5101:1-40-25.1 Medicaid: budgeting methodology for individuals under the age of twenty-one not living with a parent or spouse.

(A) This rule outlines the budgeting process when determining covered families and children medicaid eligibility for individuals under the age of twenty-one not living in the same household as a parent or spouse. For the purpose of this rule, only the individual’s income is considered.

(B) Definitions

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

(2) “Countable income” is: the amount of income which is compared to the appropriate payment or need standard to determine if an individual is eligible for medicaid. Countable income is determined by adding nonexempt gross unearned income and gross earned income minus all appropriate disregards.

(3) “Gross countable income” is determined by adding all non-exempt unearned income and all earned income without earned income disregards.

(4) An “individual” is:

(a) An applicant or recipient of a medical assistance program; and,

(b) For the purposes of this rule, an individual under the age of twenty-one not living with a parent or spouse.

(C) Administrative agency responsibilities

(1) The administrative agency shall total all gross countable income.

(2) The administrative agency shall subtract the following disregards if appropriate:

(a) The first ninety dollars of monthly earned income.

(b) Thirty dollars and one-third of the remaining income in accordance with Chapter 5101:1-40 of the Administrative Code.

(c) All other appropriate disregards in accordance with Chapter 5101:1-40 of the Administrative Code.

(3) The administrative agency shall then compare the countable income to the Ohio works first (OWF) payment standard.

(a) If the individual’s countable income is equal to or less than the OWF payment standard, eligibility exists.

(b) If the individual’s countable income is greater than the OWF payment standard, eligibility does not exist.

Replaces: 5101:1-40:251

Effective: 01/01/2006

R.C. 119.032 review dates: 01/01/2011

Promulgated Under: 111.15

Statutory Authority: 5111.01

Rule Amplifies: 5111.01

Prior Effective Dates: 8/1/1986 (Emer.), 10/3/1986, 3/1/1994 (Emer.), 4/18/1994, 7/1/2000