How Multisector Plans for Aging and PACE Can Work Together to Improve Care for Older Adults

Introduction

As the population of older adults in the U.S. continues to grow, delivering the services needed to support an aging population becomes increasingly important. States are seeing the impact of the predicted demographic shift across multiple domains—including increased pressure on the health system, direct care workforce, accessibility of home and community-based services, housing, and transportation. The solutions vary for those with different social, behavioral, and complex care needs, but there remains room for collaboration and coordination between the entities working to support older Americans.

Multisector Plans for Aging (MPAs) are cross-sector, government-led plans that aim to address the growing and varied needs of older adults by creating a coordinated system of high-quality care and support services. Programs of All-Inclusive Care for the Elderly (PACE) provide comprehensive health care and social support services to frail older adults with complex chronic care needs. MPAs rely on stakeholder input as they are developed, and PACE organizations have an important role in ensuring that the needs of their participants are included.

This brief provides an overview of MPAs and PACE, includes examples, and provides recommendations for consideration on how MPAs and PACE can work together to improve care for older adults. Exhibit 1. Overlap of States with PACE and MPA Activities shows the sixteen states with both PACE and MPA efforts underway (California, Colorado, Indiana, Iowa, Maryland, Massachusetts, Missouri, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and Washington). In these states, there is an opportunity now for collaboration. The appendices of this brief provide state-specific information on MPA and PACE resources for these states.

Note: PACE may not serve entire counties, and to reach out to the local PACE organizations for more information about exact service area

Exhibit 1: Overlap of States with PACE and MPA Activities

Background on Multisector Plans for Aging for PACE Programs

As of October 2023, more than half of U.S. states are working to either build momentum, develop, or implement Multisector Plans for Aging (MPAs). MPAs are government-led, cross-sector, whole person-focused plans that coordinate and prioritize the state’s goals and initiatives to address the needs of the growing aging population. The goal of an MPA is to create a coordinated system of high-quality care and support services that promote healthy aging, independent living, and social engagement, while also addressing intersecting issues related to healthcare, housing, transportation, and other social determinants of health.

MPAs are different from State Plans on Aging, which are required by the Older Americans Act and outline the roles and responsibilities of each state and its Area Agencies on Aging. A State Plan on Aging documents achievements and describes how the state will allocate funds and administer the Older Americans Act going forward. States are required to update this plan and submit it to the Administration for Community Living every four years. In contrast, an MPA is cross-sector and has support from the Governor or state legislature.

MPAs coordinate and elevate existing state and local efforts such as age-friendly initiatives, healthy aging, dementia care, accessible housing, transportation, disability justice, and more. MPAs also work across state agencies to engage diverse stakeholders including older adults, caregivers, industries, providers of services, researchers, advocates, and representatives from diverse communities. While MPAs vary depending on individual state priorities, they share the common purpose of serving as a blueprint for state and private efforts to improve the well-being of older adults and people with disabilities for 10 or more years. MPA development is backed by legislation or an Executive Order in ten states as of October 2023 (California, Colorado, Massachusetts, Missouri, New York, North Carolina, Pennsylvania, Texas, Utah, and Vermont). Leadership from the Governor or legislative leaders is an important step in creating buy-in and support for the development of the plan.

For more information and the latest on the MPA movement, visit multisectorplanforaging.org. This website serves as a hub for involvement opportunities, including an interactive map showing state progress on MPAs, links to helpful resources such as articles, event recordings, and toolkits, and an option to sign up for our periodic MPA newsletter.

Background on PACE for MPA Leaders and Advocates

The Program of All-Inclusive Care for the Elderly (PACE) is a unique, integrated care model that provides comprehensive health care and services to frail older adults with chronic care needs. To be eligible for PACE, an individual must be 55 or older, live in a PACE service area, certified by their state as needing nursing home level of care, and able to live safely in the community with PACE services.

There are over 150 PACE organizations serving about 70,000 individuals in 32 states plus the District of Columbia. PACE uses an interdisciplinary team approach to provide enrollees with all Medicaid and Medicare-covered services, as well as any other services to improve and maintain the participant’s overall health status. The 11-person interdisciplinary team (IDT) members include physicians, nurses, physical therapists, social workers, dietitians, and transportation drivers. They work together to meet the health needs of each person in the program – from primary care, medication management, social work, and physical and occupational therapy to home care, home modifications, transportation, dietary support, and more. PACE organizations also contract with hospitals, skilled nursing facilities, and community-based specialists for any additional healthcare needs. Each person enrolled in PACE has a personalized care plan to meet their needs. PACE organizations are responsible for providing or arranging care to meet participants’ needs 24/7 and 365 days a year.

