A proposed federal Medicaid cuts could dismantle the lifeline that thousands of low-income Michigan seniors rely on to remain at home and out of institutions.
The Program of All-Inclusive Care for the Elderly — better known as PACE — provides comprehensive medical and social services to individuals 55 and older who are eligible for nursing home-level care but prefer to remain in their communities.
The program, jointly funded by Medicare and Medicaid, has earned bipartisan support for its ability to reduce hospitalizations and emergency room visits while improving quality of life.
A new report from the Michigan Department of Health and Human Services outlines the potential fallout from proposed federal Medicaid cuts totaling $880 billion. Among the most vulnerable programs is PACE.
“These are essential services,” says Kimberly Smith, CEO of Care Resources, the PACE provider serving Kent County and parts of Allegan, Barry, Ionia and Ottawa counties. “Cutting Medicaid could force Michigan to eliminate or reduce PACE services, which would have a disastrous effect on the most vulnerable in our community.”
Care Resources serves nearly 400 seniors through its day centers in Grand Rapids and Lowell, as well as in-home care. The services include medical support, medication management, physical therapy, transportation and nutritious meals, with costs covered primarily through Medicaid.
“PACE costs pennies on the dollar compared to a nursing home,” Smith says. “We’re actually saving money while providing a higher quality of life. These cuts would do the opposite by pushing people back into institutions they don’t want or need.”
Smith, a former nursing home administrator, says many people end up in facilities not because they require constant care, but because they lack community-based support. PACE offers that alternative.
“We’re not just caregivers — we’re family to many of our participants,” she says. “If this program disappears, so does the only support system some of them have.”
The day-to-day experience of PACE participants reflects a model rooted in dignity and connection. From group bingo sessions to themed proms, participants say the social interaction can be as important as the medical care.
“One of our participants cried because she had to leave our prom early to catch her bus,” Smith recalls. “She told us, ‘This is the most fun I’ve had in so long.’ That’s what’s at stake.”
Across Michigan, 14 PACE providers serve nearly 6,000 people through 26 locations. Most participants qualify for Medicaid, says Stephanie Winslow, executive director of the PACE Association of Michigan.
“These are nursing-home eligible individuals who rely on our services to live safely at home,” Winslow says. “If we’re not able to provide care because of cuts, they will still need help — they’ll just end up in hospitals and emergency rooms instead. And that will cost more, not less.”
Winslow says the proposed changes include no alternatives — only reductions.
“We’re not talking about trimming fat,” she says. “There’s no overspend in what we do. These are essential services. When Medicaid goes, so do our programs.”
Under the PACE model, providers receive a set monthly payment per participant, covering all care needs. This flexibility allows for proactive treatment and personalized support.
“If someone needs therapy five times a week just to be able to walk to their mailbox, we’ll do that,” Winslow says. “We don’t have to fight with an insurance company to justify care.”
Caregivers also benefit. Smith points to one participant whose wife initially enrolled him for just one day a week, hoping for a short break. “She saw such an improvement in his sleep and mood that now he comes three days a week,” Smith says. “It’s changed their lives.”
If enacted, the proposed cuts could lead to devastating consequences, according to the MDHHS report:
- $1.1 billion in annual Medicaid funding losses for Michigan
- Termination of health coverage for 700,000 residents
- $2.3 billion reduction in statewide hospital payments
- Up to $325 million in cuts to Michigan nursing homes
- A total loss of $4.1 to $13.4 billion over 10 years due to block grant funding changes
“These proposed cuts would be the largest in Medicaid’s 60-year history,” Gov. Gretchen Whitmer said in a statement. “They go too far, too fast. Everyone — including those not on Medicaid — will end up paying more for their insurance.”
Advocates like Smith and Winslow say they aren’t waiting for decisions to be made in Washington. They’re mobilizing staff, caregivers and participants to tell their stories and raise awareness.
At Care Resources, participants recently wrote letters to local representatives. Many had never done so before but felt compelled to act.
“They watch the news. They hear the worry,” Smith says. “They’re asking, ‘What will happen to us?’ That’s why we’re helping them advocate.”
Winslow is spending this week in Lansing, urging lawmakers to preserve the program and encouraging constituents to speak out.
“We’re trying to put a face to the numbers,” she says. “This isn’t about budget line items. It’s about human lives.”
PACE programs are especially critical in rural areas, where few other health care options exist. Without them, entire communities could lose access to senior care.
“Without PACE, many people would be completely alone,” Smith says. “They’d have no way to get to the doctor, no way to get their medications, no social connection. The system would absorb them back into high-cost, crisis-based care. That’s not just bad policy, it’s inhumane.”
As advocacy continues, both leaders stress that community-based care works and it saves money.
“We want people to know there is a better way,” Smith says. “And it’s already working.”
To learn more about PACE in Michigan or get involved, visit
https://paceofmichigan.com or call 877-2MI-PACE.