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The PACE Organization will provide the disenrollment date on the DHB-5106, PACE/Medicaid Referral. The caseworker should take the following action:

1. End date the PACE evidence in NC FAST with the last day of the disenrollment month which will make the disenrollment effective the first day of the next month.

2. A DHB-8020, Medicaid Eligibility Corrections Form, may be required to be submitted to the DHB DSS Support Unit, if the action is taken too late to end PACE eligibility for the month of disenrollment. See NC FAST Job Aid: DHB Queue for Claims.

3. Redetermine eligibility using PLA budgeting. Refer to MA 2260, Financial Eligibility Regulations – PLA.

a. Individual remains eligible for Medicaid without PACE:

Send an adequate DSS-8110, Notice of Modification, Termination, or Continuation, stating the PACE eligibility end date and the Medicaid benefits will continue.

b. Individual ineligible for Medicaid without PACE:

Send a timely DSS-8110, Notice of Modification, Termination, or Continuation, stating the PACE end date and the Medicaid end date. Follow notice requirements found in MA-2420 Notice and Hearings Process. Evaluate for all other Medicaid programs prior to termination.

B. County Transfers

1. When a PACE a/b moves out of the county and is no longer enrolled with a PACE organization, the caseworker must evaluate for PLA Medicaid, and

a. If a/b continues to be eligible for Medicaid in another program, remove PACE evidence in NC FAST. Follow procedures in MA-2221, County Residence and NC FAST job aid: Completing a County Transfer.

b. If a/b is ineligible for Medicaid, terminate the case and send a timely DSS- 8110, Notice of Modification, Termination, or Continuation.

2. When a PACE a/b moves out of the county (County 1) and enrolls in PACE in another county (County 2), follow county transfer procedures in MA-2221, County Residence and NC FAST job aid: Completing a County Transfer. When changing PACE enrollment to a different PACE Organization, there may be a break in PACE Medicaid and the a/b must be evaluated for PLA Medicaid.

3. When a PACE a/b moves out of the county (county1) and remains enrolled in the same PACE Organization in a new county (county 2), follow county