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Medicaid and Medicare Work Together

Medicare beneficiaries who have limited income and resources may get help paying for their Medicare premiums and out-of-pocket medical expenses from Medicaid. Medicaid also covers some important services not provided under Medicare, such as community-based long-term services and supports, nursing facility care (for stays beyond 100 days), and a wide array of behavioral health services.  As of 2014, more than 10.7 million Americans were enrolled in both Medicare and Medicaid; two-thirds were elderly individuals with low incomes, and one-third were under age 65 with disabilities. 

When care is provided to Medicare-Medicaid beneficiaries through an “integrated” care model, the beneficiary can get the full array of Medicaid and Medicare benefits through a single delivery system. This approach can improve care coordination and quality, and reduce administrative burdens. One such model is the Program for All-Inclusive Care for the Elderly, or PACE.  PACE provides comprehensive medical and social services to certain frail elderly individuals enabling them to continue living in the community. There are currently 113 PACE programs operating in 32 states. 

In Spanish,“bien vivir” means “good life” or “to live a good life.”  At Bienvivir Senior Health Services in El Paso, Texas that is what seniors are able to do, thanks to PACE.  Currently, 865 seniors, most of whom speak Spanish as their first language, participate in the program. In addition to providing health and social services, the program provides both participants and staff with English, literacy and GED classes. The program has taken additional steps to ensure the health and well-being of the community by LEED (Leadership in Energy and Environmental Design) -certifying two of its facilities using grants and bonds received from the city of El Paso.  Bienvivir is planning to continue promoting the growth of PACE with a new center for 150 participants scheduled to open in San Antonio, Texas in the near future.

CMS is offering links/charts for informational purposes only, facts should not be construed as an endorsement of the organization's programs or activities

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