state did not need to overlay a corrective ADL floor.

In practical 2026 navigation, the carve-out makes PACE the operative integrated-care route for several specific senior populations:

• Seniors whose nursing-home-level need is driven primarily by skilled-nursing demand (complex wound care, frequent IV therapy, advanced cardiovascular monitoring) rather than ADL impairment, and who therefore clear NF-LOC without three ADLs.
• Seniors with mid-range dementia whose primary clinical concern is supervision and behavioral redirection rather than ADL dependence, and who do not satisfy the supervisory-with-two-ADLs-plus-dementia route.
• Seniors at the assessment edge whose UAS-NY scores are borderline on ADL impairment but whose hospital and primary-care records establish NF-LOC.
• Pre-September 1, 2025 MLTC Partial Capitation enrollees who lose Legacy Status because of an enrollment break, and who would not clear the new floor on re-application but still clear NF-LOC.

In each case, PACE is open and MLTC Partial Capitation and MAP are not. For a New York family in 2026 that has just been told a parent does not meet the new MLTC floor, PACE is the first place to look.

The Day-Center Model

The PACE day center is the operational hub of the program. A typical center includes a primary care clinic with physicians, nurse practitioners, and registered nurses; therapy gyms for physical and occupational therapy; activity rooms for recreational therapy, group programming, music, and art; a dining area for hot lunch; a nursing assessment area for vitals, wound care, and IV infusion when indicated; restrooms with assistive devices and shower facilities at some centers; and a van bay for participant pickup and drop-off.

Most participants attend the day center three to five days per week. Some attend daily. Some attend one or two days per week if the care plan allows. The schedule is set by the interdisciplinary team and reviewed at every comprehensive reassessment, which happens at enrollment, every six months, and on any change in condition.

For a senior with advanced dementia or significant ADL needs, the day center is also where bathing, hair care, and other ADL assistance happens, three to five times a week. That structured caregiver respite is often the most concrete relief PACE provides to an unpaid family caregiver.

Transportation is included in the capitation. The PACE van picks the participant up at home, takes them to the day center, takes them home at the end of the day, and takes them to specialty appointments and many community appointments. Removing the transportation logistics from the family is, for many caregivers, the largest practical benefit of PACE enrollment.

The Interdisciplinary Team

Under 42 CFR § 460.102, every PACE organization must staff an interdisciplinary team with members qualified to fill, at minimum, eleven roles: a primary care provider; a registered nurse; a master's-level social worker; a physical therapist; an occupational therapist; a recreational therapist or activity coordinator; a dietitian; a PACE center manager; a home care coordinator; a personal care attendant or representative; and a driver or representative of the transportation team. One person may fill two roles where state licensure permits.

The team meets at least weekly to review newly enrolled participants, reassess existing participants on changed status, and coordinate care across disciplines. Within 48 hours of any inpatient hospital discharge, the team reviews hospital recommendations and adjusts the care plan. At every comprehensive reassessment, the team revisits day-center attendance, therapy schedules, home-care hours, transportation, specialty consults, and family education needs.

The structural difference from an MLTC Partial Capitation care manager is significant. An MLTCP care manager is typically a single nurse or social worker coordinating long-term services for a panel of dozens of members, with quarterly to semiannual touchpoints. A PACE interdisciplinary team is eleven disciplines collectively seeing the participant one to five days a week and meeting weekly to coordinate. The clinical evidence base on PACE outcomes (lower hospitalization rates, lower nursing-home admission rates, higher participant satisfaction) flows from that structural difference.

The 10 Active 2026 NY PACE Programs

New York has 10 active PACE programs in 2026, with a Brooklyn WelbeHealth NYC center in early-stage operation that may be counted as a recent addition or an emerging eleventh program depending on the snapshot date. The roster below has been cross-checked against the NYS PACE Alliance member list, the National PACE Association directory, and individual plan websites.

CenterLight Healthcare PACE is the largest plan by census, the largest not-for-profit PACE program in the United States, and the only New York plan with an eight-county footprint that crosses NYC, Nassau, Western Suffolk, and Westchester. ArchCare Senior Life is second largest. ElderONE is the only PACE program in the Greater Rochester area, with roughly 750 participants supported by approximately 265 team members. Eddy SeniorCare is the only Capital Region PACE plan. PACE at Hudson Headwaters opened February 1, 2025 and is the first PACE program in New York sponsored by a Federally Qualified Health Center, a structural innovation that may signal future PACE expansion through other FQHCs.

A few corrections worth flagging because they appear in older directories. Independence Care System, often miscategorized as a PACE plan, was an MLTC plan that ceased managed-care operations on March 31, 2019 and reorganized as a Medicaid Health Home. PACE CNY, sponsored by Loretto in Onondaga County, is actively operating in 2026 with two day-center locations and was the first New York PACE plan to deploy a 24/7 telehealth service for participants. LiveOn NY is an advocacy and aging-services organization, not a PACE provider, and should not be listed as one.