Who Are PACE Participants

While everyone enrolled in PACE is certified as needing a nursing home level of care, about 95 percent of PACE participants live in their communities. The average PACE participant has up to six chronic conditions. 83 percent of PACE participants need assistance with at least one activity of daily living, and 33 percent need help with five or six activities of daily living.

While there is no requirement that a PACE participant be on Medicaid or Medicare, about 87 percent of participants are dually eligible for Medicaid and Medicare and 13 percent rely solely on Medicaid.

How PACE Organizations and MPAs Can Unite to Promote Shared Goals

Both MPAs and PACE have similar goals to expand and coordinate services for older adults that allow them to remain in their communities as long as possible. As part of these goals, both aim to address issues affecting older adults’ health over and beyond the healthcare system itself, including nutrition, housing, transportation, and many other social services. This intersection is therefore useful for recognizing how both entities can work together to help support older Americans. Furthermore, identifying the locations where PACE and MPAs overlap can help bridge gaps and spread awareness of how to best deliver the services being promoted through MPAs to older adults enrolled in PACE.

MPAs can use PACE expertise to meet their cross-sector aims. These include elevating and expanding existing efforts to deliver housing, community-based supports, nutrition, transportation, and many other services. PACE has experience in working with interdisciplinary teams to meet the comprehensive health needs of participants—from primary care, medication management, social work, and physical and occupational therapy to home care, home modifications, transportation, dietary support, and more. Thus, PACE can deliver key insights and experiences to the MPA planning process on how to better coordinate the broader range of services needed to promote healthy aging at the state and local level.

For example, PACE programs can be a key resource for stakeholder engagement opportunities within MPA planning. Since MPAs are often driven by Executive Orders or legislation, they are backed by government support. This governor-led or legislative-level strategic planning for aging offers a chance for a wide range of stakeholders to be at the table, including PACE programs. PACE programs are an important stakeholder because they are a key feature of the states’ care model for dually eligible individuals. Additionally, these programs have insights into the multidisciplinary care needed to address the needs of a complex population. Through their connections with community providers, PACE programs also have access to other important leaders and stakeholders who can and should be involved in MPA planning.

PACE program involvement in MPA planning has already been happening in several states. For example, in New York, a representative from the New York State PACE Alliance was part of the Long- Term Services and Supports subcommittee developing the MPA. In California, MPA development was informed by extensive public commentary. As part of their involvement with the MPA, CalPACE was able to submit a comment letter to the Department of Aging that included recommendations for how the MPA could be leveraged to expand access to PACE programs and services. Giving PACE a seat at the table not only gives voice to the experiences of PACE participants and providers, but also helps promote PACE as an important part of the continuum of care for older adults.

Final Thoughts

Given the predicted growth of our aging population, it is now more important than ever to bring together and coordinate efforts aimed at better serving and meeting the needs of older adults. This brief has identified a variety of synergies between comprehensive Multisector Plan for Aging development and the deep expertise of PACE in serving older adults. By acknowledging these synergies, PACE and MPA leaders can uncover ideological and geographic overlap between both parties that allow them to collaborate and work together to promote their shared goals. The accompanying appendices provide further resources and information for states that have both PACE and MPA activities.

Both MPAs and PACE should be interested in what the other is doing. West Health and the National PACE Association can assist in making introductions and look forward to featuring more examples for others.

Appendix of States with Both PACE and MPA Activity Underway

1.   PACE and MPA Resources in California

California has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in California

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

• To contact the California PACE Association, click here.

MPA Activities in California

• Review California’s Executive Order for the MPA

• Visit California’s Master Plan for Aging website to learn more about MPA progress

• Review California’s Data Dashboard for Aging to see how California’s MPA is meeting its goals

• Use this contact form for more information on the MPA

2.   PACE and MPA Resources in Colorado

Colorado has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Colorado

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

MPA Activities in Colorado

• Review Colorado’s legislation for the MPA (HB 15-1033 and HB 22-1035)

• Visit Colorado’s Aging Strategy website to learn more about progress on the MPA—The Strategic Action Plan on Aging

• Contact agingstrategy@state.co.us or kristine.burrows@state.co.us for more information on the MPA

3.   PACE and MPA Resources in Indiana

Indiana has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state.

