LAW
Writer®
Ohio Laws and Rules
(A) Expedited medicaid must be explored for all pregnant women listed on any application for assistance.
(1) The CDHS shall identify individuals who are potentially eligible for expedited medicaid at the time of the individual’s request for assistance. An employee of the CDHS shall be responsible for screening all applications as they are received by mail or screening individuals as they come in to apply in person.
(2) Individuals who are found to be potentially eligible for expedited medicaid should be referred to a caseworker to determine financial eligibility.
(3) The CDHS shall also screen the applications to determine if the pregnant woman currently has a pending application for regular program eligibility or is currently on expedited medicaid.
(4) Once an individual has passed the screening process, a caseworker shall review the application to determine income eligibility.
(5) If the individual applied for assistance by completing an ODHS 7200 “Application for Cash, Medical and Food Stamp Assistance”, either an ODHS 7216 “Combined Programs Application” (CPA) or ODHS 7100 “Application for Income, Medical, and Food Assistance” (CAF) must be completed by the individual.
(B) To be eligible for expedited medicaid, a pregnant woman must meet the following criteria:
(1) Pregnancy must be medically verified by a statement signed by a doctor or a nurse, and;
(2) The assistance group’s countable income must be equal to or less than the appropriate healthy start standard.
(a) Verification of income is not mandatory at this point; the individual’s statement on the application is sufficient.
(b) The healthy start eligibility requirements as described in rule 5101:1-40-08 of the Administrative Code for income determinations apply to these individuals. Although the income of the woman’s family (if any), is taken into account to determine eligibility, expedited medicaid is available to the pregnant woman only.
(C) The regular medicaid and covered families and children medicaid eligibility requirements for citizenship and residency as described in rule 5101:1-38-02 of the Administrative Code apply to these individuals.
(D) When the CDHS receives either a CAF, APPL, or CPA that indicates that there is a pregnant woman in the household, and the criteria listed above has not been met, the ODHS 7220 “Application/Reapplication Verification Request Checklist for Healthy Start/Expedited Medicaid” must be completed immediately, indicating the specific verification still needed in order to establish eligibility.
(E) Within ten days of the date of application, the ODHS 7227 “Application Follow-Up Letter for Healthy Start/Expedited Medicaid,” must be mailed or personally delivered to the applicant, to inform her of the verification that was requested, but had not yet been received.
(F) The following also apply to expedited medicaid:
(1) No face-to-face interview requirement.
(2) No resource limit,
(3) No retroactive medicaid.
(4) Authorized representatives may apply for expedited medicaid on behalf of another individual.
(5) The provisions regarding a recipient-caused medicaid overpayment determination and recovery apply.
(6) There is no automatic assignment of third party and medical support payments for expedited medicaid.
(G) Concurrent determination of benefits.
(1) In addition to determining eligibility for expedited medicaid, the CDHS must concurrently determine eligibility for one of the following: healthy start, low-income families medicaid or regular medicaid for the aged, blind or disabled. The policy and procedure for completion of the application and the application process shall be in accordance with the rules in Chapters 5101:1-38, 5101:1-39 and 5101:1-40 of the Administrative Code pertaining to the appropriate programs, including a face-to face interview for those medicaid programs that require a face-to-face. Additionally, retroactive medicaid eligibility may be explored, if appropriate.
(2) In all instances except for healthy start or low income families only applications, an APPL or CAF must be completed. For healthy start and low income families applications, either a CPA or CAF may be completed.
(H) Eligibility span and limited medicaid coverage.
(1) An expedited medicaid card will be authorized, for all pregnant women, the day all eligibility criteria in accordance with this rule is met, but not later than the following work day. The expedited medicaid card is time-limited and does not replace a regular medicaid card.
(2) Expedited medicaid coverage is limited to sixty days from the date all expedited medicaid criteria are met.
(3) One expedited medicaid card will be issued for the entire eligibility span (sixty days).
(4) A pregnant woman may only receive one expedited medicaid card per pregnancy.
(5) Medicaid coverage under expedited medicaid is restricted to all medicaid covered services (e.g., doctor’s visits, prescriptions) except in-patient hospital services. However, since medicaid coverage under low income families, healthy start, or medicaid for the aged, blind, or disabled is being explored concurrently, inpatient hospitalization may be covered if the individual is subsequently found eligible for one of these programs.
(I) Notices.
(1) Notice of approval for expedited medicaid is required; all other approval and denial notices for the concurrent eligibility of regular program eligibility (i.e., low income families, healthy start, or medicaid for the aged, blind or disabled) shall be provided in accordance with the rules in division-level 5101:6 of the Administrative code.
(2) Termination of expedited medicaid upon expiration of the span of coverage is exempt from the normal notice requirements as described in division-level 5101:6 of the Administrative Code.
HISTORY: Eff 4-1-91 (Emer.); 6-1-91; 9-1-92; 9-1-93; 7-1-00
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.01, 5111.011
Rule amplifies: RC 5111.01, 5111.011
REPLACES FORMER RULES: 5101:1-39-96, 5101:1-39-961, 5101:1-39-962, 5101:1-39-963, 5101:1-39-964
R.C. 119.032 REVIEW DATES: 7/1/2005