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In this scenario, Mr. Jones should be budgeted as a Medicaid Individual with an Ineligible Spouse for March, April, May, and June.

Beginning July 1, Mr. Jones should be budgeted as a Medicaid Individual because the PACE enrollment agreement was signed in July.

d. Mail DHB-5002, Important Notice About Your Medicaid or Special Assistance Approval, for the approval of PACE.

2. When an application is approved, or an ongoing change is processed AFTER the second to the last workday of the month:

a. Authorization for PACE will be the first day of the month after a PACE eligibility decision is accepted and activation is completed in NC FAST.

EXAMPLE:

Susie Solomon is a widow, living alone. She applies for Medicaid and PACE services on June 27th. She also applies with the PACE organization for enrollment on June 27th.

Susie signs her enrollment with the PACE organization on July 7th.

The PACE organization sends a referral to the local agency on July 8th verifying Susie’s PACE enrollment date as July 7th.

Susie’s caseworker establishes Medicaid eligibility but does not enter PACE evidence into NC FAST until July 31st . This means the PACE organization will not be paid for August. Medicaid PACE authorization is effective September 1st.

b. For applications, evaluate retroactive months for all Medicaid programs. See MA-2300, Application.

EXAMPLE:

Using the scenario above, retroactive PLA Medicaid must be evaluated for March, April, and May. See MA-2300, Application.

c. Evaluate ongoing months for all Medicaid programs. See section V.C, above for budgeting. Beginning with the month the PACE enrollment agreement is signed, budget as one.

EXAMPLE:

The caseworker will also evaluate Susie for ongoing PLA Medicaid for June, July, and August. See MA-2300, Application and MA-2260, Financial Eligibility Regulations-PLA.