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Participant Information

Eligibility

You are eligible for our program if you:

  • Are aged 55 or older
  • Live in Hampden or Hampshire County
  • Are certified by our state agency to need a nursing home level of care*
  • Can safely live in the community with our services, as determined by our assessment team*

*Nursing home eligibility and safety are determined through our comprehensive assessment processes.

 

Covered Services

As a Program of All-inclusive Care for the Elderly, Mercy LIFE provides the necessary care and services to allow you to remain living safely at home. These include:

Primary care medical services: Personalized medical treatment is provided by physicians and nurse practi­tioners experienced in geriatric medicine.

Medical specialty care: A network of medical special­ists provide for all specialty medical needs including dental, podiatry, optometry, and audiology services and supplies. Referrals for specialty care must be ap­proved by the Medical Director and interdisciplinary team as being medically necessary.

Rehabilitative services: Occupational, physical, speech and respiratory therapies are available for restoration, as well as maintenance of function.

Nursing care: Nursing treatment, education, coun­seling and medication management are available to participants in our center or at home as needed.

Drug coverage: Prescription drugs, as well as medically necessary over-the-counter drugs, are covered.

Medical equipment and supplies: Durable medical equipment like walkers, wheelchairs, and diabetic glucometers are provided, as are supplies such as dia­betic testing strips.

Adult day services: Our day center provides medical, social, rehabilitative, recreational, personal care and nutritional services.

Social work services: Services are available for indi­vidual and family counseling, social needs assessment and advocacy in obtaining community services.

Transportation: Transportation and escort services are provided to and from the day center and medical appointments. Emergency transportation is provided as medically necessary.

Meals: Meals and snacks are provided in the day center, as well as home-delivered meals as necessary.

Personal Care: Assistance is provided in the day health center, as well as at home.

In-home services: Personal care, skilled nursing services and environmental supports as recommended by the interdisciplinary team are also provided.

Outpatient Services: Services such as lab work, tests, x-rays, and surgery are covered.

Inpatient hospital and nursing home care: When medically necessary as determined by you, your family and the team, inpatient and nursing home care is provided.

* Participants may be fully and personally liable for the costs of unauthorized services or services outside of our PACE program agreement (excluding emergency services).

Mercy LIFE does not discriminate in the delivery of services based on race, ethnicity, national origin, religion, sexual orientation, age, mental or physical disabilities, or source of payment.

Cost

Mercy LIFE services are paid through an “all-inclusive” arrangement, which means that for most people, there are no out-of-pocket or de­ductible charges. Traditional costs for co-pays, medications, dental, hearing and vision care, in-home services, hospitalizations, rehabilita­tive care – even long-term care placement – are covered by Mercy LIFE if they become necessary.

If you qualify for Medicaid, or both Medicaid and Medicare, you pay nothing. If you do not qualify for Medicaid, you pay the Medicaid equiv­alient – a flat monthly fee (premium) – that will not vary even as your needs increase.*  This monthly premium is a fraction of paying privately for nursing home care, which sometimes is the only alternative.

Note: Medicaid income limits are higher for those needing long-term care services.  A member of our staff can help you determine if you may be eligible for Medicaid and if so, are available to assist you with the application process.

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