5101:1-40-25 Covered families and children medicaid: low income families (LIF).

(A) This rule describes the budgeting methods and eligibility standards for low income families (LIF) medicaid.

(B) Definitions.

(1) “Administrative agency” means 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) “Countable income”, for the purposes of this rule, means the amount of income compared to the payment standard and is determined by adding all of a family’s nonexempt unearned income to nonexempt earned income after subtracting all appropriate disregards.

(3) “Family” has the same meaning as in rule 5101:1-40-01 of the Administrative Code.

(4) “Income” has the same meaning as in rule 5101:1-40-20 of the Administrative Code.

(5) “Individual” means an applicant for or recipient of a medical assistance program.

(1) Non-financial criteria:

(a) The individual must be the parent of a child younger than nineteen, and reside with the child.

(b) The individual must not be eligible for another category of medicaid.

(2) Financial criteria:

(a) There is no resource limit.

(b) There are two income standards. An individual is financially eligible for medicaid if either:

(i) The individual’s gross income is no more than ninety per cent of the federal poverty level for the appropriate family size; or

(ii) The individual’s countable income is no more than the payment standard for the appropriate family size.

(D) Individual responsibilities. The individual must:

(1) Provide verification in accordance with Chapter 5101:1-38 of the Administrative Code.

(2) Inform the administrative agency of any available health insurance, as provided in rule 5101:1-38-02.2 of the Administrative Code.

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

(1) Determine medicaid eligibility in accordance with the eligibility rules contained in Chapters 5101:1-37 to 5101:1-42 of the Administrative Code.

(2) Calculate the family’s countable income in accordance with Chapter 5101:1-40 of the Administrative Code.

(3) Not terminate medical assistance for a member 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.

(4) Issue proper notice and hearing rights as outlined in division 5101:6 of the Administrative Code.

Replaces: 5101:1-40-25

Effective: 01/01/2008

R.C. 119.032 review dates: 01/01/2013

Promulgated Under: 111.15

Statutory Authority: 5111.01

Rule Amplifies: 5111.01, 5111.019

Prior Effective Dates: 10/31/97 (Emer.), 1/26/98, 10/1/99, 7/1/00, 1/1/06