How to Enroll
BEcome A PACE MEMBER
Review of program eligibility
The state and federal governments have set eligibility and enrollment criteria. The intake nurse reviews this information with the potential participant to determine eligibility for the PACE program. If the person is ineligible or not interested in the PACE model, information on other local programs that may meet an individual’s needs will be provided.
Payment/insurance coverage
If you are not currently enrolled in Medicaid, a financial assessment to help determine eligibility is completed; the potential participant will need to provide a summary of income and assets for this assessment. If the decision is made to apply for Medicaid, a list of documents needed for that process is provided, and the Loretto Finance Department will help with the process.
Medicaid and Medicaid-pending status
New York State law requires that persons with Medicaid or who are Medicaid-pending have a conflict-free evaluation by an independent nurse provided by New York State to determine eligibility for any managed long-term care program (MLTC). We will provide the individual with the number to call to schedule this evaluation.
PACE CNY assessment process
To know if you are eligible for pace you need to have an assessment. There are two ways you can choose to have your assessment.
Direct Eligibility: You can have PACE CNY complete your assessment, which will see if you are eligible to join our plan. If you select Direct Eligibility our Plan will conduct your assessment. We will let you know if you are eligible for PACE. If you are found eligible, we can work with you to join our Plan. All Direct Eligibility assessments will be reviewed by the New York Independent Assessor (NYIA) to see if you can remain in the Plan. You should note that our Direct Eligibility assessment only applies towards enrollment into PACE CNY.
OR
New York Independent Assessor: You can contact NYIA to schedule an assessment. NYIA is the state-contracted independent assessor, that oversees and conducts assessments for individuals seeking personal care services, consumer directed personal assistance services, or Managed Long Term Care (MLTC), including PACE. If you choose to have a NYIA assessment and you are found eligible for PACE enrollment, there will be no further review. If you are not eligible for PACE enrollment, the NYIA assessment can also be used to see if you are eligible for other MLTC programs.
You will receive the PACE Direct Eligibility Disclosure Letter which you should review carefully prior to deciding between either PACE Direct Eligibility or New York Independent Assessor.
If you would like someone to represent you in your dealings with Medicare, Medicaid or the Social Security Administration, you must fill out, sign and submit a written statement to social security. You can use the appointment of representative form #1696 for this purpose. Please click below on PDF for ‘Appointment of Representative Form’.
Click to Download Appointment of Representative form
Enrollment
Upon enrollment, our interdisciplinary team completes an in-depth healthcare evaluation and develops a comprehensive, individualized care plan based on medical, physical, emotional and social needs. The individual’s enrollment becomes effective of the first of the month.
Download PACE Enrollment Agreement (English)
Descargue el Acuerdo de Inscripción de PACE (Español)