By Cleveland Senior Advisor Care Team · August 31, 2026
PACE covers everything Medicare and Medicaid cover, with one team and one bill, for people who already qualify for nursing home care. In Northeast Ohio it serves Cuyahoga, Lorain and Summit. Not Lake, Geauga, Medina or Portage.
The program most Cleveland families have never heard of
If your parent needs a nursing home level of care but wants to stay in their own house, there is a program built for exactly that situation. It is called PACE, the Program of All-Inclusive Care for the Elderly. It is not a waiver, not a Medicare Advantage plan, and not a home care agency. It is all of a person's medical and long-term care, delivered and paid for by one organization.
The Ohio Department of Aging describes PACE as a model for adults 55 and older who need a nursing facility level of care, so they can get that support at home instead of moving into an institution. The state's own framing is worth reading twice: PACE participants are people who have already been assessed as needing the level of care a nursing home provides. This is not a program for a parent who is merely slowing down.
What makes it different from everything else on this site is the scope. One interdisciplinary team — physicians, nurses, physical and occupational therapists, dietitians, social workers, recreation therapists — is responsible for the whole person. The state lists primary and specialty care, adult day health services, personal care, inpatient hospital care, prescription drugs, therapies, and nursing home care as included. There is no separate Part D plan to shop, no separate home care agency to hire, and no coordination gap between them, because it is all the same organization.
Most participants nationally and in Ohio are dually eligible for Medicare and Medicaid. That is the population PACE was designed around.
The map is the first question, not the last
Here is the part that decides whether any of this matters to your family: PACE is county-based, and in Northeast Ohio it does not cover our whole region.
PACE is available in Cuyahoga, Lorain, and Summit counties. The operator for all three is McGregor PACE, a Cleveland organization. According to McGregor's own eligibility page, you must be 55 or older, live in Cuyahoga, Lorain, or Summit County, be eligible for a nursing home level of care, and be able to live safely in the community.
PACE is not available in Lake, Geauga, Medina, or Portage counties. If your mother lives in Mentor, Chardon, Brunswick, or Kent, there is currently no PACE program to enroll her in — not a waiting list, not a different provider, simply no service area. That is a hard line, and it catches families off guard because Cleveland-based advice rarely mentions county boundaries at all.
This is the same problem we wrote about with the aging-agency split across Summit and Portage. The regional advice you find online is usually written for Cuyahoga and quietly assumes everyone else is covered by the same programs. On PACE, they are not.
McGregor operates five centers: Forest Hill in Cleveland, Warrensville Heights, Brooklyn, Elyria in Lorain County, and a site at Ohio Living Rockynol in Akron for Summit County. Their main line is 888-895-7223, with a TTY line at 1-800-325-2223.
Why Summit is new and the others may not be far behind
Until recently this was an even shorter list. In its December 2023 announcement of a statewide expansion, the Ohio Department of Aging stated plainly that prior to the expansion, PACE was available in Ohio only in Cuyahoga County. One county, in the entire state.
That expansion was funded through House Bill 45 of the 134th General Assembly, which allocated $50 million in federal ARPA money to help selected providers stand up PACE programs — building the centers, hiring staff, and creating transportation networks. The state selected McGregor PACE for both Lorain and Summit counties, with other operators awarded Franklin, Hamilton, Lucas, Montgomery, and a rural service area covering Ashtabula, Mahoning, and Trumbull.
In July 2025 the state announced that Franklin and Summit had gone live, joining Cuyahoga and Lorain. At that time the department said services were expected to expand into Ashtabula, Hamilton, Lucas, Mahoning, Montgomery, and Trumbull counties by early 2026, and estimated that more than 220,000 Ohioans aged 55 and older would be eligible once the expansion finished.
We are not going to tell you which of those six counties are open today, because we could not confirm it from a primary source. Announced timelines and open enrollment doors are different things. If you are outside Cuyahoga, Lorain, and Summit, check the Ohio Department of Aging's "Find a Local PACE Center" directory rather than trusting any date you read in an article, including this one.
None of the six pending counties are in our region anyway. For a Northeast Ohio family, the practical answer for the foreseeable future is three counties out of seven.
The trade you are actually making
PACE is generous, and the reason families sometimes back out has nothing to do with the benefits. It is the doctors.
