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(619) 981-PACE (7223)
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Do I Qualify?

Fast & Simple Evaluation

Is PACE Right for You?

Do you or your loved one qualify for all-inclusive care?

Talk to an Enrollment Specialist today by calling (619) 981-PACE (7223) and ask about how to qualify, or fill out our easy online evaluation form.

Please select one:

I am the potential participant.

I am filling this out on behalf of a loved one.

Participant's name:(Required)

First

1. I live in a designated FHCSD PACE service area.(Required)

ZIP Code

1. Enter the current zip code of the potential participant below.(Required)

ZIP Code

2. I am 55 years of age or older (or will be in the next six months).

Yes

2. Is your loved one 55 years of age or older (or will be in the next six months)?

Yes

3. I have made multiple trips to the hospital or emergency room in the past six months.

Yes

3. Has your loved one made multiple trips to the hospital or emergency room in the past six months?

Yes

4. I currently need assistance from others for activities like bathing, dressing, eating or walking.

Yes

4. Does your loved one currently need assistance from others for activities like bathing, dressing, eating or walking?

Yes

5. I need transportation assistance for medical appointments.

Yes

5. Does your loved one need transportation assistance for medical appointments?

Yes

6. I want to live safely in my home, but may need help from others.

Yes

6. Does your loved one want to live safely at home, but may need help from others?

Yes

7. I currently have, or am eligible for, Medi-Cal.

Yes

7. Your loved one currently has, or is eligible for, Medi-Cal?

Yes

Name(Required)

First Last

How do you prefer to be contacted?

Phone

Email(Required)

Phone(Required)

DOB(Required)