PACE Flex Cards: A Participant-Centered Shift

Flex - OTC - Spending - Debit Cards in PACE:

A Practical, Participant-Centered Change

PACE (Program of All-Inclusive Care for the Elderly) is reaching new heights of participant-centered care with the introduction of spending cards, also known as flex or OTC cards. These cards are becoming more than a buzzword—they’re a practical solution, allowing participants to take greater control of their own lives. But, like anything worthwhile, they come with challenges. Let’s look at how these cards enhance care and what it takes to make them work in PACE.

Why Spending Cards Matter for PACE Participants

Imagine a PACE participant shopping for their specific dietary needs or personal care preferences. Spending cards let them choose their preferred brand of vitamins, nutrition shakes, or personal items that cater directly to their needs. The effect goes beyond convenience; it’s about respect and control. These cards give seniors autonomy over their daily choices, empowering them to make decisions that improve their lives.

Spending cards also connect directly to the core PACE mission of treating the whole person. It’s one thing to offer high-quality medical care and support; it’s another to give participants more say in the small, everyday things that make life comfortable and meaningful.

 

Meeting Participants Where They Are: Personalization at Its Best

Spending cards allow PACE teams to personalize support in ways that directly serve each individual. Here’s how they help participants thrive:

Health and Wellness: Giving participants control over grocery purchases and personal care items can lead to better nutrition and health outcomes, directly supporting our long-term care goals.

Cultural and Dietary Relevance: With spending cards, elders can buy foods and items that align with their cultural backgrounds, helping them feel more comfortable and “at home” in the PACE community.

Emotional and Psychological Well-being: The ability to make purchasing choices improves not just physical health but also emotional and psychological well-being. Participants feel valued and in control of their daily routines.

Does the Data Support Spending Cards?

Yes, for groceries especially

A lot of plans talk about how giving people grocery spending plans is an enormous lever on health outcomes. However hard data is not disclosed (so far, in 2024).

At a Dual Special Needs Plan conference in 2024, a plan manager told the audience that "the grocery benefits of spending cards" are the #1 variable that improved health outcomes for their members, more than check-ups and transportation. The data were not disclosed, and this was surprising to hear as a "PACE person," but the D-SNP people nodded along in agreement.

Here is what we know:

• Supplemental Nutrition Assistance Program (SNAP) has been linked to better self-reported health, reduced risk of heart disease and obesity among adults who had access to SNAP as children, and greater medication adherence among older participants.
• Additionally, "food is medicine" initiatives show promise. These programs, which include medically tailored meals and produce prescriptions, have been associated with improved health outcomes and reduced healthcare usage and costs.
• Meals on Wheels America - in light of the Older Americans Act - says their program aims to "reduce hunger, food insecurity, and malnutrition; promote socialization; [and] promote the health and well-being of seniors through access to nutrition and to nutrition-related disease prevention and health promotion services."

Tackling Internal Challenges: Making Spending Cards Work in PACE

Implementing spending cards takes careful planning and internal collaboration. Here’s how to address some common concerns:

Cost and Misuse: While there may be worries about misuse, these cards can actually be cost-neutral. Limiting spending to approved vendors or categories, like local grocery stores, helps participants get what they need without exceeding budget constraints.

Operational Adjustments: The logistics of managing these cards can seem daunting, but starting small is a great way to ease into it. Testing the cards with specific item categories and monitoring usage can build confidence for participants and staff.

Alignment with Care Plans: Making spending cards an intentional part of individualized care plans is key. Social workers can evaluate each participant’s needs during intake and care planning, aligning spending card usage with specific health and wellness goals.

Finding a Vendor: PACE is very small and niche, and a lot of the big "spending card" vendors don't want to offer customized solutions. In 2024, some PACE are using on-line apps in place of spending cards, or giving people debit cards or grocery cards. This remains a challenge, it will be interesting to see which vendors can be efficient in PACE in 2025.

 

Staying Competitive: Keeping Up with Medicare Advantage

Medicare Advantage (MA) plans have been using spending cards as an enrollment tool, and we’re seeing the effects. As competition heats up, PACE organizations that adopt spending cards are not only meeting these new demands—they’re exceeding them by combining financial support with our comprehensive, high-touch care model.

Generations Now clients are privately reporting that adding spend cards has increased enrollment. They have turned a barrier to enrollment into an advantage. For some, the lack of a spending card is the only thing standing between an interested participant and enrollment. By meeting this need, we’re doing more than “keeping up”; we’re setting a standard for person-centered care that other models simply can’t match.

 

Success in Action: Learning from Real Implementations

Other PACE centers are leading the way and proving that spending cards can work. Here are a few practical takeaways from successful programs:

Personalized Care Plans: Each participant’s card is tied directly to their needs. This ensures spending aligns with individual care plans and PACE’s mission of personalized, high-quality support.

Pilot Programs and Phased Rollouts: Some centers start with limited vendors or item categories, which helps teams monitor usage and refine processes before rolling out the program fully.

Data-Driven Decision Making: Tracking the impact of spending cards on enrollment helps justify the program. For instance, one PACE center tracked a list of lost enrollments due to lack of a card.  This made the case for adoption crystal clear.

Creative Safeguards: In situations where substance misuse might be a concern, centers have explored options like online grocery orders or supervised purchases to minimize risks while still empowering participants.

 

Moving Forward: Why Spending Cards are Here to Stay

Spending cards in PACE aren’t just a trend—they’re a powerful, practical tool that supports participant autonomy and well-being. They reinforce our mission by meeting seniors where they are, offering independence alongside comprehensive care. If your organization is still on the fence, it might be time to consider how spending cards could fit into your care model.

In a world where participants expect personalized, empowering solutions, spending cards offer an effective way to bridge that gap. It’s about more than providing financial help; it’s about affirming our commitment to dignity, independence, and top-notch care for every person PACE serve.

 

Training Marketing and Enrollment Teams for Spending Cards

To make spending cards a strong part of your enrollment process, consider how you’re introducing this benefit to potential participants. In our Empathy Enrollment Training at Generations Now, we equip your team with tools to explain spending cards in a way that resonates—emphasizing personal choice, dignity, and control over day-to-day needs. This training helps your staff connect with participants on a deeper level, making enrollment conversations more impactful and building trust from day one.

Ready to see the difference empathy can make in enrollment? Let’s get started.