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2. Spousal resource protection applies in PACE. The non-institutionalized spouse is entitled to resource protection. Resource protection begins the first day of the month the PACE Enrollment Agreement is signed. Refer to MA- 2231, Community Spouse Resource Protection.

I. Transfer of Assets

Transfer of assets sanctions apply to PACE. When a transfer of assets sanction period is determined for an applicant/beneficiary who is enrolled in the PACE program, evaluate for MQB only. Individuals enrolled in the PACE program are ineligible for all other Medicaid programs, (excluding MQB) during the sanction period. Refer to MA-2240, Transfer of Assets, and X.C . below.

J. Estate Recovery

PACE a/b’s are subject to estate recovery. See MA-2285, Estate Recovery.

K. Managed Care

PACE beneficiaries are excluded from enrollment in NC Medicaid Managed Care and they are exempt from choosing a primary care provider (PCP). NC FAST will populate the PACE exemption code (9999906) automatically on the beneficiary’s Benefit History. See NC FAST Job Aid: Program of All-inclusive Care for the Elderly (PACE).

L. Medicare Buy-In

Medicaid-eligible PACE beneficiaries eligible for Medicare qualify for Medicare enrollment and buy-in. Follow procedures in MA-2410, Medicare Enrollment and Buy-In.

M. Medicare Part D

The PACE organization is also the Medicare Part D prescription drug plan provider. PACE beneficiaries will enroll with PACE for Medicare Part D prescription drug plan. Part D enrollment is completed by the PACE organization.

N. Skilled Nursing and Adult Care Homes

When a beneficiary who is enrolled with a PACE Organization enters a skilled nursing facility or an adult care home, PACE is responsible for paying the facility for the beneficiary’s cost of care. See X.D, below, for further instructions on how to react to this type of change in circumstance.

Beneficiaries who are receiving Medicaid for PACE are not eligible to receive Special Assistance while enrolled with a PACE Organization.

V. PACE BUDGETING