Reimagining PACE Access: How Kentucky Is Making Statewide Coverage Possible

Program of All-Inclusive Care for the Elderly (PACE)

The Commonwealth of Kentucky is demonstrating how PACE can evolve from limited-service areas into a full statewide model, spanning all 120 counties, nearly half of which are classified as entirely rural by the U.S. Census Bureau. With approximately 4.6 million residents and just three major urban centers, Kentucky offers a powerful example of how PACE can succeed in low-density and rural environments.

PACE in Kentucky is now among the fastest growing programs in the country and is reshaping expectations for statewide and rural implementations. We recently published a case study highlighting Kentucky’s expansion strategy, key barriers overcome, and practical lessons learned for other states considering similar rural growth.

Case Study: Building a Commonwealth-Wide PACE Strategy in Kentucky

The Commonwealth of Kentucky has emerged as a leading example of how phased execution can transform the Program of All-Inclusive Care for the Elderly (PACE) from a localized initiative into a scalable, statewide model.

Rather than limiting PACE to a small number of metropolitan areas, Kentucky adopted a long-term strategy focused on expanding access across all counties, including rural and underserved communities. This commitment supports aging in place, strengthens community-based care, and advances equitable access to comprehensive services for older adults with complex needs.

At Myers and Stauffer, we are proud to support government health care agencies nationwide as they explore, manage, implement, and expand PACE. Kentucky’s experience offers practical insights for other states seeking to move beyond limited implementation toward sustainable, accessible, statewide models.

From Initial Launch to Commonwealth-Wide Expansion

PACE in Kentucky began in a limited number of counties, initially concentrated in areas where provider infrastructure and workforce capacity were already established. Like many early adopters, the Commonwealth used these initial service areas to establish operational standards, develop readiness expectations for providers, align programmatic requirements, and build internal expertise to support PACE oversight.

Over time, PACE expanded county by county, moving beyond population centers into more geographically dispersed regions. Rather than treating rural access as a later objective, the Commonwealth incorporated rural communities into its primary objective. This ensured that expansion efforts addressed both urban and rural realities, including differences in workforce availability, transportation challenges, and provider readiness. As PACE organizations pursued geographic expansion, providers were responsible for assessing local network adequacy, transportation capacity, and workforce availability within proposed service areas.

Today, Kentucky is actively working toward making PACE available across all counties, demonstrating that with sustained commitment and coordinated strategy, integrated care models can reach communities that have historically faced barriers to access.

This deliberate, phased approach allowed the Commonwealth to balance growth with quality, ensuring that expansion was supported by appropriate oversight and operational readiness.

Barriers the Commonwealth Worked Through

Kentucky’s expansion journey reflects many of the challenges faced by government health care agencies pursuing statewide PACE strategies:

Rural Provider Capacity. Building provider networks in rural areas required careful attention to workforce limitations, infrastructure gaps, and market readiness.
Policy Alignment Across Regions. The Commonwealth maintained consistent statewide expectations while allowing flexibility to accommodate regional differences. Clear policies and standardized procedures helped support operational consistency.
Readiness and Operational Consistency. Establishing uniform state readiness review standards required dedicated oversight capacity and a team with the training and expertise to oversee them.
Multi-stakeholder Coordination. Aligning Medicaid and the Department for Aging and Independent Living leadership, providers, federal stakeholders, and consultants was critical to supporting policy development, monitoring, readiness reviews, rate setting, and other technical functions.
Balancing Growth with Sustainability. Expansion required maintaining focus on long-term operational and financial viability with advancing access to services.

Rather than allowing these barriers to slow progress, Kentucky addressed them through phased implementation, clear guidance, and early investment in readiness and oversight frameworks. Strategic investments in technical infrastructure and data collection strengthened decision-making and positioned the Commonwealth to support long term program sustainability.

Keys to Implementation Success

Lifecycle Thinking. PACE was treated as a continuum rather than a milestone, anticipating future expansion, oversight needs, and sustainability from the outset.
Early Integration of Rural Access. Rural communities were part of the statewide objective from the beginning, ensuring that local workforce, transportation, network, and infrastructure needs were addressed as expansion continued.
Consistent Readiness Standards. Clear and uniform provider readiness expectations were supported by the collection and analysis of clinical, operational, and financial data.
Strong Stakeholder Collaboration. Policy development and operational coordination occurred across Cabinet agencies, providers, and technical partners under a common vision.
Community Assessment. Expansion decisions were informed by an understanding of local populations, access to services, and health care workforce availability.
Alignment with Goals. PACE expansion was aligned with broader Cabinet priorities, including reducing waiver waiting lists and strengthening efforts to support aging at home.
Focus on Long-term Sustainability. Growth decisions balanced access, quality, and equity with operational and financial viability.

Supporting States Across the PACE Lifecycle

Kentucky’s experience shows that PACE can be scaled across diverse geographies when implementation is intentional and supported by strong operational readiness.

At Myers and Stauffer, we support state agencies across every phase of the PACE lifecycle, including program exploration, policy development, provider onboarding, financial oversight, and ongoing monitoring.

If your Commonwealth or state is exploring, managing, implementing, or expanding PACE, we welcome the opportunity to share national insights and explore how we can support your goals and initiatives.