Because PACE is responsible for all of a participant's care, participants are expected to use PACE providers. Medicare's own guidance is blunt about the consequence: you may be held financially responsible for care you receive outside the program that is not approved by the PACE interdisciplinary team. Emergency care is handled differently, but the routine relationships are not.
In Cleveland, that is not an abstraction. A lot of people here have been going to the same Cleveland Clinic or University Hospitals physician for twenty years. A parent who has a cardiologist at Hillcrest and a neurologist downtown is being asked to hand the coordinating role — and often the physician relationship itself — to a new team. For some families the trade is obviously worth it. For others it is the thing that ends the conversation.
So ask it directly, before you get to paperwork: what happens to my parent's current doctors, specifically by name? Which of them can we keep, under what arrangement, and who decides? A good enrollment team will answer that plainly. Get the answer before anything is signed, not after.
The other side of the ledger is real too. One team that already knows the whole picture is the opposite of what most families experience during a hospital discharge, where nobody owns the handoff and the family becomes the coordinator by default.
What it costs
There is no single number, and anyone who gives you one is guessing.
If your parent has Medicaid, Medicare's guidance is that there is no monthly premium for the PACE benefit. If your parent does not qualify for Medicaid, there is a monthly premium covering the long-term care portion of the benefit plus a premium for Part D drug coverage. Ohio's Department of Aging confirms that participants can also pay out of pocket.
One feature genuinely worth understanding: once enrolled, the monthly amount does not change based on how much care a person ends up needing. That is the nature of a capitated model. A month with three specialist visits, home care, and a hospital stay costs the family the same as a quiet month. Compare that to the arithmetic in paying privately as needs escalate, where every added hour of help adds to the bill.
We are not publishing a private-pay PACE premium figure for Northeast Ohio, because none is published by a source we trust. Premiums are set per organization and can change. Ask McGregor for the current figure in writing.
How it compares to PASSPORT and the Assisted Living Waiver
Ohio families in this situation are usually weighing three things at once, and the three are not interchangeable.
PASSPORT is a Medicaid waiver that buys in-home services — aide hours, meals, emergency response — while your parent keeps their existing doctors and their regular Medicare coverage. It is a supplement layered on top of the care arrangement you already have.
The Assisted Living Waiver pays for the services side of assisted living in a participating community, and does not pay room and board. It is for someone who is moving, not staying.
PACE replaces the arrangement rather than supplementing it. That is the structural difference, and it is why enrollment is a bigger decision than adding a waiver. If your parent is already on PASSPORT or MyCare Ohio, ask the PACE enrollment team exactly what happens to that enrollment before you commit — do not assume the programs stack.
All three share one gate: a nursing facility level of care determination. If your parent has not been assessed, that assessment is the first step regardless of which direction you go.
Enrollment does not wait for fall open enrollment
This is worth knowing right now, at the end of August, because the mail is about to get confusing.
Medicare's annual election period runs October 15 through December 7, and the Annual Notice of Change letters land by September 30. PACE does not follow that calendar. Medicare's guidance is that PACE enrollment and disenrollment generally occur at the beginning of each month, and that a participant can leave the program at any time.
That cuts both ways. You do not have to wait until October to start, and you are not locked in for a plan year if it turns out to be the wrong fit. It also means there is no deadline pressure to make a decision this month, whatever anyone tells you.
If you want to start, the assessment and enrollment process runs through the PACE organization itself, not through a county office.
Before you say yes
Five questions, in the order we would ask them:
Is my parent's address inside the service area? Not the county they get their mail in, the actual service area. Confirm it with the organization, not with a map you found online.
Has a nursing facility level of care determination already been done? If not, nothing else can move.
Which current physicians can we keep, by name? Get it specifically, and get it before signing.
What is the monthly cost for our exact situation? Medicaid, Medicare-only, or private pay produce very different answers. Ask for it in writing.
What happens if it does not work out? Ask how disenrollment works in practice — how much notice, how care is transitioned, and how quickly a former primary care physician can be resumed.
PACE is a strong option for a narrow group of people: someone who needs a great deal of care, wants to stay home, and is willing to change how their medical care is organized to make that possible. If that describes your parent and they live in Cuyahoga, Lorain, or Summit County, it deserves a serious look. If they live in Lake, Geauga, Medina, or Portage, the honest answer is that this door is closed for now, and the conversation should move to PASSPORT or in-home care instead.