PACE in Indiana

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

4.   PACE and MPA Resources in Iowa

Iowa has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Iowa

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

MPA Activities in Iowa

• To learn more about Iowa’s plan, contact Eugenia Kendall at eugenia.kendall@iowa.gov

5.   PACE and MPA Resources in Maryland

Maryland has both PACE and MPA efforts underway. This appendix includes information about the PACE programs across the state, as well as MPA contacts.

PACE in Maryland

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

MPA Activities in Maryland

• To learn more about Maryland’s plan, contact Jenna Crawley at jennifer.crawley@maryland.gov

• Review Maryland’s Executive Order for the Longevity Ready Maryland Initiative

6.   PACE and MPA Resources in Massachusetts

Massachusetts has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Massachusetts

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

• To contact the Massachusetts PACE association, visit https://masspace.net/.

MPA Activities in Massachusetts

• Review Massachusetts’ Executive Order for the MPA

• Visit Massachusetts’ Multisector Plan for Aging website to learn more about the MPA

7.   PACE and MPA Resources in Missouri

Missouri has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Missouri

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

MPA Activities in Missouri

• Review Missouri’s Executive Order for the MPA

• Visit Missouri’s Multisector Plan for Aging website to learn more about the plan

• To learn more about Missouri’s plan, contact Mindy Ulstad at Mindy.Ulstad@health.mo.gov

8.   PACE and MPA Resources in New York

New York has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in New York

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

MPA Activities in New York

• Review New York’s Executive Order for the MPA

• Visit New York’s Master Plan for Aging website to learn more about the plan

• Use this form to receive updates on the MPA

9.   PACE and MPA Resources in North Carolina

North Carolina has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in North Carolina

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

• To contact the North Carolina PACE Association, click here.

MPA Activities in North Carolina

• Review North Carolina’s Executive Order for the MPA

• Visit North Carolina’s Multisector Plan for Aging website to learn more about MPA progress

• To join one of the four stakeholder workgroups, fill out this form

• If you would like a member of the Steering Committee to speak to your organization, email Rebecca Freeman at freeman@dhhs.gov

10.   PACE and MPA Resources in Oklahoma

Oklahoma has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Oklahoma

• To find and contact a PACE Program in Oklahoma, visit the National PACE Association website.

MPA Activities in Oklahoma

• Visit Oklahoma’s Multisector Plan for Aging website to learn more about the plan

11.   PACE and MPA Resources in Oregon

Oregon has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Oregon

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

MPA Activities in Oregon

• Visit Oregon’s Multisector Plan for Aging website to learn more about the MPA

12.   PACE and MPA Resources in Pennsylvania

Pennsylvania has both PACE (known as LIFE in Pennsylvania) and MPA efforts underway. This appendix includes information about finding LIFE programs across the commonwealth, as well as MPA contacts.

PACE in Pennsylvania

• This is the LIFE footprint as of November, 2023. Plans to expand LIFE are underway. Visit the National PACE Association website for information about exact service areas.

• To contact the Pennsylvania LIFE Provider Alliance, click here.

MPA Activities in Pennsylvania

• Review Pennsylvania’s Executive Order for the MPA—Aging Our Way, PA

• Visit Pennsylvania’s Master Plan for Older Adults website to learn more about MPA progress

• Contact AgingPlan@pa.gov to provide input on Pennsylvania’s Master Plan for Older Adults

13.   PACE and MPA Resources in South Carolina

South Carolina has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in South Carolina

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.

MPA Activities in South Carolina

• To learn more about South Carolina’s plan, contact Lily Cogdill at lcogdill@aging.sc.gov

14.   PACE and MPA Resources in Tennessee

Tennessee has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Tennessee

• To find and contact a PACE Program in Tennessee, visit the National PACE Association website.

MPA Activities in Tennessee

• Visit Tennessee’s Multisector Plan for Aging website to learn more about the MPA

• Review Tennessee’s MPA data dashboard

15.   PACE and MPA Resources in Texas

Texas has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.

PACE in Texas

• To find and contact a PACE Program in Texas, visit the National PACE Association website.

MPA Activities in Texas

• Review Texas’ Executive Order for the MPA

• Visit the Multisector Plan for Aging website to learn more about Texas’ MPA

• For questions regarding Texas’ plan, or to learn more, contact AgingTexasWell@hhs.texas.gov

16.   PACE and MPA Resources in Washington

Washington has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state.

PACE in Washington

• This is the PACE footprint as of November, 2023. Plans to expand PACE are underway. Visit the National PACE Association website for information about exact service areas.