5101:1-40-02.1 Medicaid: coverage for families.

(A) This rule describes low-income families (LIF) medicaid in accordance with section 1931 of the Social Security Act . There is no resource limit for families in this covered group.

(B) Definitions.

(1) "Comply" or "compliance", for the purpose of this rule, is defined as an agreement (verbal or written) to cooperate with a work activity requirement that is listed in the self-sufficiency contract.

(2) "Deemed", for the purpose of this rule means eligible for but not receiving Ohio works first (OWF) payments due to the following:

(a) The OWF payment is less than ten dollars; or

(b) The administrative agency is recovering an OWF overpayment that results in an OWF monthly payment not being received.

(3) "OWF Sanction", for the purpose of this rule, means an adult member of an OWF assistance group who, as a result of his or her own failure, has become ineligible for OWF payments for at least six months due to a third or subsequent failure or refusal, without good cause, to comply in full with a provision of a self-sufficiency contract related to a work activity.

(C) Eligibility criteria for the LIF covered group.

(1) The family's net countable family income is no more than ninety per cent of the federal poverty level; and

(2) The family includes a child who resides with the family or is temporarily absent with the intent to return home; or

(3) A dependent child in the care of a specified relative.

(4) A family receiving or deemed to be receiving an OWF cash payment and meets all other non-financial conditions of eligibility for medicaid is eligible for LIF.

(5) If a pregnant woman is included in this covered group and it is necessary to count the fetus in the family size to make the family financially eligible, the pregnancy must be verified.

(6) An OWF sanctioned individual is not eligible for medicaid. The family members of an individual on an OWF sanction remain eligible. The sanctioned individual shall regain medicaid eligibility beginning the first day of the month in which the individual agrees to comply with the work activity.

(7) The family shall receive an additional four consecutive months of LIF when there is a collection or increased collection received of child or spousal support, regardless of the amount, that caused ineligibility for LIF. The family must have been eligible for and received LIF in the state of Ohio in at least three of the six months immediately preceding the month in which the family becomes ineligible for LIF.

(D) Individual responsibilities. An individual under an OWF sanction shall provide verbal or written compliance to the administrative agency to regain medicaid eligibility.

(E) Administrative agency responsibilities. The administrative agency shall:

(1) Compare the net countable family income to ninety per cent of the federal poverty level. Approve, deny, or terminate the family's eligibility for LIF medicaid based upon the eligibility criteria described in paragraph (C) of this rule.

(2) Terminate an individual's eligibility if the individual is under an OWF sanction.

(3) Accept and document in the electronic eligibility system the receipt of verbal or written notice of compliance from the sanctioned individual and approve medicaid eligibility.

(4) Not terminate a woman who is pregnant or in her postpartum coverage period even if she is subject to an OWF sanction.

Effective: 01/09/2012
R.C. 119.032 review dates: 07/01/2016
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.011
Rule Amplifies: 5111.01 , 5111.011 , 5111.0120
Prior Effective Dates: 9/3/77, 10/26/78, 5/1/79, 9/21/79, 2/21/80, 1/1/83, 6/1/84, 10/1/84 (Emer.), 12/27/84, 1/1/85 (Emer.), 2/15/85 (Emer.), 3/12/85 (Emer.), 4/1/85, 6/10/85 (Emer.), 11/30/85, 1/3/86, 8/1/86 (Emer.), 8/1/86, 9/23/86, 10/3/86, 10/8/86, 2/13/87 (Emer.), 4/25/87, 10/1/87, 11/1/87, 1/1/88 (Emer.), 1/1/88, 6/20/88, 1/1/89 (Emer.), 2/6/89, 3/6/89, 3/28/89 (Emer.), 10/1/89, 12/16/89, 1/1/90 (Emer.), 4/1/90 (Emer.), 4/1/90, 6/20/90, 6/22/90, 10/1/91, 1/1/92, 1/1/93, 3/1/94 (Emer.), 4/18/94, 9/1/94, 9/1/95, 10/31/97 (Emer.), 12/31/97 (Emer.), 1/26/98, 3/9/98, 9/1/98, 10/1/98, 10/1/99, 11/1/99 (Emer.), 2/1/00, 7/1/00, 10/1/01, 6/1/02 (Emer.), 8/30/02, 1/1/05, 1/1/06, 1/1/08, 3/1/08, 7/17/11