How PACE Differs From MLTC and MAP

PACE, MLTC Partial Capitation, and Medicaid Advantage Plus are the three integrated or near-integrated long-term-care managed-care products in New York. They share some surface features and differ in load-bearing ways. The comparison below is the one caregivers most often need to walk through.

The bullet-point version: PACE delivers more, costs nothing for full duals, and demands more (day-center attendance) in exchange. MLTC Partial Capitation is broader geographically but covers only Medicaid LTSS and does not include Medicare integration. MAP integrates Medicare and Medicaid like PACE but uses a conventional plan-and-network model rather than a day center. PACE is the most clinically intensive of the three; MLTC Partial Capitation is the most flexible; MAP is the closest substitute for PACE for seniors who want integrated dual-eligible care without a day-center attendance commitment.

How to Apply

Application to PACE is direct, not routed through New York Medicaid Choice or NYIAP. Under 42 CFR § 460.150 and a May 2024 NYSDOH policy update, PACE plans conduct their own clinical assessments and enroll members directly without going through the New York Independent Assessor Program three-stage process that governs MLTC Partial Capitation and MAP enrollment.

The practical steps:

1. Contact a PACE plan that serves the senior's county of residence. The phone numbers and websites for all 10 plans are listed in plan-directory resources at the New York State PACE Alliance and through the National PACE Association locator.
2. The PACE plan schedules an intake assessment. This assessment evaluates NF-LOC, community-safety eligibility, age, residence, and any plan-specific conditions in the program agreement. The assessment is performed by the plan's clinical staff.
3. Medicaid eligibility is verified through the local department of social services (the Human Resources Administration in NYC) or, for institutionalized applicants, through the relevant district. If the senior is not yet enrolled in Medicaid, the application can be filed during the PACE intake process.
4. The state administering agency reviews and confirms the LOC determination. NYSDOH verifies that the PACE plan's NF-LOC determination meets state standards.
5. Enrollment becomes effective the first of the month after approval. The three-way program agreement covering the plan, NYSDOH, and CMS attaches the participant to the PACE capitation streams.

A senior who is already enrolled in MLTC Partial Capitation or MAP can switch into PACE without a lock-in penalty on the PACE side, although the prior plan's disenrollment process and timing apply on the way out. A senior in fee-for-service Medicaid can enroll in PACE through the same direct-application route.

Disenrollment and the Absence of Lock-In

PACE is structurally easy to leave on the Medicaid side. Under 42 CFR § 460.162, a participant may voluntarily disenroll from PACE without cause at any time. Voluntary disenrollment is effective the first day of the month following the date the PACE organization receives the participant's notice. There is no 90-day grace period, no 9-month MLTC lock-in, and no Good Cause regime to navigate.

After Medicaid-side disenrollment, the participant routes back to whatever Medicaid pathway they elect. A dual-eligible can return to fee-for-service Medicaid for LTSS plus original Medicare or any Medicare Advantage plan they elect, or can enroll in MLTC Partial Capitation, MAP, or a non-FIDE D-SNP. A Medicaid-only participant defaults to fee-for-service Medicaid.

Involuntary disenrollment is permitted only on specific grounds under 42 CFR § 460.164: nonpayment of premium after a 30-day grace period (rare in New York because most participants are full duals with $0 premium); nonpayment of Medicaid spend-down or post-eligibility income after a 30-day grace period; disruptive or threatening behavior by the participant or a caregiver; loss of NF-LOC at recertification; movement out of the service area; or termination of the PACE organization. Importantly, NYSDOH must review and approve any involuntary disenrollment before it takes effect, which is a meaningful due-process safeguard.

The asymmetry to flag: while the Medicaid side of disenrollment is immediate and unconditional, the Medicare side follows standard Medicare Advantage and Special Enrollment Period rules. A dual-eligible can use the dual-SEP to switch Medicare options at any time, but a non-dual participant may need to wait for the Annual Enrollment Period or the MA Open Enrollment Period to make Medicare-side changes.

Long-Stay Nursing-Home Coverage

If a PACE participant requires long-term nursing-home placement, the PACE plan continues to cover the placement indefinitely. The PACE organization keeps receiving capitation, the participant remains enrolled, the same interdisciplinary team manages care in the new institutional setting, and the family does not have to navigate a re-enrollment back to fee-for-service Medicaid.

This is structurally different from MLTC Partial Capitation, which under PHL § 4403-f(7-a) covers only the first 3 months of a Long-Term Nursing Home Stay before disenrolling the member to fee-for-service Medicaid. For a family caring for a senior whose acuity is approaching nursing-home placement, the choice between PACE and MLTC Partial Capitation is partly the choice between an indefinite institutional benefit (PACE) and a 3-month bridge followed by fee-for-service transition (MLTCP). MAP, like PACE, covers long-stay placement indefinitely.

