Across the U.S., more states are turning to the Program of All-Inclusive Care for the Elderly (PACE) as an alternative to nursing homes. This model provides medical, social, and support services that help seniors live safely in their communities. PACE is designed for adults aged 55 and older who need a nursing home level of care but prefer to stay at home.
Most participants pay little to nothing out of pocket, as the program is funded through Medicare and Medicaid. From 2010 to 2022, PACE programs grew by 116%, and enrollment rose by 211%.
Based on 2025 data from the National PACE Association, here are the top U.S. states leading this shift in elder care.
Texas
Texas is actively developing its PACE program to support seniors who prefer community-based care over nursing homes. The Texas Health and Human Services Commission provides guidance for organisations establishing PACE programs, emphasizing the state’s commitment to expanding elder care services.
Prospective providers must enroll in Texas Medicaid and collaborate with the National PACE Association to ensure compliance with federal and state regulations.
California
California leads the nation in PACE adoption, with more than 24,000 participants enrolled across 27 counties, the highest in the country as of 2025. The state’s diverse aging population benefits from localized care models, especially in urban hubs like Los Angeles and San Diego.
Strong Medicaid support and a robust healthcare infrastructure have helped California expand access to community-based alternatives, allowing more seniors to age in place rather than enter institutional care.
New York
New York has emerged as a significant hub for PACE, with 9 organizations serving approximately 10,000 residents as of 2024. The state’s commitment to expanding community-based elder care is evident in its recent approval of a new PACE program, aiming to broaden access for its aging population.
This growth reflects New York’s dedication to providing integrated, home-based care solutions that allow seniors to age with dignity within their communities.
Pennsylvania
Pennsylvania’s PACE presence is one of the strongest in the nation, with over 9,500 participants enrolled across multiple programs as of March 2025. The program is backed by a long-established network that prioritizes care for low-income seniors.
Since February 2022, PACENET raised income limits by $6,000, allowing more seniors to access reduced drug costs through Medicare Part D and other plans. The state also integrates state-funded pharmaceutical assistance, strengthening care coordination’s overall impact.
Colorado
With 4,853 participants, the state has proactively expanded its PACE offerings to support seniors desiring community-based care. In January 2023, the state lifted an enrollment moratorium on InnovAge Colorado, its largest PACE provider, allowing new participants to enroll across multiple counties.
This development reflects Colorado’s commitment to enhancing accessible, comprehensive care for its aging population, enabling more seniors to receive integrated health services while remaining in their homes.
Massachusetts
By April 2023, Massachusetts recorded 24.3 PACE enrollees for every 10,000 residents aged 55 and up, ranking second nationwide. In 2024, Fallon Health announced plans to open a new Summit ElderCare PACE center in Dartmouth, aiming to serve and extend services to approximately 9,000 eligible residents in Bristol, Plymouth, and parts of Barnstable counties of Massachusetts.
This growth underscores the state’s commitment to providing comprehensive, community-based care as an alternative to nursing homes.
North Carolina
North Carolina has significantly expanded its PACE offerings, with 11 organizations serving approximately 2,115 participants as of May 2024. This growth reflects the state’s commitment to providing comprehensive, community-based care for seniors.
Carolina SeniorCare stands out for prioritizing wellness and preventive care to support healthier, more independent aging. Additionally, the state’s Medicaid expansion has enrolled over 600,000 low-income adults, further increasing access to healthcare services for seniors.
Florida
As of January 2025, Florida operates 8 PACE organizations, serving approximately 2,947 participants across the state. The Florida Agency for Health Care Administration oversees these programs, which provide comprehensive care to seniors eligible for nursing home services but who can safely remain in the community.
Notably, Florida PACE Centers in Miami-Dade County have a considerable capacity of many slots, with 1161 participants enrolled, reflecting the state’s commitment to expanding community-based elder care.
New Jersey
Currently, New Jersey has a total of 1,384 participants enrolled. As of February 2025, New Jersey extended PACE coverage to Hunterdon, Morris, Sussex, and Warren counties—officially reaching full statewide access. This expansion underscores the state’s dedication to providing integrated, community-based care for seniors.
The New Jersey Department of Human Services continues to support PACE growth, ensuring that older adults have access to comprehensive healthcare services that enable them to age in place safely and with dignity.
Michigan
Michigan has demonstrated a strong commitment to the PACE model, with active participants of 2,371 operating statewide as of 2025. All 14 centers provide comprehensive medical and social services to seniors, allowing them to remain in their communities while receiving necessary care.
In February 2025, Michigan collaborated with Medicaid to raise asset limits to over $9,000 for individuals and $14,000 for couples, enhancing accessibility to PACE services for more seniors. This expansion underscores Michigan’s dedication to supporting its aging population with integrated, community-based care alternatives to nursing homes.
Virginia
Virginia’s Program of All-Inclusive Care for the Elderly (PACE) provides community-based healthcare services to adults aged 55 and older with chronic needs or disabilities. The Department of Medical Assistance Services (DMAS) oversees PACE, ensuring participants receive comprehensive care to remain in their homes and communities longer.
As of 2025, Virginia has experienced significant growth in PACE with a total of 2,138 participant enrollments, reflecting the state’s commitment to expanding elder care services.
Indiana
As of January 2025, Indiana’s PACE program serves 831 participants across the state. PACE of Northeast Indiana, located in Fort Wayne, offers comprehensive medical and social services to help seniors aged 55 and older remain in their communities.
Eligible individuals must require a nursing facility level of care and live within a PACE service area. Indiana’s commitment to PACE reflects its dedication to providing integrated, community-based care alternatives to nursing homes.
