PACE Programs by State: 82,196 Medicare Enrollees, and 17 States With None

Disclaimer: General educational research only — not legal, tax or financial advice. PACE, Medicaid and estate recovery rules vary by state and change. Talk to an elder law or estate planning attorney in your state before you act.

Estate Planning Data & Research → PACE Programs by State

82,196 people with Medicare were enrolled in PACE, the Program of All-Inclusive Care for the Elderly, in October 2026, according to our analysis of Centers for Medicare & Medicaid Services (CMS) contract enrollment data. That’s up 12.5% from 73,044 a year earlier and 57.7% from 52,124 in October 2021. The number of PACE organizations with a CMS contract grew from 141 to 208 over the same five years.

PACE is a way for an older person who already needs a nursing home level of care to keep living at home. One organization takes over all of the person’s Medicare and Medicaid care: doctors, a day center, home care, therapy, prescriptions, hospital stays and, if it comes to that, nursing home care. But it only exists where a PACE organization operates. In October 2026, 17 states had no Medicare enrollees in PACE at all, and in the states that do, programs typically cover only some ZIP codes or counties. For families, PACE often comes up at the same moment as the hardest estate planning questions: who can sign for Mom, whether the house is at risk from Medicaid, and what happens to the healthy spouse. This page shows where PACE is available and what to put in place before you enroll.

If PACE or Medicaid is on the horizon for your family, the documents that matter most are the ones signed now: powers of attorney, a will or trust that protects a spouse, and a plan for the house. See whether a trust or a will fits your situation.

Key findings

• 82,196 Medicare enrollees in 208 PACE organizations as of October 2026, or 7.8 per 10,000 residents age 55 and older (12.7 per 10,000 age 65+). CMS’s monthly summary report, which also counts the smallest programs, puts the total at 82,218.
• Growing quickly. Enrollment rose by 9,152 people (12.5%) from October 2025 and by 30,072 (57.7%) from October 2021. Ten PACE contracts that weren’t in the October 2025 data appeared by October 2026, in Arkansas, California (four), Florida, Michigan, New Jersey, Ohio and Oregon.
• 17 states have no Medicare PACE enrollees: Alaska, Arizona, Connecticut, Georgia, Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia and Wyoming. 33 states and the District of Columbia have at least one program with enrollees.
• Highest use relative to the older population: Colorado (29.9 per 10,000 residents 55+), Massachusetts (24.5), California (21.6), Michigan (18.6) and Pennsylvania (17.1). Lowest among states with PACE: Illinois (0.4), Alabama (1.0), Missouri and Tennessee (both 1.1) and Texas (1.4).
• Concentrated in a few states. California alone has 24,903 enrollees in 42 PACE organizations, 30.3% of the national total. California, Pennsylvania, New York, Michigan and Massachusetts together account for 62.4%.
• Fastest growth since October 2025 came from small bases: Illinois (+87.3%), Ohio (+64.0%), Maryland (+56.2%), Kentucky (+54.1%) and Missouri (+40.6%). Enrollment fell in Nebraska (−8.9%) and the District of Columbia (−4.4%).

PACE enrollment by state, October 2026

Source: Family Estate Guide analysis of CMS Monthly Enrollment by Contract and Monthly Enrollment by CPSC (contract, plan, state, county) reports for October 2026 and October 2025, and U.S. Census Bureau Vintage 2025 population estimates (July 1, 2025). PACE organizations are CMS contracts with organization type “National PACE”; each is assigned to the state where its enrollees live (in every case, at least 98.98% of a contract’s reported enrollment is in one state). Enrollees are people with Medicare; people in PACE through Medicaid only are not included. Change compares the same contracts’ October 2025 enrollment. States are ranked by enrollees per 10,000 residents 55+.

What the numbers mean

The table counts people, not programs’ capacity. A high rate in Colorado or Massachusetts means PACE is a well-established option there, with several organizations and sites; a low rate in Texas or Illinois means PACE exists in only a few areas, so most older residents can’t use it even if they qualify. A state listed with zero means no CMS PACE contract reported Medicare enrollment there in October 2026. CMS lists a PACE Georgia contract, for example, but no enrollment was reported for it. Programs are being added every year, so a state with none today may have one soon; your state Medicaid agency will know.