Costs to the Member

For a full-benefit dual-eligible (full Medicare A, B, D and full Medicaid), PACE costs $0 per month. Both Medicare and Medicaid pay the PACE organization directly through capitation, and the participant has no premium, no deductible, no coinsurance, and no copay for any covered service.

For a Medicaid-only participant who is not yet 65 or otherwise not Medicare-eligible, PACE costs $0 per month, with Medicaid paying the full capitation.

For a Medicare-only or private-pay participant, the cost is the Medicaid portion of the capitation paid out of pocket plus any Medicare cost-sharing under their MA or original Medicare arrangement. Full private-pay PACE in New York City commonly runs $4,000 to $9,000 or more per month, varying by service area and acuity. The path exists but is rare.

For a participant subject to Medicaid excess income or a Net Available Monthly Income (NAMI) contribution, the participant pays the spend-down or NAMI amount to the PACE organization each month. PACE organizations typically waive nominal premium amounts under their internal policy. Failure to pay the spend-down or NAMI contribution after a 30-day grace period is a permitted ground for involuntary disenrollment under 42 CFR § 460.164.

Appeals and ICAN

PACE participants have access to a layered appeals system. At the plan level, a participant or representative can file a grievance or appeal directly with the PACE organization for service authorization disputes, quality concerns, or administrative actions. The plan's grievance and appeals process is governed by 42 CFR Part 460 Subpart G and by the program agreement.

For Medicaid-side issues, including service authorization and benefit denials that flow through the Medicaid funding stream, the participant has a right to a New York State Fair Hearing under 18 NYCRR Part 358. The Fair Hearing is filed with the New York State Office of Temporary and Disability Assistance. Aid Continuing under 18 NYCRR § 358-3.6 keeps the existing service or benefit in place during the hearing if the participant requests Aid Continuing before the effective date of the proposed action or within 10 days of the agency's notice.

For Medicare-side issues, the participant follows the standard Medicare appeals process, which begins with reconsideration and proceeds to independent reviewer, administrative law judge, Medicare Appeals Council, and federal court if necessary.

The Independent Consumer Advocacy Network (ICAN), reachable at 1-844-614-8800, is the New York State ombudsprogram for people with Medicaid who need long-term care or behavioral health services. ICAN is operated by the Community Service Society of New York and explicitly covers PACE in addition to MLTC Partial Capitation, Medicaid Advantage Plus, mainstream Medicaid managed care, and HARP. ICAN's services are free and confidential. For any PACE participant or family navigating a service dispute, plan-level grievance, or fair hearing, ICAN is the first call.

Common Misconceptions

• PACE is not a nursing home. It is a community-based program for nursing-home-eligible adults who can live safely at home with PACE support. Day-center attendance is part of the model; institutional residence is not.
• PACE eligibility is not gated by an ADL count. It is gated by NF-LOC. The September 1, 2025 Minimum Needs Requirement under MLTC Policy 25.04 does not apply to PACE.
• PACE has no lock-in. Participants may disenroll voluntarily at any time under 42 CFR § 460.162. The 9-month MLTC lock-in does not apply.
• PACE covers the full long-stay nursing-home placement. The 3-month rule under PHL § 4403-f(7-a) applies to MLTC Partial Capitation, not to PACE.
• PACE includes Part D-equivalent drug coverage automatically. No separate Prescription Drug Plan enrollment is required, and dual-eligible Low-Income Subsidy auto-assignment to a benchmark PDP does not apply once PACE is effective.
• PACE plans run their own eligibility assessment. As of a May 2024 NYSDOH policy update, PACE plans are authorized to conduct intake assessments and direct enrollment without routing through the New York Independent Assessor Program.
• LiveOn NY is not a PACE plan. It is an advocacy and aging-services organization. The misclassification appears in older directories.
• PACE CNY has not closed. It is actively operating in Onondaga County in 2026. The 2023 closure claim circulating in some materials is incorrect.
• Independence Care System was not a PACE plan. It was an MLTC Partial Capitation plan that ceased managed-care operations March 31, 2019 and reorganized as a Medicaid Health Home.
• PACE plans are not rated under Medicare Advantage Stars. CMS excludes PACE from the MA Star Ratings program. Quality is benchmarked through National PACE Association participant satisfaction data and 42 CFR Part 460 Subpart H quality measures.

Frequently Asked Questions

Learn More

• New York Medicaid Programs for Seniors
• New York Managed Long Term Care (MLTC)
• New York MAP & FIDE-SNP Plans
• How to Apply for Medicaid in New York
• How CDPAP Pays You to Care for a Loved One in New York
• New York Medicaid Long-Term Care & Nursing Homes

Find personalized help comparing PACE, MLTC Partial Capitation, and MAP at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.