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B. SAIH and PACE Cannot Be Received At the Same Time

Individuals who receive Special Assistance or SAIH cannot receive NC

Program of All-Inclusive Care for the Elderly (PACE) coverage at the

same time, as PACE provides all-inclusive care.

When an active PACE recipient applies for Special Assistance or SAIH,

the PACE recipient must disenroll from PACE by the end of the SA or

SAIH application processing time standard (45th/60th day) and meet all

other SA or SAIH eligibility criteria in order for the SA or SAIH application

to be approved.

• If the individual has not been disenrolled from PACE by the 45th/60th day, the SA or SAIH application must be denied.

• If the PACE recipient has been disenrolled from PACE by the 45th/60th day of the SA or SAIH application and meets all other SA and/or SAIH eligibility criteria, the effective date of SA or SAIH benefits cannot be on or prior to the PACE disenrollment date.

• “Disenrolled” refers to all parts of the PACE disenrollment being completed, with an effective end-date for PACE in NC FAST.

Important: For any month in which an SA or SAIH payment is received

while the SA or SAIH beneficiary is also enrolled in PACE,

that payment is an overpayment which must be recouped.

There can be no overlap of SA and PACE services.

C. NC Innovations Waiver and SAIH

Depending on individual circumstances and need as determined by the

Adult Services Case Manager, an individual can potentially receive both

Community Alternative Program (CAP) via the NC Innovations Waiver and

SAIH at the same time. The client must meet all eligibility criteria for

SAIH as outlined in the SA and SAIH policy manuals.

The IMC will determine financial eligibility and refer client to the Case

Manager in Adult Services. The Case Manager will complete a functional

assessment. The Case Manager handles ongoing oversight of SAIH services and needs, and will work very closely with the CAP Innovations Care Coordinators to ensure there is no duplication of services in case management functions.

CAP services via NC Innovations Waiver are the only type of CAP

services that a Special Assistance or SAIH beneficiary may receive.

SA-5200 I.