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In this scenario, Susie is budgeted as a Medicaid Individual for all months because she lives alone. If Susie had a spouse, LTC budgeting would begin July 1 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.

The caseworker should make every effort to process applications and ongoing changes prior to the second to the last workday of the month. When the PACE Product Delivery Case (PDC) is not activated in NC FAST on or before the second to the last workday of the month, the a/b will not be eligible for PACE Medicaid and the PACE organization will not be paid for the next month.

VIII. MEDICAID CERTIFICATION AND AUTHORIZATION FOR PACE

A. For an application

1. Certify the case for 12 months,

AND

2. Follow the procedures in MA-2350, Certification and Authorization.

Refer to NC FAST job aids: Program of All-Inclusive Care for the Elderly (PACE) and Application to Case.

B. For an ongoing case, continue in the established certification period.

IX. REDETERMINATION OF ELIGIBILITY/REVIEW

Follow policy in MA-2320, Redetermination of Eligibility.

X. CHANGE IN SITUATION

When a change in situation results in an individual’s ineligibility for Medicaid authorization for PACE, always explain that disenrollment from PACE is an option and refer them to the PACE organization. PACE applicants/beneficiaries that disenroll from PACE must be evaluated for other Medicaid programs. PACE a/b’s that do not disenroll from PACE are not eligible for any Medicaid services.

A. Voluntarily/Involuntarily Disenrolls from the PACE Program

A PACE participant may voluntarily disenroll or be involuntarily disenrolled at any time. The disenrollment is effective on the first day of the month after the disenrollment date provided by the PACE Organizations. Disenrollment can occur any day of the month, including the last day of the month and the effective date is the first day of the next month.