California’s PACE Program Freeze: What Every Orange County Family Needs to Know

Robert Gordon Home Care Policy Analyst, At Home VA Staffing April 13, 2026 • 14 min read

California’s two-year freeze on PACE applications leaves thousands of seniors without a key safety net. Photo: Pexels

If your aging parent in Orange County qualifies for nursing home care but desperately wants to stay home, there’s a program that could make it happen — covering every doctor visit, every prescription, every therapy session, and every ride to appointments, all at zero out-of-pocket cost. It’s called PACE, the Program of All-Inclusive Care for the Elderly. And as of November 2025, California effectively slammed the door on expanding it.

The Department of Health Care Services (DHCS) imposed a minimum two-year freeze on all new PACE organization applications and service area expansions — a moratorium that won’t lift until at least November 2027. For the 28,000 seniors currently enrolled in PACE across California, services continue. But for the hundreds of thousands of eligible seniors still waiting to get in — including families across Orange County — the freeze means the safety net they were counting on just got pulled further out of reach.

Here’s what every Orange County family needs to understand about the PACE freeze, what it means for your care options right now, and what alternatives can fill the gap.

What Is PACE — and Why Should OC Families Care?

PACE enables seniors who need nursing home-level care to remain safely in their own homes. Photo: Pexels

PACE stands for the Program of All-Inclusive Care for the Elderly, and it’s arguably the most comprehensive — yet least known — healthcare program available to older Californians. Jointly funded by Medicare and Medi-Cal, PACE provides every medical and support service a qualifying senior needs, all coordinated through a single interdisciplinary team.

Think of PACE as a one-stop shop for your parent’s entire healthcare life. Instead of juggling separate doctors, pharmacies, therapists, and transportation providers, a PACE team handles everything: primary care physicians, nurses, social workers, physical and occupational therapists, dietitians, home health aides, and even drivers who pick your parent up and bring them to the PACE center for social activities and medical appointments.

The services PACE covers are extraordinary in their breadth:

• All medical care — primary care, specialists, hospital stays, emergency services
• All prescriptions — with no copays, no formulary hassles, no prior authorizations
• In-home care — personal care aides, light housekeeping, meal preparation
• Rehabilitation — physical therapy, occupational therapy, speech therapy
• Adult day health center — socialization, activities, supervised care during the day
• Transportation — door-to-door rides to every medical appointment and the PACE center
• Dental, vision, and hearing — services Medicare alone doesn’t fully cover
• Social services — case management, counseling, caregiver support

For seniors who qualify for both Medicare and Medi-Cal (known as “dual eligibles”), the cost is $0. No premiums, no copays, no deductibles, no co-insurance. Every service the PACE team determines you need is covered — period.

PACE by the Numbers: Why It Works

The data behind PACE is striking. A 2021 CalPACE study found that PACE participants were hospitalized 44% less often than comparable non-PACE seniors and used emergency rooms 26% less frequently. Perhaps most telling: 98% of PACE participants continued living in the community rather than being institutionalized.

Financially, PACE saves everyone money. States are required to set PACE capitation rates below what they’d otherwise pay for nursing home care and home-and-community-based services. In 2024 alone, PACE enrollment saved California taxpayers $369.4 million. Nationally, states pay PACE programs roughly 12% less than the equivalent cost of nursing homes and HCBS combined.

The Freeze: What Happened and Why

DHCS halted all new PACE applications effective November 20, 2025, citing overwhelming growth and staffing constraints. Photo: Pexels

On November 20, 2025, DHCS issued Policy Letter 25-02, imposing an immediate pause on all new PACE applications. The moratorium covers two categories: initial applications from organizations wanting to become new PACE providers, and service area expansion applications from existing PACE organizations seeking to serve additional zip codes or counties.

The freeze will remain in effect for a minimum of two years, meaning no new applications will be accepted until at least November 20, 2027 — and potentially longer if DHCS determines the backlog hasn’t been resolved.

Why DHCS Hit the Brakes

The core issue is growth outpacing oversight. California’s PACE enrollment exploded from roughly 3,100 participants in 2011 to over 28,000 in 28 counties by late 2025 — a ninefold increase in 14 years. The number of PACE organizations multiplied as well, with new providers rushing to enter the market.

But DHCS’s staffing and budget didn’t keep pace with that growth. The agency responsible for reviewing applications, conducting site visits, and monitoring quality found itself buried under an ever-growing backlog. Without additional funding to hire and train reviewers, the department concluded it couldn’t ensure adequate oversight of new entrants while maintaining quality standards for existing programs.