Even in states with PACE, where you live matters. Each PACE organization has a service area approved by CMS and the state, often a set of ZIP codes around a PACE center, and you must live in it to enroll. A state with 10 or more organizations can still have counties with no PACE at all.

Because PACE is for people who already need a nursing home level of care, these 82,196 people are among the frailest older adults living at home. That’s why PACE matters for an estate plan: by the time someone qualifies, it may be late to sign new documents, and the family is often already thinking about Medicaid.

How PACE works

PACE is set up by federal law (42 U.S. Code 1395eee for Medicare and 1396u-4 for Medicaid) and federal rules in 42 CFR Part 460. States choose whether to offer it under their Medicaid program.

• Who qualifies. You must be 55 or older, live in the PACE organization’s service area, be found by the state to need the level of care required for Medicaid nursing home coverage, and, at the time you enroll, be able to live in the community without jeopardizing your health or safety (42 CFR 460.150).
• One organization for all care. Once enrolled, a participant must receive Medicare and Medicaid benefits only through the PACE organization (42 CFR 460.90). The package must include all Medicare-covered services, all Medicaid-covered services in the state plan, and anything else the PACE care team decides is necessary (42 CFR 460.92). Seeing doctors outside PACE generally isn’t covered unless PACE arranges it.
• No deductibles or copays. Medicare and Medicaid deductibles, copayments and other cost-sharing don’t apply in PACE (42 CFR 460.90).
• What it costs. A participant who has Medicaid (with or without Medicare) can’t be charged a premium. A participant with Medicare Parts A and B but no Medicaid pays a monthly premium equal to the Medicaid capitation amount, which is the state’s monthly PACE rate for the long-term care part of the benefit (42 CFR 460.186), plus a premium for Part D drug coverage, according to Medicare.gov. Because that premium pays for long-term care, it is expensive, and for most families PACE works as a Medicaid program in practice.
• Start and stop dates. Enrollment takes effect on the first day of the month after the PACE organization receives the signed enrollment agreement (42 CFR 460.158). A participant can leave for any reason at any time, effective the first of the next month (42 CFR 460.162). Enrollment otherwise continues until death, regardless of changes in health, unless the participant is involuntarily disenrolled, for example for moving out of the service area or not paying a premium (42 CFR 460.160 and 460.164).
• No enrollment season. The federal rules tie the start date to the signed enrollment agreement, not to an annual election period, so you don’t have to wait for Medicare’s fall open enrollment (Oct. 15 to Dec. 7) to join.

Why PACE is an estate planning issue

Medicaid estate recovery can apply. For anyone who receives Medicaid at age 55 or older, federal law requires the state to seek repayment from the person’s estate for Medicaid-paid nursing facility services, home and community-based services and related hospital and prescription drug services, and lets states recover for other Medicaid services too (42 U.S. Code 1396p(b)(1)(B)). Medicaid pays PACE through a monthly capitation payment that covers exactly this kind of long-term care, so in many states the Medicaid payments made for a PACE participant can be claimed against the estate after death. How states count PACE payments, and which assets they can reach, varies. Recovery is generally postponed while a surviving spouse is alive or a child under 21 or a blind or disabled child survives (42 U.S. Code 1396p(b)(2)), and states must have hardship waivers. See Medicaid estate recovery by state.

A revocable living trust doesn’t shelter assets from Medicaid. For Medicaid eligibility, the assets in a revocable trust are treated as available to the person who created it (42 U.S. Code 1396p(d)(3)(A)). A living trust still has real value for a PACE family, because a successor trustee can manage money and the house without a court if the person can no longer do it. But it isn’t a Medicaid plan by itself.

Gifts made to qualify can backfire. Medicaid looks back 60 months for gifts and transfers for less than fair market value, and a transfer can cause a period of ineligibility (42 U.S. Code 1396p(c)(1)). Giving the house to a child right before applying for Medicaid to pay for PACE can delay coverage, and it can also cost the child a step-up in tax basis. Get advice before transferring anything.

