Enrollment in the Program of All-Inclusive Care for the Elderly (PACE) has accelerated in recent years, reflecting renewed state interest and growing recognition of the model’s ability to serve older adults with complex needs. During a recent webinar, ATI PACE experts Tyler Cromer, Tina Hansen Pickett, and Josh McGilliard discussed where growth is occurring today, what is driving momentum, and how PACE organizations can position themselves for the next phase of expansion.
Three themes emerged from the discussion: continued state-led expansion, new opportunities tied to rural health transformation efforts, and the importance of strengthening enrollment performance within existing PACE organizations.
Why PACE Growth Is Accelerating
PACE enrollment has increased steadily over the past several years, with growth accelerating since 2023. The number of PACE organizations and participants has expanded alongside heightened state interest, particularly as states reassess long-term services and supports (LTSS) strategies following the COVID-19 pandemic.
Much of this momentum reflects a broader policy focus on integrated, community-based care models that support aging in place while managing total cost of care. For states facing workforce shortages, nursing facility capacity constraints, and rising demand for LTSS, PACE is increasingly viewed as a viable and scalable solution.
State-Led Expansion Continues to Open New Markets
State action remains a primary driver of near-term PACE growth. Several states with existing programs are pursuing expansion through new service areas, while others are authorizing PACE for the first time. In many cases, states are using competitive procurement processes to manage demand and select operators with demonstrated readiness.
Recent activity illustrates the range of state approaches. Some states have actively expanded or refined their PACE programs, while others have paused new applications to reassess growth and oversight capacity. At the same time, states without PACE are advancing legislative or procurement steps to launch programs, often beginning with targeted service areas.
For organizations considering entry into new markets, preparation is increasingly important. Competitive RFP environments tend to be tightly scored, placing a premium on early feasibility analysis, clear market selection, and strong partnerships. Successful applicants typically demonstrate both operational readiness and a nuanced understanding of local population needs, referral networks, and provider landscapes.
Rural Health Transformation Creates New Pathways for PACE
Rural communities represent a growing focus of PACE expansion efforts. Many rural areas face aging populations, limited provider supply, and fragmented access to medical, behavioral health, and LTSS services. PACE’s integrated, capitated model aligns well with these challenges by coordinating care across settings and supporting older adults in their homes and communities.
This alignment is reflected in the federal Rural Health Transformation Program (RHTP), which provides substantial multi-year funding to states to advance rural health priorities. All states have received initial awards, and many explicitly reference PACE in their applications—either as a mechanism to expand existing programs into rural areas or as a model to launch for the first time.
Some states with existing PACE programs have highlighted rural PACE expansion as a priority, while several states without PACE have identified the model as a potential tool to address access gaps and sustainability challenges. Other states reference PACE more generally, signaling interest without committing to specific initiatives.
For PACE organizations, the near-term opportunity lies in understanding how their state is structuring its RHTP efforts, which agencies are responsible for implementation, and where early engagement may be possible. Even in states that did not explicitly name PACE, organizations can play a role by demonstrating how the model advances shared goals such as access, care coordination, and system sustainability.
Driving Enrollment Growth Within Existing PACE Organizations
While new markets and rural initiatives attract significant attention, enrollment growth within existing PACE organizations remains a critical—and often underappreciated—source of impact. There is no single strategy that drives sustained growth. Instead, successful organizations tend to focus on coordinated improvements across operations, sales, and community engagement.
Common areas of emphasis include refining intake and enrollment processes, setting clear performance goals, and routinely monitoring key metrics on intake and enrollment processes. Professionalizing sales functions—through training, competitive positioning, and consistent messaging—can also improve conversion and retention.
Equally important is the strength of referral relationships. Formalizing outreach to hospitals, providers, community organizations, and other referral sources helps ensure a steady flow of qualified leads. Many organizations also emphasize staff as key sales agents, recognizing their networks and word-of-mouth referrals play a role in reinforcing PACE’s value proposition within the community.
What to Watch Going Forward
Looking ahead, several developments are likely to shape the next phase of PACE growth. Rural PACE pilots and expansions supported by RHTP funding may provide new models for serving sparsely populated areas. States that issued RFPs in prior years are moving into implementation, bringing new programs online and expanding geographic reach. At the policy level, continued bipartisan support for PACE at the state level remains a notable strength, providing a stable foundation for future growth.
Taken together, these trends suggest that PACE is entering a period of meaningful expansion—one driven not by a single policy change, but by alignment across state priorities, federal investment, and the evolving needs of aging populations. For organizations already operating PACE programs, and for those considering entry, the coming years will reward early preparation, strong partnerships, and disciplined execution.