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DHS details LIFE (PACE) program status, cites data gaps that complicate rate reforms
Summary
DHS officials told the House Aging & Older Adult Services Committee that Pennsylvania’s LIFE (PACE) program serves roughly 8,000 people across dozens of counties but that missing Medicaid encounter data and uneven provider reporting limit alternative rate-setting and slow enrollment and expansion efforts.
The House Aging & Older Adult Services Committee heard from the Department of Human Services on the status of Pennsylvania’s Living Independence for the Elderly (LIFE) program, a state PACE program that combines Medicare and Medicaid benefits to allow older adults to remain in their communities.
Deputy Secretary Juliet Marsala told the committee the LIFE program is federally recognized as PACE and is “unique in its 3 way partnership between CMS, the state, and the LIFE provider organizations.” She said the program serves about 8,000 Pennsylvanians through 18 providers and 57 centers and that state providers operate across roughly 54 counties, enabling LIFE services for a large share of the eligible population.
Why it matters: Marsala said the department is pursuing both expansion and improved reporting so policymakers can evaluate program costs and consider rate reforms. She flagged three operational issues that complicate rate-setting and access: (1) the absence of standardized Medicaid encounter data that would allow a LIFE-specific capitation methodology; (2) provider variation in reporting and information technology capacity; and (3) federal rules that constrain enrollment timing (participants may only enroll on the first day of the month) and safety-to-serve assessments.
Marsala summarized recent steps DHS has taken to address those gaps: a May 2024 kickoff for Medicaid encounter data collection, test submissions from providers beginning July 2025, and an ARPA-funded opportunity that awarded roughly $4,500,000 to 16 of 18 LIFE providers to improve data and quality reporting. She said Medicare encounter submissions are already in production and that standardized financial reports are under review, but initial analyses show underreporting of service utilization.
On enrollment and outreach, Marsala described the multi-step process: an independent enrollment broker (IEB) provides unbiased choice counseling and forwards interested applicants to the appropriate LIFE provider; Aging Well Pennsylvania completes functional eligibility assessments; county assistance offices make financial determinations; and LIFE providers perform a ‘‘safe to serve’’ assessment before enrollment. Marsala said DHS has worked to streamline enrollment since May 2021 and that the IEB has contributed to a 6% increase in referrals since statewide implementation.
On timing, Marsala told the committee that some internal DHS figures show a portion of the enrollment pathway can be completed in about 21 days, while acknowledging other witnesses and providers reported longer end-to-end waits depending on the assessment contractor and process in place.
Marsala also described the department’s Rural Health Transformation Plan, which includes expanding LIFE into more rural counties through targeted solicitations and awards; she noted awards announced on Oct. 10 to assign several previously unawarded counties to LIFE providers and said work continues for remaining counties.
What DHS asked for: the department urged continued collaboration with providers and federal partners, standardization of encounter and financial data, and time for providers to implement required system changes so that an alternative LIFE-specific rate‑setting methodology can be considered in the future.
The committee did not take formal action; members asked follow-up questions about the timeline for data collection, rate-setting mechanics and how DHS negotiates with providers. Marsala emphasized that without comprehensive Medicaid encounter data, OLTL cannot adopt the same actuarial process used for Community HealthChoices capitation rates.