What the Freeze Does NOT Affect

It’s important for Orange County families to understand what continues unchanged during the moratorium:

• Existing PACE programs keep operating — if your parent is already enrolled, nothing changes
• Current enrollment stays open — existing PACE organizations can still accept new participants within their approved service areas
• Change-of-ownership applications are still processed — if an existing PACE organization is acquired, the new owner can continue operations
• Applications submitted before November 19, 2025 remain in the review queue

PACE in Orange County: What’s Available Right Now

Orange County families still have PACE options through existing providers, but coverage gaps remain. Photo: Pexels

Orange County is served by two primary PACE organizations, both of which continue to enroll new participants despite the statewide freeze on new providers:

Both providers serve limited zip codes within Orange County. This is the critical gap the freeze makes permanent for at least two years: if your parent’s zip code isn’t in a current PACE service area, no new provider can step in to fill that gap until the moratorium lifts.

How to Check If Your Parent Qualifies

If your parent lives in Orange County and you want to explore PACE, here’s the step-by-step process:

1. Check the service area — Call Orange County PACE at (714) 798-9044 or AltaMed PACE at (855) 252-7223 and provide your parent’s zip code. They’ll tell you immediately if the address falls within their approved area.
2. Verify age and insurance — Your parent must be 55+ and ideally enrolled in both Medicare and Medi-Cal. Medicare-only seniors can enroll but will pay a monthly premium.
3. Request a clinical assessment — DHCS must certify that your parent needs nursing home-level care. The PACE organization arranges this assessment.
4. Tour the PACE center — Most organizations encourage families to visit the day center, meet the care team, and see the program in action before committing.

PACE vs. Other Care Options: A Side-by-Side Comparison

For eligible seniors, PACE offers a comprehensive alternative to nursing home placement. Photo: Pexels

For families weighing their options — especially those who can’t access PACE due to the freeze — understanding how PACE stacks up against alternatives is essential.

When PACE Is the Clear Winner

PACE excels when your parent has complex, overlapping medical needs — multiple chronic conditions, frequent hospital visits, polypharmacy issues, or cognitive decline — and also needs help with daily living activities. The all-inclusive, team-based model eliminates the fragmentation that causes so many seniors to fall through the cracks of the traditional healthcare system.

When Alternatives Make More Sense

If your parent needs help with daily tasks but is relatively healthy medically, IHSS (In-Home Supportive Services) or private home care may be more appropriate. IHSS is free for Medi-Cal recipients and allows family members to serve as paid caregivers. Private home care from agencies like At Home VA Staffing offers flexible scheduling and personalized one-on-one attention that a PACE day center model can’t match — particularly for seniors who prefer staying in their own home environment rather than attending a group setting.

The Ripple Effect: How the Freeze Hurts OC Families

Families in underserved zip codes face at least two more years without access to new PACE providers. Photo: Pexels

The PACE freeze creates several cascading problems for Orange County families:

1. Geographic Gaps Stay Frozen

Parts of southern Orange County — including portions of San Clemente, Dana Point, Laguna Niguel, San Juan Capistrano, and Rancho Santa Margarita — have limited or no PACE coverage. Under normal circumstances, new providers or service area expansions could fill these gaps. The freeze locks those gaps in place until at least late 2027.

2. Waitlists Could Grow

With no new providers entering the market, existing PACE organizations face increased demand without the competitive pressure that normally keeps waitlists manageable. If Orange County PACE or AltaMed reaches capacity in a given zip code, families have no alternative PACE option to turn to.

3. Innovation Stalls

New PACE entrants often bring fresh approaches — technology-enabled monitoring, specialized dementia tracks, multilingual teams, extended hours. The freeze prevents these innovations from reaching the market. Existing providers have less incentive to innovate without competitive pressure.

4. Pressure on Other Programs Increases

When families can’t access PACE, they turn to IHSS, Medi-Cal managed care (CalOptima in OC), private home care, or — worst case — premature nursing home placement. Each of these alternatives absorbs demand that PACE was designed to handle more efficiently and at lower cost to taxpayers.

“The PACE moratorium is a paradox: a program that saves California hundreds of millions annually is being paused because the state didn’t invest enough in the staff to oversee it. Families pay the price.” — Robert Gordon, AHVA Home Care

What OC Families Can Do Right Now

Even without PACE expansion, OC seniors have multiple pathways to quality in-home care. Photo: Pexels

The freeze is frustrating, but it doesn’t mean your options are gone. Here’s a practical action plan for Orange County families navigating this landscape:

If Your Parent IS in a PACE Service Area

Act now. The freeze doesn’t stop existing PACE programs from enrolling new participants. If your parent lives in a covered zip code and meets the eligibility criteria, start the enrollment process today. There’s no guarantee that capacity will remain available indefinitely.

