Rule 173-50-02. PACE: eligibility requirements

119.03 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 April 27, 2026 at 8:31 AM Supplemental Information Authorized By: 121.07 , 173.01 , 173.02 , 173.50 Amplifies: 173.50 , 42 C.F.R. 460.150 7/1/2030 3/28/2009, 8/1/2016