Growing businesses know diversifying income streams can unlock growth. But when the subject of moving beyond private pay comes up, skepticism arises at pursuing government payer programs. The bureaucracy feels impenetrable, the sales cycle is long, and finding a unique value proposition seems unlikely.
Still, government-funded programs like PACE (Program of All-Inclusive Care for the Elderly) offer an opportunity to serve frail seniors and unlock steady growth. Recent evidence suggests organizations that provide data-driven care get approved faster and stay a partner longer. That’s because PACE seeks better participant experience and proves the efficacy of their programs using data that their funder, Centers for Medicare & Medicaid Services (CMS), cares about.
Once you’re part of PACE, your organization is in an integrated, government-funded care infrastructure. Since PACE participants have their medical, social, and health needs met through an interdisciplinary team, enrollees typically stay in the program until end of life. That allows care teams to build genuine long-term relationships, lowers client acquisition costs, and ensures steady revenue for your program.
What Is PACE?
PACE is a federal, state-administered Medicare and Medicaid full-service health care model designed to keep seniors who face complex health and social needs in their homes and in their communities. PACE participants are the same average age as other Medicare seniors, but are often more frail. Without a program devoted to keeping them in their homes and communities, most participants would live in medical nursing homes.
PACE launched in San Francisco’s Chinatown in the early 1970s as part of On Lok, after community leaders recognized Chinese and Hispanic immigrants needed comprehensive eldercare but viewed nursing homes as culturally unacceptable. The original goal was to combat the over-institutionalization of seniors by offering a safety net that allowed them to remain in their homes. Today, about 90% of PACE enrollees are dually eligible for Medicare and Medicaid.
To qualify for PACE, an individual must:
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- be 55 years of age or older;
- live in a PACE service area;
- be able to live in the community at the time of enrollment; and
- be certified by the state to need a medical nursing home level of care.
PACE programs receive a fixed monthly capitated payment per participant from Medicare and Medicaid. Because the program bears full financial risk for each enrollee’s care, it prioritizes outcome metrics: reducing hospitalizations, avoiding ER visits, and keeping elders out of nursing home care. That financial alignment between quality care and cost control is why PACE is a fit for organizations that can prove reductions in the outcome metrics that matter to Centers for Medicare & Medicaid Services (CMS).
What is behind PACE growth?
CMS has recognized the importance of serving the over 12 million of dually eligible individuals and are expanding PACE funding. If your service area does not have a PACE program with your focus, or very few PACE programs, it’s a good time to consider creating a program to cater to this audience.
As of mid-2026, PACE has grown to 202 programs across 33 states and DC and enrollment is at 95,500 participants. This is a 5.4% increase from December 2025. States like Connecticut, Louisiana, Minnesota, New Jersey, Pennsylvania, Oregon, and Tennessee have issued request for proposals (RFPs) for new programs, and CMS announced a $50 billion rural health initiative that includes PACE expansion.
What PACE looks for in a home care partner
Becoming an approved PACE contractor or launching a PACE program in your service area requires patience, operational excellence, and the ability to show data-backed value to institutional payers.
Here is what to keep in mind before you launch a PACE program:
Outcomes are the only currency. PACE programs are accountable to CMS and state Medicaid agencies for participant health outcomes. Among indicators of physical and social health indicators, hospitalization readmission rates, vaccination rates, and ER visits are some of the metrics PACE uses to measure success. When you speak to a PACE administrator, frame your pitch beyond your services to what you can reduce and track. Consider participants reduced hospitalization rates, fewer ER visits, and shorter nursing facility stays. Track clinical outcomes like fall rates, ADLs, vision/hearing tests, flu vaccines, UTIs, and depression screenings. Come with outcome data, documented care trends, and a record of proactive interventions.
You need a feasibility study (or pilot) before you launch. For organizations applying for formal PACE program status (rather than a contractor or referral partner relationship), CMS requires a pre-approval feasibility study demonstrating the program will be cost neutral or generate savings for the state. Your odds of approval are higher if there are few PACE programs in the community you serve. In addition, this study of the program’s finances and operations will assess whether your program can serve enough participants, operate within the capitated payment structure, and deliver cost savings compared to nursing home care. Besides the study, an organization needs a governing board with community representation, the ability to deliver a comprehensive service package, and a physical site for adult day services.
