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a. If eligible send the appropriate notice and continue as regular Medicaid.

b. If eligible with a deductible, send the appropriate notice indicating that a deductible must be met. c. If ineligible, terminate and send a timely notice (DSS 8110) stating that both TBI Waiver participation and Medicaid will terminate.

B. County Transfer

The NC TBI Waiver is only available to individuals in the Alliance Behavioral Health catchment area of Cumberland, Durham, Johnston, and Wake counties.

1. If the waiver participant transfers to a county within the Alliance Behavioral Health catchment area, the beneficiary will maintain eligibility in the waiver program.

2. Any transfer outside of the Alliance Behavioral Health catchment area will result in: a. Removal from the TBI Waiver program. b. Recertification of Medicaid eligibility. c. Removal of the TBI waiver code by the Income Maintenance Caseworker. For keying instructions refer to NC FAST job aid: Community Alternatives Program (CAP), Traumatic Brain Injury and Innovations and Completing a Case County Transfer.

VII. NOTICES

Send the LME/MCO care coordinator a copy of all notices sent to the applicant/beneficiary (a/b).

VIII. APPEALS

A. Requests for an appeal related to TBI Waiver services start with the LME/MCO. Instruct the beneficiary to contact the assigned LME/MCO.

B. Requests for an appeal related to the need of TBI Waiver services go directly to the NC Office of Administrative Hearings (OAH).

C. Follow the basic Medicaid Eligibility appeal rules in the Appeals section MA- 2420, Notice and Hearings Process for appeals related to eligibility. For keying instructions refer to NC FAST Job Aid: Appeals