Expanding PACE in Rural Communities: Early Signals from State RHTP Plans

The Centers for Medicare & Medicaid Services recently announced 50 state awards for the Rural Health Transformation Program (RHTP), a federal investment to support strengthening rural health care delivery. Among publicly posted state applications prioritization varied—from rural hospital stabilization, workforce development, to behavioral health. One strategy states propose to address older adult health in rural areas is expanding access to the Program of All-Inclusive Care for the Elderly (PACE) in rural areas.

PACE is an interdisciplinary, community-based Medicaid and Medicare model designed to help older adults who meet criteria for a nursing-home level of care remain safely at home. It integrates primary and specialty medical care, behavioral health, long-term services and supports, transportation, social engagement, and care coordination under one umbrella. While the number of PACE sites and enrollment are growing nationally, there are a number of barriers to PACE growth in rural areas, including ensuring sufficient patient volume and provider shortages.

Based on submitted RHTP applications, a few states intended to explicitly highlight rural PACE expansion or exploration. For example:

• Kansas has an intentional strategy to expand PACE access. The state noted that approximately one-third of PACE-eligible Kansans living in rural areas currently lack an accessible PACE program. In response, Kansas proposes working with two existing PACE organizations to extend services into rural regions with the highest concentration of PACE-eligible residents. Other innovations these providers will pursue include using telehealth to connect enrollees with clinical teams, establishing alternative care sites, and forming partnerships with rural hospitals.

• Rhode Island proposes launching the first PACE program on Block Island, a rural community with about 1,100 year-round residents and dramatic seasonal population swings. Establishing the PACE program is part of a multi-faceted initiative aimed at strengthening Block Island’s health infrastructure. By integrating PACE with home-based primary care, workforce development, and information technology infrastructure, Rhode Island illustrates how PACE can serve as a partner in strengthening rural health delivery.

• Montana proposes assessing whether integrated care models such as PACE can be adapted to meet the challenges of serving rural communities. The results will help inform the state’s strategy for improving care for rural dual eligible residents and people who use LTSS.

Why Rural PACE Expansion Matters

Because rural populations continue to age at a faster rate than urban ones, interest in PACE is likely to grow. Furthermore, research suggests rural PACE could:

• Reduce hospitalizations and improve chronic disease management;

• Expand access to interdisciplinary, integrated care;

• Offer transportation and social supports that are often scarce in rural settings;

• Support family caregivers and reduce social isolation; and

• Create stable jobs in rural communities.

What Comes Next

States that are expanding, launching, or exploring PACE as part of the RHTP can help build a clearer picture of how the model performs in rural settings, what adaptations may be necessary, and how integrated care for older adults can be strengthened in communities with limited infrastructure.

Aurrera Health will continue monitoring how states move from planning to action on their RHTP initiatives. If early efforts succeed, they may offer a roadmap for future rural health investments focused on keeping older adults healthy, supported, and connected within their communities.

If you are interested in discussing how your organization can better support rural older adults’ access to services, please reach out to Kristal Vardaman.

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Authors

Alisa Chester [Director]

Kristal Vardaman [Managing Principal]