By Raleigh Senior Advisor Care Team · June 27, 2026
PACE lets qualifying seniors with Medicare, Medicaid, or both stay in the community instead of moving to a nursing home. Here's how the program actually works, who qualifies, and how to confirm whether it currently serves your part of the Triangle.
A Program Most Families Have Never Heard Of
Of all the long-term care options available to North Carolina seniors, the Program of All-Inclusive Care for the Elderly — PACE — is probably the least understood, even though it can be one of the most comprehensive. PACE isn't a waiver, a nursing home, or a home care agency; it's a fundamentally different care model that wraps medical care, therapy, transportation, meals, social activities, and often long-term supports into a single coordinated program built around keeping someone living independently for as long as possible.
For families navigating Medicare and Medicaid simultaneously — the "dual-eligible" situation that affects many lower-income seniors with significant health needs — PACE deserves serious consideration alongside more familiar options like in-home care and assisted living. This guide explains how PACE works, who qualifies, and how to find out whether it's actually available near you in the Triangle, since coverage areas are specific and shouldn't be assumed.
What PACE Actually Provides
PACE stands apart from other senior care programs because of how much it bundles into one relationship. A PACE organization typically operates its own adult day health center, where participants attend for some portion of the week to receive primary medical care, physical and occupational therapy, meals, and social engagement, all under one roof with an interdisciplinary care team — physicians, nurses, social workers, therapists, and aides — who coordinate every aspect of a participant's care.
Beyond the day center, PACE organizations arrange and pay for whatever additional services a participant needs to remain safely in the community: prescription drugs, specialist visits, hospital care when necessary, home health aide visits, transportation to appointments, and durable medical equipment. If a participant's needs eventually exceed what can be safely managed at home, PACE also covers nursing facility care when required, without the participant having to leave the program or start over with a new care team. The goal throughout is to delay or avoid nursing home placement, not to force a transition once someone's needs increase.
Who Qualifies
PACE in North Carolina is designed for adults age 55 and older who have needs consistent with a nursing-home level of care but who want to continue living in the community rather than move into a facility. Unlike many long-term care programs, PACE doesn't require participants to be exclusively Medicaid-eligible, exclusively Medicare-eligible, or dual-eligible for both — it's structured to accept individuals across that whole spectrum, plus private-pay participants and a category called "PACE Medicaid" for people whose income exceeds standard NC Medicaid limits but who still meet long-term-care financial criteria.
That flexibility is part of what makes PACE distinctive: a dual-eligible senior (someone enrolled in both Medicare and Medicaid, common among lower-income adults with significant chronic health needs) can have both programs' benefits coordinated through PACE rather than juggling separate Medicare Advantage or Medicaid managed care plans. In practice, this tends to make PACE most attractive to lower-income seniors with multiple chronic conditions who need a level of coordinated support beyond what a typical primary care relationship can offer, but who are determined — clinically and personally — to avoid a nursing home.
The Adult Day Health Center Model, and What It's Not
It's worth being clear about what PACE is not. It is not an assisted living benefit, and it does not pay for room and board in an assisted living community or adult care home — North Carolina doesn't have a Medicaid mechanism that does that at all, waiver or otherwise. PACE is also not simply a fancier version of adult day care; the medical oversight, interdisciplinary team structure, and full financial responsibility a PACE organization takes on for a participant's overall health outcomes go well beyond a typical day program.
Participants generally attend the PACE center on a schedule tailored to their needs, which might be a few days a week or nearly every weekday depending on care requirements, while continuing to live at home (their own home, a family member's home, or in some cases a supportive living arrangement) the rest of the time. Transportation to and from the center is typically included, which matters in a spread-out region like the Triangle where getting to appointments can itself be a significant burden for a homebound or driving-limited senior.
PACE Coverage in the Raleigh-Durham Area: What to Confirm Directly
As of the most recent published NC Medicaid information, North Carolina has 11 PACE organizations operating across 14 locations statewide, and the program continues to expand. Third-party listings identify a PACE provider — Senior CommUnity Care of North Carolina — based in the Durham/Triangle area, but we want to be careful here: confirming exactly which counties and ZIP codes a given PACE site currently serves is something families should verify directly with NC Medicaid or the provider before making any plans, rather than relying on general statements about regional coverage.
This caution matters because PACE service areas are defined narrowly — often by specific ZIP codes surrounding a physical day center — and can change as programs expand. A senior living in Durham may be in an active PACE service area while a family member twenty minutes away in Orange County or rural Chatham County may not be, simply based on which side of a service boundary they fall on. The only reliable way to know is to contact NC Medicaid's PACE program directly or reach out to a specific PACE organization's intake team and ask them to confirm coverage for your exact address.
How PACE Compares to CAP/DA and Other Dual-Eligible Options
Families researching dual-eligible options in the Triangle often come across North Carolina's other major Medicaid HCBS program, the Community Alternatives Program for Disabled Adults (CAP/DA), and wonder how it differs from PACE. CAP/DA is a Medicaid waiver providing a specific menu of in-home services — personal care, home modifications, meal preparation, respite care, and more — coordinated through a case manager, with participants generally directing their own separate providers for each service.
PACE, by contrast, is a single integrated program where nearly all care flows through one organization and one care team, and it can serve people who aren't exclusively Medicaid-eligible, unlike CAP/DA which is a Medicaid-specific waiver. For a senior with complex, multiple chronic conditions who wants coordinated medical oversight in addition to home-based support, PACE may offer more comprehensive coverage; for a senior who mainly needs a defined set of in-home supports and prefers more control over which providers deliver each service, CAP/DA's more modular structure might be a better fit. Both require an assessed need for a nursing-facility level of care to qualify.
How to Apply and What to Ask
To explore PACE, start by contacting NC Medicaid's Program of All-Inclusive Care for the Elderly office directly, or reach out to a PACE organization serving the Triangle area to request an eligibility screening. The intake process typically includes a clinical assessment to confirm nursing-facility level of care need, along with financial eligibility screening if you're applying under a Medicaid or PACE Medicaid category.
When you speak with a PACE organization, ask specifically: which ZIP codes does your day center currently serve, what is the transportation radius, how many days a week would my family member typically attend, what happens if nursing home care eventually becomes necessary, and what out-of-pocket costs apply for private-pay or above-Medicaid-income participants. For general Medicaid application questions, the NC Medicaid Contact Center (888-245-0179) can also point you toward the right regional PACE contact and clarify current program status in your county.
When PACE Isn't the Right Fit
PACE requires a real commitment to attending the day health center on a regular schedule, which doesn't suit every family or every senior's preferences — some strongly prefer receiving all care at home with minimal outside travel, in which case CAP/DA or a private-pay in-home care arrangement may fit better. PACE also isn't available everywhere in the Triangle, and even where a service area exists, capacity can be limited.
If PACE turns out not to be available or appropriate for your situation, it's still worth exploring the full range of options: our guides on signs it's time for assisted living and in-home care versus assisted living costs cover the more commonly available paths for Triangle families, and a county Department of Social Services caseworker can help clarify which Medicaid long-term care pathways you may qualify for regardless of PACE availability.
