If your loved one is being discharged from a rehab facility or nursing home and needs ongoing help at home, you’ll likely be introduced to two very different kinds of long-term care plans: a standard Managed Long Term Care (MLTC) plan or the Program of All-Inclusive Care for the Elderly (PACE). Both can arrange home care in New York City, but they work very differently — and for many seniors coming out of a higher level of institutional care, PACE offers a deeper, more coordinated safety net. Here’s how to tell which one actually fits your family’s situation.
What’s the real difference between PACE and MLTC?
The core difference is integration. A standard MLTC “partial capitation” plan only manages Medicaid long-term services and supports — home health aides, personal care, adult day health, and similar services. Your Medicare stays completely separate, so you keep your own doctors and your existing Medicare Advantage plan or Original Medicare. PACE, by contrast, combines Medicare and Medicaid into one program: the same team manages your primary care doctor, specialists, medications, transportation, meals, and home care, often centered around a community day center you can attend for therapy, socialization, and meals (New York Medicaid Choice).
Why does this matter more right now, in 2026?
New York State tightened MLTC eligibility rules effective September 1, 2025. Under MLTC Policy 25.04, new applicants to standard MLTC (partial capitation) or Medicaid Advantage Plus (MAP) must now need help with more than two activities of daily living (such as bathing, dressing, eating, toileting, transferring, or walking) — or, for someone with a documented dementia or Alzheimer’s diagnosis, supervision with more than one. PACE is exempt from this new rule. Instead, PACE continues to use the older nursing-facility level-of-care test. That means some seniors coming out of a nursing home or rehab stay who might not clear the new MLTC bar could still qualify for PACE.
Who is eligible for PACE?
To join PACE in New York, you generally must:
- Be age 55 or older
- Be eligible for both Medicare and Medicaid (dual-eligible), or be able to privately pay
- Meet the nursing-facility level-of-care standard
- Be able to live safely in the community with PACE’s support at the time of enrollment
- Live in a ZIP code served by a PACE organization
New York currently has PACE organizations including CenterLight Healthcare PACE (serving all five boroughs, Nassau, Western Suffolk, and Westchester) and ArchCare Senior Life (Manhattan, Bronx, Staten Island, Westchester). Availability depends on your address, so it’s worth confirming directly with the program.
What does a standard MLTC plan cover instead?
MLTC plans arrange Medicaid-funded home care services — home health aides, the Consumer Directed Personal Assistance Program (CDPAP), adult day health care, and short-term nursing facility stays — while you continue to see your own Medicare doctors and keep your existing Medicare coverage untouched (New York State Department of Health). This works well for someone who is happy with their current doctors and only needs help with home care logistics. It may not work as well for someone who needs tightly coordinated medical and social support, like many people coming straight out of a nursing home.
A real-world example
Consider a senior discharged from a nursing home who needs a home health aide a few times a week, plus close medical follow-up, transportation to appointments, and social engagement to avoid isolation. A standard MLTC plan can arrange the aide, but the senior’s Medicare doctors, medications, and transportation stay separate and uncoordinated. Under PACE, one interdisciplinary team — doctors, nurses, social workers, therapists — manages all of it together, often with the option to attend a day center for therapy and meals.
What You Should Do Now
- Get a Conflict-Free Evaluation. Contact New York Medicaid Choice (Maximus) to schedule the required independent assessment that determines eligibility for MLTC, MAP, or PACE.
- Ask specifically about PACE exemption. If your loved one doesn’t meet the new 2025 MLTC minimum-needs floor, ask directly whether they might still qualify for PACE under the nursing-facility level-of-care test.
- Check service area and doctor preferences. PACE and MAP require using the program’s own care team; standard MLTC lets you keep your existing Medicare doctors. Decide which trade-off fits your family.
- Talk to a licensed advisor before you decide. A free consultation can walk you through both options side by side based on your loved one’s specific needs and address.
Frequently Asked Questions
Can someone be in both PACE and MLTC at the same time?
No. PACE, MAP, and standard MLTC are separate programs, and a person can only be enrolled in one integrated long-term-care option at a time.
Is there a lock-in period for PACE?
No. Unlike standard MLTC plans, which have a nine-month lock-in after a 90-day grace period, PACE has no lock-in and you can disenroll at any time.
Does PACE cost more than MLTC?
For dual-eligible members, PACE is generally covered by Medicare and Medicaid with little to no additional cost, similar to MLTC. Costs can vary by individual circumstances, so confirm details directly with the program.
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