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North Carolina Department of Health and Human Services AGED, BLIND, AND DISABLED MEDICAID MANUAL

MA-200

DEFINITIONS

25 REISSUED 03/01/11 – CHANGE NO. 03-11 (III.) Personal Representative --- A substitute payee appointed by the court when the specified relative payee is unwilling or unable to manage the assistance payment in the best interest of the children.

Plan to Achieve Self-Support (PASS) --- The Social Security Act authorizes the exclusion of income and resources of an individual who has a disability or is blind when the individual needs such income and resources to fulfill an approved Plan to Achieve Self-Support (PASS).

Poverty Level --- A Federally established income guideline used to define persons who are economically disadvantaged.

Presumptive Disability or Blindness --- Conditions under which SSI presumes that disability or blindness requirements are met and makes payment for a period of up to six months. If eligibility is not established for full benefits it is not required that repayment of benefits be made.

Presumptive Eligibility --- A determination of limited Medicaid eligibility for pregnant women, completed by qualified medical providers enrolled with and approved by the Division of Medical Assistance.

Primary Heating Source --- The source of heat used most by the household. (N/A to Medicaid.)

Private Disability or Unemployment Benefits --- Includes benefits paid by private insurance plans for persons incapacitated/unemployed.

Private Living Arrangement (PLA) Budgeting --- Evaluation of eligibility for medical charges only when an individual lives in his own home or an adult care home, and spousal and parental financial responsibility applies.

Private Rate --- The rate charged by a facility for a patient who is paying his own cost of care.

Processing Deadline --- The last date in the month the county can take appropriate action on a case.

Program of All-Inclusive Care for the Elderly (PACE) --- A program of all-inclusive care for the elderly. Managed care service delivery for the frail community-dwelling elderly, most of whom are dually eligible for Medicare and Medicaid benefits, and all of whom are certified eligible for nursing home placement according to North Carolina standards.

Program Transfer --- The process of transferring from one category of assistance to another.

Property Tax Value --- The latest tax value of property as ascertained according to Subchapter II of Chapter 105 of the N.C. General Statutes.

Prorated Benefits --- Benefits issued from the date of application. (N/A to Medicaid.)

Prospective Budgeting --- The best estimate of income for a specified period.