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Ohio Laws and Rules
(A) This rule defines four-month extended coverage for purposes of determining medicaid eligibility. Four-month extended coverage is for certain individuals who lose medicaid eligibility under the covered group of healthy families/low-income families (LIF) wholly or partly as a result of new or increased receipt of child or spousal support.
(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” for the purposes of this rule means an individual or individual(s) and may include the following:
(a) The healthy families/LIF assistance group at the time of loss of healthy families/LIF eligibility;
(b) Individuals who would be included in the healthy families/LIF assistance group if the assistance group applied in the month of loss of healthy families/LIF eligibility;
(c) Specified relative because the natural parent is not in the home in accordance with rule 5101:1-40-01 of the Administrative Code;
(d) A child born after healthy families/LIF is terminated or an individual who returns home after healthy families/LIF is terminated; and
(e) Parents or specified relatives of children for whom federal, state, or local foster care maintenance payments are made, who are otherwise eligible for healthy families/LIF.
(3) “Individual” is the applicant or recipient of a medical assistance program.
(C) Eligibility criteria.
(1) The assistance group must meet the medicaid eligibility criteria in accordance with the eligibility rules contained in Chapters 5101:1-37 to 5101:1-42 of the Administrative Code.
(2) The assistance group must have become ineligible to receive healthy families/LIF wholly or partly as a result of new or increased receipt of child or spousal support under title IV-D of the Social Security Act.
(3) The assistance group must have been eligible for and received healthy families/LIF in the state of Ohio in at least three of the six months immediately preceding the month in which the assistance group became ineligible for healthy families/LIF.
(D) Eligibility period.
(1) The eligibility period is four calendar months beginning with the first month of ineligibility for healthy families/LIF.
(2) There is no eligibility redetermination for assistance groups that receive four-month extended coverage.
(3) If an individual loses eligibility for four-month extended coverage during the four-month period, the individual cannot become eligible for four-month extended coverage during the same four-month period. However, the individual may be found eligible during the same four-month period under another category of medicaid.
(E) Administrative agency responsibilities.
(1) The administrative agency shall determine medicaid eligibility in accordance with the eligibility rules contained in Chapters 5101:1-37 to 5101:1-42 of the Administrative Code.
(2) The administrative agency shall issue proper notice and hearing rights as outlined in division-level designation 5101:6 of the Administrative Code.
(3) The administrative agency shall not terminate medical assistance for a member(s) of an assistance group until a pre-termination review (PTR) of continuing medicaid or medical assistance eligibility has been completed in accordance with rule 5101:1-38-01.1 of the Administrative Code.
HISTORY: Replaces former rule 5101:1-40-05.9; Eff. 1-1-05
Promulgated Under: 111.15
Statutory Authority: 5111.01
Rule Amplifies: 5111.01, 5111.012
R.C. 119.032 review dates: 01/01/2010