Submit applications online via CMS’s Health Plan Management System (HPMS), alongside a state application process that varies by state.
Organizations can take part as subcontracted partners. Don’t be discouraged, if the barriers to participation seem high. Participation doesn’t need an agency to become a PACE organization. PACE programs can subcontract home care services to provide in-home support for participants who cannot travel to a PACE center. Start by locating PACE programs in your area through the National PACE Association (NPA) and ask them about contractor positions. The NPA also helps prospective organizations assess demand, plan resources, and build referral networks.
How Sensi supports agencies’ PACE contracts
PACE administrators want partners whose data proves their program’s success. PACE wants proof the organizations they partner with catch problems, prevent hospitalization readmissions, and reduce ER visits.
This is exactly what Sensi Care Intelligence was built for.
Sensi is a HIPAA compliant unified agentic operating system and virtual care assistant for the senior care industry. The audio-enabled platform is powered by AI and detects over 100 care signals, such as falls, cognitive decline, and distress, enabling proactive interventions. The platform flags warning signs of UTIs, respiratory changes, falls, and behavioral shifts, allowing intervention before a situation becomes an emergency.
For PACE, it means organizations can present a documented clinical record that proves program efficacy before a feasibility study is even scheduled. Care event reports, hospitalization avoidance logs, and intervention trends speak to the metrics PACE administrators use to evaluate partners and justify referral relationships.
Sensi’s operations and growth agents support the back-office infrastructure that government payers require. Senior care organizations get the data-backed insights, consistent reporting, and professional follow-through that signal a reliable long-term partner.
For organizations already using Sensi, the data you need to approach PACE is already in your account. The question is whether you’re using it to grow your institutional payer sources.
Customer story: Home Matters Caregiving
Clay Foutch, founder of Home Matters Caregiving, a home care franchise based in Beaverton, Oregon, won approval for a PACE pilot in October 2023. Before then, his agency was 100% private pay.
“If you want to be different, you actually have to be different. Sensi care data allowed us to open up real growth.”
Clay used Sensi’s care agent, which provides 24/7 continuous monitoring and predictive care insights, to frame the conversation around cost savings through interventions. As Clay says, “If you want to be different, you actually have to be different. Sensi care data allowed us to open up real growth.” A client with congestive heart failure avoided hospitalization through a medication intervention flagged by Sensi data. A UTI caught before it became an ER visit. Case by case, the care data he presented was exactly what PACE wants in their referral partners.
By the end of the pilot, Home Matters Caregiving reduced hospitalization rates from a PACE baseline of 54% down to 18%, and lowered ER visits from 85% to 21%. PACE calculated $350,000 in avoided hospital stays and $100,000 in avoided ER visits. Three of six home care liaisons within the Oregon PACE program now refer to Home Matters Caregiving. The pilot created $2.5 million in revenue that, as Clay put it, “did not exist on September 30th, 2023.”
The numbers make the case
If you’re on the fence about whether it’s worth the effort, look at who PACE serves.
PACE participants have 24% lower hospitalization rates and 16% lower hospital readmission rates than other dual-eligible beneficiaries. Research from NCBI suggests PACE enrollees have up to four additional years of independence compared to people in comparable care models. The impact of PACE enrollment for its participants is notable since this senior population has some of the highest social and health needs of their age cohort and if their medical and social health is improving, that can be attributed to their involvement with PACE.
For organizations that can prove reductions in falls, UTIs, hospitalizations, and emergency visits, the financial case writes itself. As a preferred PACE partner, you differentiate your agency and retain participants by reporting clinical data and a clear record of outcomes. PACE pays a fixed monthly rate per participant, so once you lock in a referral relationship, you’ve built a steady, government-backed revenue stream that grows as enrollment grows.
If you want to learn more about how the Sensi platform can help you build the clinical and operational track record that wins PACE contracts, book a demo.
If you want to learn more about how the Sensi platform can help you build the clinical and operational track record that wins PACE contracts, book a demo.
