Eligibility and Enrollment
Mount Sinai Eldercare’s enrollment team is dedicated to helping prospective participants and their families determine their eligibility and guide them through the enrollment process.
Eldercare eligibility is determined by specific PACE enrollment criteria as directed by the State of Florida and the Centers for Medicare and Medicaid Services.
Eligibility Requirements
To qualify and benefit from Mount Sinai’s PACE Program, you must:
- Be 55 years of age or older
- Be certified as eligible for nursing home care by the State Administering Agency
- Be able to live safely in the community with Mount Sinai Eldercare’s assistance at the time of enrollment
- Live in Mount Sinai Eldercare’s approved service area, which includes the following ZIP codes in Miami-Dade County:
33010
33012
33013
33014
33015
33016
33018
33054
33055
33056
33101
33109
33122
33125
33126
33127
33128
33129
33130
33131
33132
33133
33134
33135
33136
33137
33138
33139
33140
33141
33142
33143
33144
33145
33146
33147
33149
33150
33154
33155
33160
33161
33162
33165
33166
33167
33168
33169
33172
33173
33174
33175
33179
33180
33181
33183
33184
Enrollment
There is no cost to enroll in the Mount Sinai Eldercare program. Eldercare participants must agree to receive all of their health care from Mount Sinai Eldercare or one if its network providers (except for emergency care). In addition, participants may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.
Once enrolled in Mount Sinai Eldercare, you may leave or disenroll at any time.
Our enrollment specialists are available to help you through the enrollment process and answer any questions you may have. Call 786.584-5560 (toll-free 1.833.352.0939 or TTY for hearing-impaired 1.800.955.8771) or send an email to enrollment@msmc.com.
Enrollment Process
- Once contact is made, a Mount Sinai Eldercare enrollment specialist will provide information about our PACE program and answer any questions. The enrollment specialist will obtain additional information regarding the potential participant’s needs and determine if the eligibility criteria appears to be met. Then, the enrollment specialist will invite the potential participant and their family to come take a tour of the Mount Sinai Eldercare Center and meet with key members of the Interdisciplinary Team, like our Eldercare physician and center manager.
- Once the potential participant has acknowledged their interest in joining Mount Sinai Eldercare, the enrollment specialist will ask for financial information and request that a medical release form be completed. The enrollment specialist will assist with the Medicaid eligibility process with support from the potential participant.
- A referral is sent to the Department of Elder Affairs (DOEA) to schedule an in-home assessment to determine if the nursing home eligibility criteria is met.
- A home visit is scheduled with a Mount Sinai Eldercare home care coordinator and occupational therapist to complete a more in-depth assessment of the potential participant’s medical needs and determine if their medical needs and safety requirements meet the level of care provided by Mount Sinai Eldercare.
- The Interdisciplinary Team reviews the information it has gathered along with the DOEA’s assessment and if all eligibility criteria are met, an enrollment specialists will extend an invitation to join the Mount Sinai Eldercare PACE program. Then, the potential participant will review and sign the Enrollment Agreement. If the enrollment criteria are not met, an enrollment specialist will call and send written information regarding this decision, including how to appeal the decision as well as provide alternative support options.
Learn more about the program and eligibility requirements by calling our enrollment team at 786.584.5560 (toll-free 1.833.352.0939 or TTY for hearing-impaired 1.800.955.8771).
Evaluation or Referral Form
Page Last Updated 7/12/2023