PACE Southeast Michigan is one of the few programs in Metro Detroit designed for a parent who already meets nursing home level of care but wants to stay in their own house. It bundles Medicare, Medicaid, primary care, therapy, day programming, transportation and home help under one interdisciplinary team - and it asks families to give up something real in exchange. Here is how PACE works in Wayne, Oakland and Macomb County, who qualifies, what it costs, and how it compares to the MI Choice waiver or a move into a licensed AFC or Home for the Aged.
By Detroit Senior Advisor Care Team · August 29, 2026
PACE Southeast Michigan is the regional version of a federal program called the Program of All-Inclusive Care for the Elderly, and it exists for a very particular kind of Detroit family: one whose parent has been told they need nursing home level care, but who has no intention of leaving the house on Woodbridge or Rosedale Park where they have lived for forty years. PACE is jointly authorized by Medicare and Medicaid, and unlike almost every other benefit a Metro Detroit family encounters, it is not a payer that reimburses outside providers. It is the care system itself - a single organization that becomes responsible for essentially every medical and supportive service a participant needs.
In practical terms, an enrolled participant gets primary medical care from the PACE clinical team, prescription drug coverage, physical and occupational therapy, specialist referrals, hospital and nursing facility care when it is needed, personal care at home, meals, social work, and transportation to and from a PACE day center. The day center is the visible heart of the model. Participants typically attend on a schedule set by their care plan - some several days a week, some far less - and the center functions as clinic, therapy gym, social hub and observation point all at once. A nurse who sees the same person every Tuesday notices a shuffling gait or a new bruise long before an adult child in Novi does on a Sunday phone call.
The demographic PACE serves in Southeast Michigan is narrower than most families assume. It is not a program for a generally healthy 70-year-old who wants help with housekeeping, and it is not an assisted living alternative for someone who is medically stable and simply lonely. It is built for the frail, complex, multiple-chronic-condition older adult whose care is already fragmented across a cardiologist at Henry Ford, an endocrinologist at DMC, a primary care doctor who left the practice last year, and a daughter who takes unpaid days off to drive to all of it. PACE consolidates that fragmentation, which is precisely why it appeals to some families and frustrates others.
Four conditions have to be true at once. The person must be at least 55 years old. They must live inside the program's defined service area, which in Southeast Michigan covers portions of Wayne, Oakland and Macomb County but is drawn by specific communities and ZIP codes rather than by county line - a Grosse Pointe address and a Sterling Heights address can land on opposite sides of it, so this is worth confirming by phone before any other planning happens. They must be certified by the State of Michigan as needing a nursing facility level of care. And a PACE interdisciplinary team must conclude that with PACE services in place, the person can live safely in the community.
That third condition is the one families misread most often. A nursing facility level of care determination in Michigan is a formal state assessment of functional and medical need - it looks at help required with activities of daily living, cognitive status, medication management, mobility, and skilled nursing needs. Meeting it does not mean a parent must enter a nursing home. It means they clinically qualify for one. This is the same threshold used for the MI Choice waiver, which is why families who have already been assessed for MI Choice usually have the paperwork groundwork done. If a parent was recently denied MI Choice on functional grounds, they will very likely not meet PACE's clinical bar either.
The fourth condition - can this person live safely in the community with our help - is a judgment call made by the PACE team, not a checklist, and it can go either way. A participant living alone with advanced dementia and no informal support may be deemed unsafe even with a full PACE care plan. The same person with a spouse in the home, or with an adult child two blocks away in East English Village, may be accepted. Families should understand this as a genuine clinical evaluation of the whole household situation rather than a formality, and should be candid during it. Understating the current level of family strain does not help anyone.
This is the trade-off, and no Detroit family should enroll without understanding it. Once a participant is enrolled, PACE becomes the exclusive provider and coordinator of their care. The interdisciplinary team - physician, nurse, social worker, therapists, dietitian, home care coordinator, personal care aides, transportation staff - authorizes services. Going outside that network without authorization generally means the participant pays for it themselves. The cardiologist your mother has seen for eleven years at Henry Ford is not automatically part of the plan.
Sometimes continuity is preserved: PACE organizations contract with outside specialists, and a long-standing specialist relationship can often be maintained through a contract or a referral. Sometimes it is not, and the primary care relationship in particular usually moves to the PACE clinician. For a family whose parent has a decades-long bond with a trusted physician, that is a real loss and a legitimate reason to decline the program. For a family whose parent has been bounced between practices, missed appointments because nobody could drive them, and been readmitted to Corewell Health twice in six months because nobody was watching the medication list, the same change is the entire point.
Emergency care is the exception families should not misunderstand: nobody has to call PACE before dialing 911, and emergency services are covered. But every non-emergency decision - a new specialist, a rehab stay, durable medical equipment, a change in home care hours - runs through the team. Ask directly, during the enrollment interview, which of your parent's current physicians the program contracts with, and get the answer before signing. That single question resolves most of the regret families report after the fact.