Someone has to be able to sign. Enrolling in PACE means signing an enrollment agreement, sharing medical records and, often, applying for Medicaid. If the person no longer has capacity and never signed a durable financial power of attorney and a health care power of attorney, the family may need a court guardianship first. PACE also means one organization manages all care, so a health care agent who can speak to the care team and make decisions matters even more.

The healthy spouse’s will matters. If one spouse is in PACE through Medicaid and the other spouse dies first leaving everything outright to the PACE spouse, the inheritance can put the PACE spouse over Medicaid’s asset limit and, later, into estate recovery. Many elder law attorneys use a trust for the spouse created in the healthy spouse’s will instead. See married couples where a spouse has memory or decision-making trouble.

What to do if a parent or spouse might need PACE

1. Check whether PACE serves the person’s address. Search for PACE plans on Medicare.gov or call the state Medicaid office. Being in a state with PACE isn’t enough; the address must be inside a program’s service area.
2. Sign documents first, while the person can. A durable financial power of attorney, a health care power of attorney or proxy, a living will and a HIPAA authorization. If they’re already signed, make sure they’re recent and that the agents are still willing and able.
3. Ask about the level-of-care assessment. The state decides whether the person needs a nursing home level of care. Keep copies of the assessment.
4. Figure out Medicaid before you enroll. If the person has Medicare only, the private-pay premium may be unaffordable. If they’ll apply for Medicaid, talk to an elder law attorney about countable assets, the 60-month look-back, the home and spousal allowances.
5. Ask how your state handles estate recovery for PACE, including whether it places a lien on the home and how it treats a home the person still owns.
6. Update the will or trust and beneficiary forms, both for the person entering PACE and for a spouse, so nothing lands outright in the wrong hands.
7. Keep the plan in one place the family can find, with the PACE organization’s contact information and the names of the agents.

An example

Helen, 81, lives alone in a paid-off house worth $260,000 in a city with a PACE program and has $1,500 in savings. After a stroke and two falls, the state finds that she needs a nursing home level of care. She joins PACE, qualifies for Medicaid, pays no premium, and gets a day center three days a week, home aides and all her medical care through one team. She stays home for four more years. Because her daughter has her durable power of attorney and health care proxy, signed years earlier, the daughter handles the enrollment and the Medicaid application without court. After Helen’s death, the state files an estate recovery claim for the Medicaid paid on her behalf, which in her state includes the PACE payments, and the house has to be sold to pay it unless an exception applies. Helen’s family is surprised only because no one asked about estate recovery at the start. An elder law attorney could have explained the state’s rules and options before she enrolled.

Related: Medicaid estate recovery by state · nursing home capacity by state · home care cost vs. retirement income · Medicaid dollars per senior by state

Methodology

We used the CMS Monthly Enrollment by Contract reports for October 2026, October 2025 and October 2021 and the Monthly Enrollment by CPSC report for October 2026, downloaded from cms.gov on Oct. 26, 2026, plus the CMS Monthly Contract Summary Report for October 2026. PACE organizations are contracts with organization type “National PACE.” The contract report gives each contract’s total enrollment; CMS suppresses counts of 10 or fewer, so six small or new contracts with suppressed totals are counted as organizations but add no enrollment (the summary report’s total of 82,218 includes them). To place each contract in a state, we used the CPSC report’s county-level enrollment, where at least 98.98% of every contract’s reported enrollment is in one state, and assigned the contract’s full total to that state. Summing the CPSC county figures directly gives a lower total (79,606), because counties with 10 or fewer enrollees are suppressed there. October 2025 enrollment uses the same state assignment for each contract; all October 2025 PACE contracts appear in the October 2026 CPSC report. Population is the Census Bureau’s Vintage 2025 resident population estimate by single year of age (July 1, 2025), summed for ages 55 and older and 65 and older. Legal descriptions are from 42 CFR Part 460 (eCFR, current as of Oct. 22, 2026) and 42 U.S. Code 1395eee, 1396u-4 and 1396p.

