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A. When to begin Long-Term Care (LTC) budgeting

Use Long-Term Care budgeting for a/b’s enrolled or seeking enrollment in the PACE program beginning the first day of the month following the month the PACE Enrollment Agreement is signed. Follow procedures in MA-2270, Long-Term Care Need and Budgeting with the following exceptions:

1. Because PACE beneficiaries are living in the community and have greater needs for shelter, food and clothing, a different maintenance allowance is required. To meet these greater needs, PACE beneficiaries living in their homes are allowed a Personal Needs Allowance (PNA) in the amount of 100% of the Federal Poverty Level (FPL).

2. 1/3 Reduction does not apply to PACE beneficiaries.

B. Determine Whose Income to Count

1. For all months (including retro months for applications) prior to the month a PACE enrollment agreement is signed, budget the a/b with all other financially responsible household members, see MA-2260, Financial Eligibility Regulations-PLA.

2. Beginning the month that a PACE enrollment agreement is signed, the a/b is budgeted as a Medicaid individual, see MA-2270, Long-Term Care Need and Budgeting.

C. Establish Financial Eligibility

Follow policy in MA-2270, Long-Term Care Need and Budgeting. Contact the appropriate PACE organization to obtain the PACE facility private rates used in Step I and Step II. budgeting.

D. Determine Patient Monthly Liability (PML)

1. PACE Beneficiary Residing at Home or Temporarily in a Nursing Facility

If financial eligibility exits, proceed to determine the a/b’s share of cost.

a. Temporary placement in a nursing facility by PACE is defined as less than 6 months.

b. Establish Gross Income

Establish gross amounts of all types of income, earned or unearned, that are countable based on policy in MA-2250, Income.

(1) Count actual amount of SSA benefit received if it is reduced to recoup an SSA overpayment.