HOW TO: Disenroll a Participant

In PACE, participants may disenroll for a variety of reasons. Below is a summary of the most common disenrollment scenarios encountered across programs.

Disenrollment Type	Examples
Voluntary	Participant chooses to leave the PACE program for personal reasons Participant wishes to return to fee-for-service Medicare/Medicaid or enroll in another health plan
Involuntary	Participant moves out of the PACE service area Participant exhibits non-compliance or disruptive behavior Participant no longer meets medical or financial eligibility requirements Long-term placement in a facility outside the PACE organization’s network
Deceased	Participant passes away while enrolled in the program

Best Practices for Managing Disenrollments

✔ Involve the IDT early to review and support the disenrollment decision, especially for involuntary cases.

✔ Accurately enter the disenrollment reason, effective date, and supporting notes in the EMR for compliance and audit readiness.

✔ Work with external providers or plans (when applicable) to ensure a smooth handoff of care post-disenrollment.

Follow the step-by-step guide to disenroll Participants: