5101:1-40-02.2 Medicaid: coverage for children born to medicaid eligible women.

(A) This rule defines how the administrative agency shall deem medicaid eligibility to a child born to a woman eligible for and receiving medicaid on the date of the child’s birth.

(B) Definitions

(1) “Administrative agency” is the county department of job and family services (CDJFS), Ohio department of job and family services (ODJFS) or other entity that determines eligibility for a medical assistance program.

(2) “Assistance group” is defined in accordance with rule 5101:1-38-01.2 of the Administrative Code.

(3) “Individual” is the applicant or recipient of a medical assistance program.

(1) A child born to a woman eligible for and receiving medicaid on the date of the child’s birth is deemed to have filed an application and been found eligible on the date of birth and to remain eligible for one year provided:

(a) The child resides continuously in the woman’s household; and

(b) The woman remains eligible for medicaid or would have remained eligible if she were still pregnant.

(2) A child is deemed eligible only within the state in which the woman was eligible on the date of the birth.

(3) No additional eligibility requirements, including income, have to be met in order for medicaid coverage to continue for the child as long as the mother remains eligible for medicaid or would have remained eligible if she were still pregnant.

(D) Application

(1) No application form is necessary for a child born to a medicaid recipient.

(a) The case record must contain written notification of the birth, or

(b) Verbal notification of the birth shall be carefully recorded by the administrative agency in the case record.

(2) The effective date of eligibility shall be the birth date of the child.

(E) Administrative agency responsibilities

(1) If the administrative agency finds that the child is not residing in the mother’s household, or is no longer a resident of the state, the child loses deemed eligibility.

(2) If a mother applies for medicaid after her child is born, and is determined to have retroactive eligibility (in accordance with rule 5101:1-40-08 of the Administrative Code) that includes the date of birth, she is considered to have been eligible for and receiving medicaid at the time of the birth.

(a) The child is deemed eligible at birth and retains that deemed eligibility under the same conditions as a child whose mother applied for and was found eligible for medicaid prior to the birth.

(3) A child eligible for medicaid assistance will be placed on medicaid within five business days from receipt of:

(a) Verbal notification of the birth, or

(b) The JFS 02453 “Inpatient Hospital Admission” form, or

(4) The administrative agency shall not terminate medical assistance for a member of an assistance group until a pre-termination review (PTR) of continuing medicaid eligibility has been completed in accordance with rule 5101:1-38-01.1 of the Administrative Code.

(5) Prior notice and hearing rights as outlined in division-level designation 5101:6 of the Administrative Code shall be observed.

(F) Individual responsibilities

(1) Continued eligibility after the child’s first birthday requires a reapplication and determination of continued eligibility for medicaid, as described in rule 5101:1-38-01 of the Administrative Code.

Replaces: 5101:1-40-02.2

Effective: 07/01/2005

R.C. 119.032 review dates: 07/01/2010

Promulgated Under: 111.15

Statutory Authority: 5111.01

Rule Amplifies: 5111.01

Prior Effective Dates: 6-1-84, 10-1-84(EMER.), 12-27-84, 1-1-85(EMER.), 4-1-85, 8-1-86(EMER.), 10-3-86, 11-1-91(EMER.), 1-1-92, 5-1-92, 9-1-92, 11-1-99, 2-1-00