If Your Parent Is NOT in a PACE Service Area

Build a comprehensive care plan using available programs:

• Apply for IHSS — Contact the Orange County Social Services Agency to start your application. IHSS provides paid in-home care hours for Medi-Cal recipients and even allows family members to serve as paid caregivers.
• Explore CalOptima Community Supports — CalOptima’s CalAIM Community Supports program offers personal care, respite care, and other services for Medi-Cal members in Orange County.
• Consider private home care — Agencies like At Home VA Staffing can provide personalized in-home care — from companionship to personal care to respite for family caregivers — on a schedule that works for your family. Call us at (213) 326-7452.
• Look into Medicare’s GUIDE Model — If your parent has dementia, the new GUIDE Model provides comprehensive dementia care and respite hours through Medicare.
• Apply for Veterans benefits — If your parent is a veteran or surviving spouse, VA Aid & Attendance benefits can cover home care costs. Learn more in our complete guide to paying for home care.

Regardless of PACE Eligibility

• Contact your state legislators — Assembly Member and State Senator offices can advocate for lifting the freeze earlier or increasing DHCS oversight staffing. The more constituent contacts they receive, the higher priority this issue becomes.
• Monitor the moratorium timeline — DHCS will reevaluate in November 2027. We’ll publish updates on this blog as they become available.
• Get a care needs assessment — Whether or not PACE is accessible, understanding your parent’s full care needs helps you make informed decisions about the right combination of services.

The Bigger Picture: California’s Growing Senior Care Crisis

California’s aging population continues to grow, making programs like PACE more critical than ever. Photo: Pexels

The PACE freeze doesn’t exist in a vacuum. It’s one of several compounding pressures on Orange County’s senior care infrastructure:

• IHSS budget cuts — The 2026-27 state budget proposes significant reductions to IHSS, the program many families rely on when PACE isn’t available
• Federal Medicaid threats — The One Big Beautiful Bill could slash federal Medicaid funding that supports both PACE and Medi-Cal home care benefits
• CalOptima membership crisis — Medi-Cal redetermination losses are stripping coverage from thousands of OC residents
• Caregiver shortage — Orange County faces a growing home care workforce shortage that makes all care options harder to access
• Rising costs — Private home care and nursing home costs continue climbing, with nursing homes in OC averaging $9,000–$14,000 per month

Taken together, these trends paint a sobering picture: demand for senior care in Orange County is rising fast, while access to affordable, high-quality options is shrinking. The PACE freeze is both a symptom of this crisis and a contributor to it.

A Growing Population, a Shrinking Safety Net

California is home to over 6 million residents aged 65+, a number projected to reach 8.6 million by 2030. In Orange County alone, seniors make up a rapidly growing share of the population. Yet the infrastructure to serve them — from PACE programs to IHSS hours to affordable home care agencies — isn’t keeping pace with demand.

The irony of the PACE freeze is that it’s pausing a program that demonstrably works. PACE keeps seniors home, reduces hospitalizations, saves taxpayer money, and improves quality of life. The solution isn’t to freeze the program — it’s to fund the oversight staff needed to manage its growth responsibly.

What AHVA Is Doing to Help

At Home VA Staffing bridges the gap for families who can’t access PACE with flexible, personalized in-home care. Photo: Pexels

At At Home VA Staffing, we understand that the PACE freeze leaves real families with real gaps. That’s why we’re working to fill those gaps with flexible, compassionate in-home care that meets families where they are:

• Respite care — Giving family caregivers the break they need, whether it’s a few hours a week or overnight support. Learn about our respite care services.
• Personal care — Assistance with bathing, dressing, medication reminders, meal preparation, and mobility. See our personal care options.
• Companionship care — Social engagement, conversation, light housekeeping, and accompaniment to appointments. Explore companionship care.
• Dementia and memory care — Specialized support for families navigating Alzheimer’s and other cognitive conditions. Learn about our dementia care approach.
• CalAIM Community Supports enrollment — We’re actively enrolling as a CalOptima Community Supports provider, which means qualifying Medi-Cal members may be able to access our services at no cost.

We work with families to find every possible funding source — IHSS, CalOptima, VA benefits, long-term care insurance, and more — so that cost doesn’t stand between your parent and the care they deserve.

Interactive Knowledge Check: Test Your PACE Understanding

Frequently Asked Questions

PACE Alternatives Checklist for OC Families