Rule 173-50-02 | PACE: eligibility requirements.
A person is eligible for PACE only if the person meets all the following requirements:
(A) The person is at least fifty-five years of age.
(B) The person resides within a PACE organization's service area.
(C) The person has an intermediate or skilled level of care in accordance with rule 5160-3-08 of the Administrative Code.
(D) ODA determines, according to 42 C.F.R. 460.150(c)(2), that the person can live in a community setting without jeopardizing his or her health and safety.
(E) The person, who may be enrolled as a medicaid or a non-medicaid enrollee, is responsible for payment to the PACE organization as follows:
(1) If a person is applying for, or enrolled in, PACE through the medicaid program, the person maintains medicaid eligibility either under the financial eligibility standard or under a needs allowance if the person has moved from an institutional setting to a non-institutional setting, and any post-eligibility treatment of income (i.e., patient liability or share of cost) ODM may require in rule 5160:1-6-07.1 of the Administrative Code.
(2) If a person is applying for, or enrolled in, PACE as a non-medicaid enrollee, the person may remain eligible for PACE if the person pays the premiums and incurred while using PACE. (For more information, see rule 173-50-05 of the Administrative Code and 42 C.F.R. 460.150.)
(F) At the time of initial enrollment, the person meets the following:
(1) The person is not enrolled in one or more of the following (or will disenroll following enrollment in PACE):
(a) A medicaid managed-care program other than PACE.
(b) A medicaid waiver program (e.g., PASSPORT, assisted living, Ohio home care, mycare Ohio).
(c) A medicare or medicaid prepayment plan (other than PACE) or optional benefit, including the hospice benefit.
(d) A nursing facility certified by medicaid while medicaid is covering the person's nursing facility expenses.
(2) The person resides in a non-institutional setting (e.g., house, apartment).
Last updated July 1, 2025 at 7:46 AM
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