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Ohio Laws and Rules
(A) To be eligible for the OHDAP program, an individual must meet the eligibility criteria outlined in paragraph (A) of rule 3701-44-05 of the Administrative Code and the following:
(1) The individual shall submit a complete, accurate, and truthful OHDAP application, a copy of any health insurance policy under which the applicant has coverage and documentation of CD4 and viral load testing results from tests taken not more than six months prior to the date of application;
(2) The individual shall cooperate with the department in applying for all potential third party benefits for which the individual may be eligible. Refusal to cooperate in obtaining third party benefits shall result in ineligibility for the OHDAP program; and
(3) If the individual’s or family’s gross income is at or below the current federal poverty level as reported in the “Federal Register” by the United States department of health and human services, the individual shall submit documentation demonstrating the applicant applied for the medical assistance program established in section 5111.01 of the Revised Code and that the individual is enrolled in an HIV medical case management program approved by the department.
(B) Applications for OHDAP shall be reviewed to determine which of the following benefits is the most appropriate for the applicant to secure HIV medications.
(1) Individuals who have public or private health insurance coverage may be enrolled in the health insurance premium payment or “HIPP” program. Individuals enrolled in the HIPP program may also be eligible for assistance from Ryan White part B resources for payment of co-payments and deductibles for medications that are covered by the OHDAP program.
(2) Individuals who are eligible for medicare part D prescription coverage may be eligible for assistance from Ryan White part B resources for payment of the medicare part D premiums, co-payments and deductibles.
(3) Individuals who are eligible for the medical assistance program through the spenddown provisions of rule 5101:1-39-10 of the Administrative Code may be eligible for the OHDAP spenddown payment program.
(C) Approval for the OHDAP program shall not exceed eighteen months from the date of application. Prior to the end of the approved OHDAP eligibility period, the individual must complete a new application for a new eligibility period.
(D) Ryan White part B resources must be used as a “payer of last resort” and all other options for obtaining medication must be exhausted.
(E) The director may deny an individual’s application and future applications or terminate an individual’s eligibility if the director determines that the individual submitted false information related to the application for Ryan White part B benefits, cancelled an insurance policy under which the individual was covered in order to receive Ryan White part B benefits, or fraudulently accepted Ryan White part B benefits or abused the payment of benefits.
(F) An individual who is denied OHDAP eligibility or is terminated from ODHAP may request reconsideration of the denial or termination in accordance with rule 3701-44-07 of the Administrative Code.
Replaces: 3701-44-08
Effective: 08/02/2009
R.C. 119.032 review dates: 08/01/2014
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 7/20/2001, 12/18/06