Older Americans are grappling with a growing physician shortage, hospital closures and transportation challenges. Nowhere are these challenges felt more than in rural communities, where receiving care can mean driving hours for an appointment.
For too long, we have accepted these challenges as inevitable. We shouldn’t. Thankfully, some in Washington are making rural healthcare a priority. As they look to achieve these goals, we shouldn’t add more layers of bureaucracy. Instead, we should look to proven models that are already delivering results.
The Program of All-Inclusive Care for the Elderly (PACE) is one such example. It’s a high-quality, cost-effective program that has remained out of reach for too many, for too long.
PACE offers an integrated approach to caring for adults 55 and older who qualify for nursing home-level care — many of whom are dual-eligible for Medicare and Medicaid — while allowing them to remain in their homes and communities.
Instead of navigating multiple providers, enrolled individuals — known as “participants” — work closely with an on-site primary care physician, home care coordinator, physical therapist and more to develop a personalized care plan.
This coordinated approach benefits rural older adults, who may otherwise face transportation barriers or limited access to healthcare professionals. By bringing medical care, social services, transportation, rehabilitation and in-home support together under one roof, PACE can reduce the need for seniors to manage multiple appointments and navigate the complex healthcare system.
The program helps older adults effectively manage chronic conditions, identify health risks, and prevent health crises that would otherwise result in a high-cost emergency room visit or hospital stay. PACE has consistently been identified as a high-performing, cost-saving model of integrated care that can help solve rural healthcare access challenges. By caring for some of the highest-cost beneficiaries, the program is estimated to save Medicaid $6,000 per participant annually.
PACE has demonstrated that rural communities don’t have to settle for fragmented, high-cost care. Instead, the program can bring a broad range of services together and deliver them effectively across rural communities.
One reason PACE has succeeded is that, in many cases, states have been given the flexibility to implement the program according to local needs. Rather than imposing a one-size-fits-all approach from Washington, states can tailor PACE to meet their communities’ unique challenges.
For example, many rural states have established service area exclusivity, which gives PACE providers the certainty they need to make necessary investments in rural communities and ensure seniors can access these services over the long haul. That state flexibility should be preserved and strengthened, not replaced with additional federal intervention.
However, some federal regulatory requirements can still make it unnecessarily difficult for qualified organizations to bring PACE to communities that need it most.
The application process to open a PACE center is a clear example. Current requirements force providers to complete lengthy, time-intensive applications, even when organizations have demonstrated experience operating successful PACE programs elsewhere. While program oversight is important, it should not come at the expense of limiting experienced organizations’ ability to meet market demand. By modernizing federal regulatory requirements — including allowing concurrent service area applications and more transparent approval timelines — policymakers can help accelerate access to the care seniors deserve.
As the population ages and care demands become increasingly complex in rural communities, policymakers must turn to solutions that improve quality while making better use of taxpayer dollars. PACE has proven it can do both. What it needs now is a regulatory framework that recognizes its potential rather than constrains it.
Expanding access to PACE will not solve every challenge facing rural healthcare, but it provides one of the most promising opportunities to help. PACE has already proven it can provide quality care to rural America. The question now is whether policymakers are willing to remove the barriers standing in its way.