Rule 5160-36-03 | Medicaid funded program of all-inclusive care for the elderly (PACE) eligibility.
(A) To be eligible and maintain eligibility for PACE, an individual will meet the requirements for PACE participant eligibility set forth in rule 173-50-02 of the Administrative Code and will have been determined to be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code.
(B) If a PACE participant who is also enrolled in medicaid has a continuous period of institutionalization as defined in rule 5160:1-6-01.1 of the Administrative Code, that individual's patient liability amount is to be calculated by the county department of job and family services as directed in rule 5160:1-6-07.1 of the Administrative Code.
(C) Individuals who fail to meet the eligibility requirements in paragraph (A) of this rule will not be enrolled as a medicaid participant in PACE.
(1) Once enrolled, participants who no longer meet the eligibility requirements in paragraph (A) of this rule will be involuntarily disenrolled from the medicaid-funded component of PACE pursuant to rule 173-50-05 of the Administrative Code.
(2) An individual who no longer meets medicaid eligibility requirements in paragraph (A) of this rule may continue non-medicaid funded enrollment in PACE as defined within rule 173-50-02 of the Administrative Code.
(D) PACE eligibility and enrollment for persons who are either medicaid enrollees or non-medicaid enrollees are described in section 173.50 of the Revised Code.
Last updated November 7, 2023 at 8:15 AM
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