Who is eligible?

You are eligible for this program if you:

  • Are 55 or older
  • Live in the Senior CommUnity Care of Michigan service care area
  • Meet State of Michigan criteria for nursing home level of care
  • Can live safely in the community with the help of our services

Who pays for PACE?

While PACE participants can pay privately for the full cost of services or be enrolled in Medicare and pay a lesser amount for some services, 9 out of 10 participants are enrolled in both Medicaid and Medicare. To qualify for Medicaid, an individual must meet income and asset eligibility requirements and provide proof of the information in a Medicaid application. Once a participant is enrolled, our experts handle paperwork and claims. Participants must follow the care plan designed by our care team. Participants may be personally liable for the costs of unauthorized or out-of-program services, except for emergency services.

-Individuals adjusted monthly income cannot exceed $2,250.
This includes Social Security, pensions and other income sources.
-Total assets must be at $2,000 or less.
This involves resources in financial accounts such as savings.
Excluded assets are: one house, one vehicle, pre-paid funeral arrangements
and term life policies.

Participant Rights

Respect and Non-Discrimination

You have the right to:

  • Take part in deciding what kind of care you need.
  • Receive comprehensive health care in a safe and clean environment and in an accessible manner.
  • Receive care from professionally trained staff.
  • Know the names and responsibilities of the people providing your care.
  • Be treated with respect and dignity.
  • Be free from harm. This includes not being physically restrained or kept alone, unless it’s needed for your safety or the safety of others. It also includes not being given too much medication and not being abused or neglected.
  • Not be required to work for the Senior CommUnity Care organization.
  • Have fair access to telephones.
  • Not be discriminated against in the delivery of services based on race, ethnicity, national origin, religion, sex, age, or source of payment.
  • Information.

You have the right to:

  • Be told, in writing, about the services you can get through Senior CommUnity Care and its contracted providers.
  • Be told about any changes to the benefits or services Senior CommUnity Care offers, including if benefits/services end or if the people who provide them change.
  • Have the Enrollment Agreement explained to you.
  • Request most recent federal or state survey results.
  • Ask for and be given the policies of Senior CommUnity Care related to member rights, and services provided by Senior CommUnity Care and the people who provide them.
  • Have information about and attend Senior CommUnity Care’s Participant Advisory Committee.

Confidentiality

You have the right to:

  • Know that Senior CommUnity Care will keep all information about you private.
  • Be assured that your written consent will be obtained for the release of information to persons not otherwise authorized under law to receive it.
  • Review and copy your medical records and request amendments to those records.

Choosing Your Provider

You have the right to:

  • A choice of health care providers within the Senior CommUnity Care provider network.
  • Request a specialist for women’s health or preventive services.

Emergency Care

You have the right to:

  • Receive health care services in an emergency without prior approval from Senior CommUnity Care.

Treatment Decisions

You have the right to:

  • Receive complete, accurate, easy-to-understand information and assistance in making informed health care decisions.
  • Make your own health care decisions.
  • Request a reassessment by the Senior CommUnity Care interdisciplinary team.
  • Refuse treatment and be told what may happen if you refuse treatment.
  • Be given fair advance notice of being transferred to another part of Senior CommUnity Care’s program. This includes transfer for medical reasons or for your safety and other participants and staff.
  • Have Advanced Directives explained and established according to your wishes.
  • Appropriate assessment and management of pain.

Exercise Your Rights

You have the right to:

  • Be encouraged and assisted in exercising your rights as a participant, including the Medicare and Medicaid appeals processes as well as civil and legal rights.
  • Appeal any treatment decision.
  • Be helped to share complaints and recommend changes in Senior CommUnity Care policies and services.
  • Dis-enroll from Senior CommUnity Care.

Privacy Policy

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects the privacy of personal health information and requires health care providers and health care plans to explain how this information will be used and shared. Under HIPAA, as an organization that manages health care information, Senior CommUnity Care is required to ensure the privacy of your health information.