Program of All-inclusive Care for the Elderly - A PACE is a type of fully-capitated MLTC plan that provides a comprehensive system of health care services for members age 55 and older who are otherwise eligible for nursing home admission. Both Medicare and Medicaid pay for PACE services (on a capitated basis). PACE members are required to use physicians & providers employed by or contracted with their plan. An interdisciplinary team develops care plans and provides on-going care management. The PACE is responsible for directly providing or arranging all primary, inpatient hospital and long-term care services required by a PACE member. Most participants are dually eligible for Medicare and Medicaid, with a small number in only one or the other.
Ordinarily, when a minor child applies for Medicaid, the income and resources of their parents are counted, because parents are Legally Responsible Relatives for their minor children. However, a child may prevent their parents' income/resources from being counted if the parent signs a statement indicating their refusal to make their income/resources available for the child's medical care. This is called a parental refusal.
When a patient pre-pays their spend-down to the Medicaid agency to activate their Medicaid coverage, instead of incurring medical bills to offset their excess income.
Personal Care Aide
- aka "home attendant." A semi-skilled paraprofessional certified under NY law to provide assistance with certain specified activities of daily living for people with disabilities. See 18 NYCRR § 505.14; Personal Care Aide Scope of Practice at http://www.wnylc.com/health/download/46/
Prenatal Care Assistance Program - A program providing comprehensive prenatal care to low income pregnant women.
Primary Care Physician - The doctor in a managed care plan that provides most of the recipient’s care and is responsible for referring recipient to specialists if needed.
Private-Duty Nursing - Clients with continuous skilled nursing needs may need a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for up to 24-hours a day. Intravenous or parenteral nutrition, suctioning of tracheostomies, direct administration of medications (putting a pill directly in the client’s mouth), and operating a ventilator are examples of tasks that PCA/HHAs may not perform. PDN is covered (subject to prior approval) by fee-for-service Medicaid and by all types of Medicaid Managed Care plans (MMC, MLTC, etc.) 18 NYCRR § 505.8.
Permanently Residing Under Color of Law - PRUCOL is a category of immigration status used by certain public benefit programs. An immigrant would be considered PRUCOL if they are residing in the United States with the knowledge and permission or acquiescence of the United States Citizenship and Immigration Services, and whose departure that agency does not contemplate enforcing. PRUCOLs are eligible for Medicaid and Safety Net Assistance in New York State.
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