(A) Medicaid assistance groups may have received or continue to receive services from the Ohio department of mental retardation and developmental disabilities (ODMR/DD) and/or the Ohio department of mental health (ODMH). ODMR/DD and ODMH provide for any and all personal needs, e.g., recreational activities and services necessary to assure a better quality of life for individuals under their care. Many of these services are not covered by medicaid and exceed the individual's available personal income. ODMR/DD and ODMH maintain records and documentation of expenses incurred on an individual's behalf that fall outside of the scope of medicaid coverage and exceed the individual's available income. When an individual receives a lump-sum payment or available resources are identified. ODMR/DD and ODMH seek reimbursement for appropriately incurred expenses.
(B) When ODMR/DD and/or ODMH are acting on behalf of the individual as the responsible party, legal guardian, etc., the appropriate department may dispose of the resource by increasing the individual's resources to the resource limit, establishing an irrevocable burial agreement, and purchasing any personal items deemed necessary to better the individual's quality of life. After these expenses, ODMR/DD and/or ODMH will reimburse their department for funds expended on behalf of the individual and provide documentation of these expenses to the CDJFS.
(C) If the individual's responsible party, legal guardian, etc., is not a representative of ODMR/DD and/or ODMH, the representative is also afforded the opportunity of increasing resources to the resource limit, establishing an irrevocable burial agreement, and purchasing necessary personal items. Again, documentation of these expenses shall be provided to the CDJFS. After such expenses, the responsible party, legal guardian, etc., must properly dispose of any excess resource to maintain continued medicaid eligibility.
(D) The CDJFS shall notify the responsible party of the options available to appropriately dispose of excess resources. One option is reimbursement to ODJFS for medicaid expenses. However, the options of reimbursing ODJFS, ODMR/DD, or ODMH or terminating medicaid and paying privately for the medical expenses remain with the responsible party.
(E) The CDJFS shall review necessary documentation for the reimbursement to ODMR/DD or ODMH to assure that the recipient did, in fact, receive fair and equitable value for the resources. If the documentation verifies the individual received fair and equitable value, the CDJFS shall accept these expenditures as valid. Valid expenses and reimbursements to ODMR/DD and/or ODMH shall not be considered an improper transfer of resources.
Eff 4-1-89 (Emer.);
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.01 , 5111.011
Rule amplifies: RC 5111.01 , 5111.011
Replaces: 5101:1-39- 07.6
R.C. 119.032 review dates: 11/07/2007