PACE enrollment rep enrolling a participant

Is Medicaid Stigmatized… and a PACE Dirty Word?

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Is “Covered by Medicaid” Hurting Your PACE Enrollment Growth (And What to Say Instead)

Summary: In rural PACE markets, well-meaning marketing language is causing serious enrollment problems. Many eligible seniors never take the first step—because the phrase “covered by Medicaid” shuts them down. New data from the Kaiser Family Foundation shows exactly how deep the stigma runs, especially in conservative and rural statess.

In every rural market, there’s a silent group of older adults who are perfect for PACE. They’re 65 or older. They need help with daily life. They’re living on modest Social Security checks. And they could qualify for Medicaid—if someone helped them apply.

But they don’t apply. They don’t call. They don’t walk through your door. Why?

Because somewhere, someone told them: “It’s free if you qualify for Medicaid.” And in their mind, the conversation ended there.

(The conversation also ends there for the PACE enrollment rep, because they are not trained to build value for PACE and are qualifying people "out" instead of enrolling people "into" PACE. That's what we solve in our Empathy Enrollment Training.)

To many older adults, “Medicaid” means welfare. Shame. Failure. Disqualification. Dependency.

So they decide it’s not for them—even when it absolutely is.

New Survey Data Confirms that Stigma Persists for Medicaid

In February 2025, the Kaiser Family Foundation released a rural tracking poll that should be front-page reading for every PACE executive. In this nationally representative survey of rural adults:

  • Only 10% of rural adults said Medicaid is their main form of insurance.
  • Half (49%) said Medicaid is not important to their family.
  • 77% believe most adults on Medicaid are unemployed (when in fact, many are working, caregiving, or disabled).
  • 69% support work requirements for Medicaid access.
  • 53% of respondents identify as Republican or lean Republican—adding a cultural-political dynamic to views of Medicaid

Let’s be clear: this is not apathy. It’s identity. Many rural seniors see Medicaid as something “not for people like me.”

Understanding the 53%: It’s Not About Politics—It’s About Identity

The fact that 53% of rural adults in the February 2025 KFF Health Tracking Poll identify as Republican or lean Republican doesn't mean they oppose Medicaid on partisan grounds. It reflects something deeper: a cultural worldview rooted in self-reliance, independence, and skepticism of government programs.

According to a 2024 report from the Pew Research Center, nearly two-thirds (65%) of Republicans believe that government aid to the poor “does more harm than good.” This belief isn’t just political—it’s philosophical. It stems from a long-standing American conservative ethic that values individual responsibility and views government assistance as a threat to personal dignity.

That’s why, when a PACE representative says “It’s covered by Medicaid,” some rural seniors instinctively reject the offer. Not because they dislike the program. But because they don’t want to be seen—or see themselves—as someone who takes help. Many think: “That’s for someone worse off than me.”

In this context, changing the language isn’t about hiding the role of Medicaid. It’s about meeting people where they are. It’s about honoring their values and making space for them to receive help without feeling like they’ve compromised who they are.

The Medicaid Rules for Seniors Are Misunderstood

In some states, Medicaid for PACE-eligible seniors looks very different than Medicaid for young adults. But the public doesn’t know that.

They don’t know that if they need care, they can qualify with income up to $2,901/month. They don’t know they can own a home and a car. They don’t know that if they’re married, their spouse can keep ~$150,000 in assets beyond the home.

And they certainly don’t know that PACE can help them apply.

Which means your outreach needs to stop leading with “Medicaid.” Because when you say “covered by Medicaid,” many qualified people walk away before they ever hear the good part.

Replace CMS Jargon Speak with Human Language

Yes, we are washing the dirty words out of PACE.

Here’s the before-and-after:

BEFORE: “PACE is covered by Medicaid for people who qualify.”

AFTER: “You may be able to get PACE at no cost, if your income is under $2,901 per month -- or even close to that. We help you apply.”

The second version doesn’t mention Medicaid. But it gives clarity. Concreteness. Hope. Possibility. It meets people where they are.

What CEOs and Diectors of Marketing Can Do Today

If you’re a PACE CEO, here’s your challenge: audit your front-line messaging. What do intake reps say when someone asks about cost? (BTW, we have mystery shopping programs to benchmark team performance and progress).

Does enrollment say “Medicaid,” or do they say “there is no cost if your income is at a certain amount”?

If you’re a Director, open up your website. Look at your flyers. Do they use insider terms like “Medicaid eligible,” or do they clearly explain who qualifies in human language?

You don’t need a rebrand. You need a reframe. And it can start with one sentence.

The Bottom Line

The words “covered by Medicaid” may be killing your best leads. Not because people aren’t eligible. But because they don’t believe they are.

It’s not just a marketing tweak. It’s a mindset shift. If you can speak in dollars, show respect, and guide people through the process, you’ll see more seniors say yes to the care they need—and more PACE centers grow the way they were meant to.

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