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2. Individual is currently a Medicaid Beneficiary

a. Process as a change in circumstance.

b. Evaluate for eligibility in appropriate Medicaid programs.

c. If the a/b has a deductible, recalculate a deductible for months in the certification period prior to TBI authorization. • Multiply the monthly private living arrangement (PLA) deductible by the number of months in the certification period prior to TBI eligibility to calculate the new deductible amount. • The new deductible amount may change the authorization date of Medicaid eligibility. • Any excess expenses previously submitted may be used towards the TBI monthly deductible.

For keying instructions refer to NC FAST job aid: Community Alternatives Program (CAP), Traumatic Brain Injury (TBI) and Innovations. B. Retroactive Coverage

Retroactive eligibility can be determined for 1, 2 or 3 months prior to application. Retroactive TBI cannot be authorized prior to May 1, 2018.

C. Individuals requesting TBI waiver services must have an LME/MCO assessment to determine the need for services appropriate to the TBI waiver program.

D. Upon completion of LME/MCO assessment the local agency will receive a NC TBI Level of Care (LOC) Eligibility Determination indicating approval or denial of services. E. When Medicaid eligibility can be established regardless of TBI eligibility 1. Do not wait for TBI waiver approval 2. Authorize Medicaid, if otherwise eligible or react to change in circumstance reported on an ongoing case.

F. When Medicaid eligibility cannot be established without TBI eligibility

1. Verify the status of the ISP with the Care Coordinator, and

2. Deny the application if the TBI decision is not received by the 45/90th day