8320 Financial Eligibility - Financial eligibility for PACE participants is based on the living arrangement of the individual. Beginning with the date of enrollment and continuing while the individual remains in a non-institutional living arrangement, all HCBS eligibility rules included in sections 8220 - 8271 are applicable, including the Spousal Impoverishment Provisions of 8244 except for the prior medical provisions of 8232 (see 8330 below). The initial resource test (see 8241) is also applicable beginning the month an individual found in need of PACE and chooses PACE. For PACE participants living in an institution, the LTC rules of 8120 - 8171 are applicable, including Spousal Impoverishment provisions of 8144. Persons who have transferred property without adequate consideration are not eligible for LTC services, including PACE, as determined under the provisions of 5720.
8320.1 Participant Obligation - PACE enrollees must participate in the cost of care if countable income exceeds the applicable standards. The share of cost for PACE is called the Participant Obligation.
8320.2 Processing - Persons enrolling in PACE will be identified through a designated code combination from the KAECSES LOTC screen. The MMIS uses this coding, along with the county of residence, to establish PACE enrollment and payment.
The following Living Arrangement Code is appropriate for PACE: PC.
The following Level of Care is appropriate for PACE: NA.
This combination must remain on LOTC as long as the individual is enrolled with PACE. Changes in living arrangement do not impact the Living Arrangement or Level of Care codes and the Temporary Care coding (TC) is not applicable as long as the individual is enrolled with PACE.
Medical cards are suppressed for PACE enrollees, but the PACE entity issues a separate PACE card. Beneficiaries who receive a medical card in error are instructed to return the card to the eligibility worker.