PACE Requests for CalOptima Letters of Support

CalOptima provides publicly funded health care coverage for low-income residents in Orange County, California. CalOptima opened Orange County’s first Program of All-Inclusive Care for the Elderly (PACE) center in October 2013, and the program has grown to nearly 300 participants. PACE recently launched several initiatives to expand access, including partnerships with Community-Based Adult Services centers, a greater role for community-based physicians in caring for PACE participants, and a larger PACE service area to reach all eligible seniors in Orange County. As a county organized health system (COHS), CalOptima sees tremendous value in PACE and remains firmly committed to expanding access to PACE services for our members.

The Department of Health Care Services (DHCS) issued PACE Policy Letters 17-03 and 18-01 on October 27, 2017, and August 17, 2018, respectively. These PACE policy letters include guidance on the operation of an independent PACE organization in a COHS county, including Orange County. Historically, the only entity that could operate a PACE program in a COHS county was the designated Medi-Cal managed care plan.

However, the DHCS policy letters describe a process by which an organization interested in becoming an independent PACE organization in a COHS county may, with the formal support of the local COHS plan, be considered to operate in that county. Specifically, DHCS will only consider an application from an independent PACE organization in a COHS county if its application includes a letter of support from the COHS Medi-Cal managed care plan.

On September 6, 2018, the CalOptima Board of Directors approved actions related to the new state policy guidance, including a process for CalOptima to use when considering requests for letters of support from independent organizations seeking to offer PACE services in Orange County.

Completed requests are due to CalOptima no later than 5 p.m. PST on Thursday, January 31, 2019. Following the submission period, CalOptima staff will analyze the information shared in the requests for letters of support and communicate that to the CalOptima Board of Directors, which will consider whether to grant any letter.

Please submit questions via email to CalOptima’s Business Integration department at businessintegration@caloptima.org.

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