PACE is financed by capitation: Medicare and Medicaid each pay the organization a fixed monthly amount per participant, and the organization is responsible for all care within that amount. What a family owes depends entirely on which of those two programs the participant has. A dual eligible participant - someone with both Medicare and Michigan Medicaid, which describes a large share of the Detroit and Wayne County older adults PACE serves - typically pays nothing out of pocket for services covered under the plan, including the prescription drug benefit. There is no separate Part D premium on top of PACE.
A participant with Medicare but not Medicaid can still enroll, but pays a monthly premium equal to the Medicaid portion of the capitation rate, plus a premium for the drug benefit. That figure is substantial and is set by the program, so it must be requested directly. Even so, it frequently compares favorably to what a Metro Detroit family is already spending: in 2026 in-home care in this market runs roughly $28 to $36 an hour, adult day programs $70 to $100 a day, and a nursing home $9,000 to $12,000 a month. Families paying privately for twenty or thirty hours of home care a week plus transportation and copays are often surprised at the comparison. Someone with neither Medicare nor Medicaid can enroll on a fully private-pay basis, though that is rare.
One financial point deserves emphasis because it drives so many Michigan planning mistakes: if a participant later needs long-term nursing facility care, PACE covers it, and the Medicaid cost-sharing rules that apply to nursing home residents apply then as well. Families concerned about spend-down, asset limits, or a spouse remaining in the family home should get counsel on Michigan's Medicaid long-term care rules before enrolling rather than after. Free, unbiased help is available through MMAP, Michigan's Medicare and Medicaid Assistance Program, and through the Area Agencies on Aging - the Detroit Area Agency on Aging for Detroit, Hamtramck, Highland Park, Harper Woods and the Grosse Pointes, The Senior Alliance for southern and western Wayne County, and AAA 1-B for Oakland, Macomb and Washtenaw.
Metro Detroit families routinely confuse these four paths, and the distinctions matter. The MI Choice waiver is Michigan's home and community based Medicaid waiver, administered by regional waiver agencies; it authorizes personal care and supports that can be used at home or inside a licensed setting, but the participant keeps their own doctors and their own Medicare arrangements, and MI Choice has an interest list that can mean a wait. MI Health Link is a Medicare-Medicaid integrated plan operating in Southeast Michigan for dual eligibles; it coordinates coverage through a health plan but does not run a day center or employ the care team directly.
Assisted living in Michigan is a different animal entirely, because Michigan has no license by that name. Communities marketed as assisted living operate as Homes for the Aged under the Public Health Code, or as Adult Foster Care homes under the Adult Foster Care Facility Licensing Act, or both - all licensed and inspected by the Department of Licensing and Regulatory Affairs through the Bureau of Community and Health Systems. Memory care is not a separate Michigan license either; it is dementia care delivered inside an AFC or HFA setting. Critically, neither Medicaid nor PACE pays the room and board portion of living in one of those buildings, which is the single most expensive line item a family faces.
So the practical decision usually shapes up like this. If the goal is keeping a medically complex parent in their own home and the family is willing to consolidate the medical team, PACE is often the strongest option available in Southeast Michigan and is worth checking before touring a single building. If the family wants to preserve existing physician relationships and needs supportive services layered on top, MI Choice fits better. If the parent's housing itself is the problem - unsafe stairs, isolation, an unheatable house in a Michigan January - then a licensed AFC or HFA may be the right answer regardless of what any program pays, and the conversation shifts to room and board affordability. These are not mutually exclusive forever; families move between them as needs change.
Start with the service area, because it disqualifies more Metro Detroit inquiries than anything else. Call the program with the exact street address and ZIP code where the person lives and ask whether that address is inside the current service area. Do not rely on a county name, a third-party directory, or an older list found online - service areas are expanded and adjusted over time, and a directory page can be years stale. If the address is outside the area and moving in with a child inside it is realistic, that is worth raising on the same call.
If the address qualifies, the next step is the intake and assessment process, which will involve an in-home or in-center evaluation and the state level of care determination. Have the current medication list, recent hospital discharge paperwork from Henry Ford, DMC, Ascension St. John, Corewell Health or Michigan Medicine, the list of current physicians, and an honest accounting of what a bad day looks like. Enrollment is voluntary, and a participant may disenroll - so a family that tries PACE and finds the model does not suit them is not permanently locked in, though the transition back to community providers takes coordination and should not be done casually. If anything in the process raises a concern about a vulnerable adult's safety, Michigan's Adult Protective Services hotline operates 24 hours a day at 855-444-3911.
Free and no pressure. We answer to families, not facilities.
Or call (313) 513-4054