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Ohio Laws and Rules
(A) In order to be eligible for the Ohio HIV drug assistance program an individual shall meet the following requirements:
(1) The individual shall be an Ohio resident and shall have a verified HIV positive infection;
(2) The individual shall submit a complete, accurate, and truthful Ohio HIV drug assistance program application in accordance with this rule and include a copy of any health insurance policy held by the applicant;
(3) The individual shall be enrolled in a community based HIV case management program approved by the department;
(4) The individual shall submit documentation of CD4 and viral load results that are not more than six months prior to the date of application;
(5) The individual shall submit satisfactory documentation that he or she has applied for medicaid or deemed to be unlikely eligible for medicaid by an HIV case manager approved by the department. An applicant who has been determined eligible for the medicaid program under the spend down provision set forth in rule 5101:1-39-10 of the Administrative Code may be eligible for the Ohio HIV drug assistance program until such time as he or she reaches their monthly spenddown amount;
(6) The individual shall meet the financial eligibility requirements of paragraph (B) of this rule;
(7) The individual shall cooperate with the department in investigating and applying for any potential third party payments. Refusal to cooperate in obtaining any third party payment shall result in ineligibility for the Ohio HIV drug assistance program.
(B) Financial eligibility for the Ohio HIV drug assistance program is determined by comparing the individual or family income to the following income standard based on an individual’s circumstances. This criteria may be adjusted upward or downward based on federal and state funding as determined by the director.
(1) For an individual eighteen years of age or older, or a minor not residing with a parent or guardian, the income standard is three hundred per cent of the currently applicable federal poverty level.
(2) For an individual under eighteen years of age residing with a parent or guardian or for individuals over eighteen years of age with dependents, the income standard is the sum of the following:
(a) Three hundred per cent of the currently applicable federal poverty level, and
(b) An amount for each dependent equal to the currently applicable federal poverty level.
(3) An individual applying for the Ohio HIV drug assistance program shall submit income verification that demonstrates to the director’s satisfaction that he or she meets the eligibility criteria. This documentation may include, but is not limited to, current and prior state and federal income tax returns. For purposes of this paragraph, “family” means the biological and adoptive parents and all children and stepchildren of such parents under eighteen years of age living in the home. A childless married couple is considered a family.
(C) When an individual resides in the same household with his or her spouse, or a child under age eighteen resides in the same household with his or her parent(s), the individual’s income and the income of such spouse and/or parent(s) shall be included in determining the applicant’s eligibility.
(D) Individuals denied medicaid or general assistance and individuals who have been determined eligible for the medicaid program under the spenddown provisions of rule 5101:1-39-10 of the Administrative Code shall be approved for a period not to exceed twelve months from the date of application approval.
(E) Individuals shall be referred to their county department of job and family services to make application for those programs and shall be eligible for the Ohio HIV drug assistance program for ninety days which may be extended as follows:
(1) If the applicant is approved for medicaid under the spenddown provisions pursuant to rule 5101:1-39-10 of the Administrative Code, the program eligibility period shall be extended for a period not to exceed twelve months from initial application approval;
(2) If the applicant otherwise meets the eligibility requirements for the Ohio HIV drug assistance program and his or her medicaid application has been denied, the program eligibility period shall be extended for a period not to exceed twelve months from initial application approval;
(3) If the applicant is approved for medicaid either without a spendown, or with a spendown the applicant can afford, his or her Ohio HIV drug assistance program eligibility shall be terminated.
(F) Prior to the end of the approved Ohio HIV drug assistance program eligibility period, the individual must complete a reapplication process to enter into a new Ohio HIV drug assistance program eligibility period.
(G) An individual who has been determined to be ineligible for the Ohio HIV drug assistance program, or has been notified that he or she is being terminated from the program, may request reconsideration of that determination by filing a written request for reconsideration with the director within thirty days after the date of mailing of the notice of the determination or termination of eligibility. The request shall be accompanied by any written material that the individual wishes to present. The director shall provide the person with a written decision regarding the request for reconsideration. The director’s decision shall be final and non-appealable.
Effective: 12/18/2006
R.C. 119.032 review dates: 10/03/2006 and 06/29/2011
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 7/20/2001