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D. Live in a private residence

E. Have been determined to be disabled

III. REQUESTING INNOVATIONS SERVICES

An individual requesting Innovations services without a referral must be referred to the local management entity/managed care organization (LME-MCO). When the applicant/beneficiary (a/b) requests Innovations services and the:

A. Individual is currently not a Medicaid Beneficiary

1. A Medicaid application must be submitted

2. Take appropriate action to determine Medicaid eligibility in appropriate Medicaid programs

B. Individual is currently a Medicaid Beneficiary

1. Process as a change in circumstances

2. Evaluate for Medicaid eligibility in appropriate Medicaid programs

3. If the a/b has a deductible, recalculate a deductible for months in certification period prior to Innovations authorization

a. Multiply the monthly PLA deductible by the number of months in certification period prior to Innovations eligibility = new deductible amount

b. New deductible amount may change the authorization date of Medicaid eligibility

c. Any excess expenses provided may be used towards the Innovations monthly deductible

For keying instructions refer to NC FAST Job Aid: Community Alternatives Program (CAP), Traumatic Brain Injury (TBI) & Innovations

C. Innovations services are retroactive, if eligibility requirements are met in the retroactive period