What this doesn’t measure. The CMS files count people with Medicare. People enrolled in PACE through Medicaid alone are not included, so actual participation is somewhat higher. The data doesn’t show each program’s service area, capacity or waiting list, or how many people qualify but don’t enroll. A state’s organization count is the number of CMS contracts, and one organization can run several centers. The data doesn’t show whether participants have a will, trust or power of attorney.

Frequently asked questions

What is PACE?

PACE, the Program of All-Inclusive Care for the Elderly, is a Medicare and Medicaid program in which one organization provides and coordinates all of a frail older person’s care, including a day center, home care, doctors, prescriptions, hospital and nursing home care, so they can keep living at home.

Who is eligible for PACE?

People 55 or older who live in a PACE organization’s service area, are found by the state to need a nursing home level of care, and can live safely in the community when they enroll.

Which states don’t have PACE?

In October 2026, CMS reported no Medicare PACE enrollees in Alaska, Arizona, Connecticut, Georgia, Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia and Wyoming.

How much does PACE cost?

Nothing in premiums for people with Medicaid. People with Medicare but no Medicaid pay a monthly premium equal to the state’s Medicaid PACE rate, plus a Part D drug premium. There are no deductibles or copays for approved services.

Can Medicaid take my parent’s house after PACE?

Possibly. States must seek estate recovery for Medicaid long-term care paid for people 55 and older, and in many states that includes PACE payments. Recovery is postponed while a spouse or certain children survive, and rules vary by state.

Can you leave PACE?

Yes. A participant can disenroll for any reason at any time; it takes effect the first day of the next month.

Is this legal advice?

No. Talk with an elder law or estate planning attorney in your state.

Sources

Public-domain government sources only. Fetched 2026-10-26.

Data

• Centers for Medicare & Medicaid Services, Monthly Enrollment by Contract, October 2026: https://www.cms.gov/files/zip/monthly-enrollment-contract-october-2026.zip
• Centers for Medicare & Medicaid Services, Monthly Enrollment by Contract, October 2025: https://www.cms.gov/files/zip/monthly-enrollment-contract-october-2025.zip
• Centers for Medicare & Medicaid Services, Monthly Enrollment by Contract, October 2021: https://www.cms.gov/files/zip/monthly-enrollment-contract-october-2021.zip
• Centers for Medicare & Medicaid Services, Monthly Enrollment by CPSC (contract, plan, state, county), October 2026: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-enrollment-contract/plan/state/county/monthly-enrollment-cpsc-2026-10
• Centers for Medicare & Medicaid Services, Monthly Contract and Enrollment Summary Report, October 2026: https://www.cms.gov/files/zip/monthly-contract-summary-report-october-2026.zip
• U.S. Census Bureau, Vintage 2025 state population estimates by age, sex, race and Hispanic origin (SC-EST2025-ALLDATA6): https://www.census.gov/data/tables/time-series/demo/popest/2020s-state-detail.html

Law

• 42 CFR Part 460, Programs of All-Inclusive Care for the Elderly (sections 460.6, 460.90, 460.92, 460.150, 460.158, 460.160, 460.162, 460.164, 460.186), eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460
• 42 U.S. Code 1395eee (PACE under Medicare): https://www.govinfo.gov/link/uscode/42/1395eee?link-type=html
• 42 U.S. Code 1396u-4 (PACE under Medicaid): https://www.govinfo.gov/link/uscode/42/1396u-4?link-type=html
• 42 U.S. Code 1396p ((b)(1)(B) and (b)(2) estate recovery; (c)(1) transfers and look-back; (d)(3)(A) revocable trusts): https://www.govinfo.gov/link/uscode/42/1396p?link-type=html
• Medicare.gov, PACE: https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-medicare-health-plans/PACE

Cite this data

You’re welcome to reuse the table with a link back to this page. The underlying government data is public.

Published October 26, 2026 by Family Estate Guide. Data vintage: CMS enrollment reports, October 2026; Census Bureau Vintage 2025 population estimates. Editorial standards.