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Chapter: 2000 Coverage Groups Program: MSSI, SFP 25 The individual must reside in an ALF or MHRTF eligible for reimbursement for Medicaid assistive services; must have been eligible for an OSS payment for August 2001 but ineligible for OSS as of September 2001 solely because their income exceeds the applicable OSS income standard of $609.40; and they are not categorically eligible for full Medicaid benefits as of September 2001. As long as the individual continues to meet all OSS eligibility criteria and their income is equal to or less than the August 2001 income standard (plus any cost of living adjustment), the individual can continue to receive OSS payments. Once the individual becomes ineligible for OSS and the case is closed, the individual cannot be considered under this coverage group. 2040.0823 Program of All-Inclusive Care for the Elderly (MSSI) Program of All-Inclusive Care for the Elderly (PACE) is an optional Medicaid benefit developed to serve the frail elderly in the home and community. This program offers comprehensive services that include acute and long-term care. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than being institutionalized. However, once enrolled in PACE, an individual may continue PACE services even if the individual moves to an assisted living facility or a nursing home.

Eligibility for PACE is determined in accordance with Institutional Care Program (ICP) rules, including transfer of assets and spousal impoverishment policies regardless of the individual’s living arrangement. The individual must also meet additional criteria as follows:

1. be at least 55 years of age, 2. be a resident of the state and reside within the PACE service area, 3. meet the level of care, 4. be determined disabled if under 65 years of age, and 5. elect the PACE provider as his/her sole source of Medicare and/or Medicaid service delivery.

Note: A PACE participant cannot elect Hospice while simultaneously receiving PACE services. PACE participants may qualify for an OSS payment if OSS criteria are met.