Chapter 5101:1-42 Non Medicaid Medical Assistance Programs

5101:1-42-01 Disability medical assistance (DMA) program.

(A) The disability medical assistance (DMA) program is a state administered program with no federal funding and no federal regulations. The DMA program provides medical assistance to persons who are medication dependent and ineligible for any category of medicaid.

(1) The DMA program has a capped appropriation that may limit the number of individuals approved for DMA. The county department of job and family services (CDJFS) shall permit all individuals to apply for DMA. However, because of the capped appropriation, approval of DMA applications may be suspended pursuant to the provisions below in order to ensure that DMA expenditures do not exceed the state’s appropriation.

(2) The director of job and family services or designee may issue an order at any time suspending the approval of any new applications for DMA. The order shall be distributed to all CDJFS agencies on the same day and shall remain in effect until revised or rescinded. During a program suspension, all new applicants shall be informed that a suspension is in effect. All new applications shall be denied during the time that a suspension is in effect. No waiting lists shall be established during periods of suspension.

(B) Definitions.

(1) “Assistance group” is defined as applicants for or recipients of DMA who are living together and treated as a unit for purposes of determining eligibility for DMA. The assistance group is formed by selecting all of the covered individuals who are medication dependent from the family group. The assistance group must contain the following covered individuals:

(a) An individual; or

(b) A married couple.

(2) “Disability benefits” include but are not limited to:

(a) Social security administration (SSA) disability benefits as defined in this rule;

(b) Veteran’s administration benefits; and

(3) “Family group” is defined as the assistance group, and any persons related to any member of the assistance group by blood, adoption (i.e., parents and their children), or marriage who are living in the same home as the assistance group.

(a) The family group must include all children, their siblings and half-siblings, under the age of eighteen who are living with their biological or adoptive parents. Additionally, a married individual who is living with a spouse must be included in the same family group with the spouse (the definition of marriage as set forth in rule 5101:1-3-03 of the Administrative Code). If the spouse has biological or adoptive children under age eighteen living with him or her, those children must also be included in the family group.

(b) An individual who is living in a residential treatment center for substance abuse that is certified by the Ohio department of alcohol and drug addiction services must constitute a family group, and must not be included in another family group while the individual remains in the residential treatment facility.

(i) Siblings and half-siblings under the age of eighteen (including emancipated minors and pregnant minors);

(ii) The parent(s) of the children included in the family group;

(iii) The spouse(s) of all members of the family group; and

(iv) Any children of the spouse.

(4) “Licensed physician” is a physician licensed under state of Ohio law or under another state’s law to practice medicine and surgery or osteopathic medicine and surgery.

(5) “Living arrangement” includes individuals living in their own homes or other suitable quarters, but not individuals who reside in a county home, city infirmary, jail or public institution. The following living arrangements meet the eligibility requirement:

(a) An individual residing in a residential treatment center certified by the Ohio department of alcohol and drug addiction services (ODADAS);

(b) An individual residing in a housing facility operated by a certified ODADAS program or provider; and

(c) An individual residing in an Ohio department of mental health or Ohio department of mental retardation and developmental disabilities licensed or supervised home.

(d) An individual residing in a mental health facility with an anticipated date of release is potentially eligible. The CDJFS processes the application, even though the living arrangement requirement is not met at the time of application.

(i) The application shall be filed in the county in which the applicant will reside upon release from the mental health facility.

(ii) The beginning date of medical assistance shall be the date of release from the mental health facility, as all eligibility factors will be met on that date. If the release occurs earlier than the given date, DMA eligibility shall be backdated to the date of release.

(iii) The initial DMA medical card shall be picked up at the CDJFS upon the individual’s release from the mental health facility. Upon request, the DMA medical card shall be mailed to the individual’s residence upon notification of the individual’s release. Subsequent DMA medical cards shall be mailed to the individual’s residence.

(iv) If during the application process, the CDJFS determines that the individual will not be released into the community, the CDJFS shall deny the DMA application.

(6) “Medication dependency” means a licensed physician has certified that the individual is under ongoing treatment for a chronic medical condition of sufficient severity (including severe pain) such that the absence of continuous prescription medication could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions, serious dysfunction of any bodily organ or part, or death. The medical condition may include physical and/or mental impairment(s) and must have lasted or can be expected to last for a continuous period of at least twelve months.

(7) “SSA disability benefits” are disability benefits provided to an individual and authorized by the SSA through Title II and Title XVI of the Social Security Act [42 USC 402 (4/7/2000) and 42 USC 416 (8/15/1994)]. “Supplemental Security Income (SSI)” are benefits authorized by the SSA through Title XVI of the Social Security Act.

(1) Non-financial eligibility criteria:

(a) Medication dependency, as defined in paragraph (B) of this rule. Medication dependency shall be verified by a completed JFS 03606, “Disability Medical Assistance (DMA) Physician Certification of Medication Dependency” (rev. 9/2005);

(b) Residence, in accordance with rule 5101:1-39-54 of the Administrative Code;

(d) Living arrangement as defined in paragraph (B) of this rule; and

(e) Third party and medical support, in accordance with rule 5101:1-38-02.2 of the Administrative Code.

(2) Financial eligibility criteria:

(a) Assistance group.

(b) Family group.

(d) Resources, in accordance with rule 5101:1-5-30 of the Administrative Code.

(e) Income standard, in accordance with rule 5101:1-5-01 of the Administrative Code.

(f) Need, in accordance with rule 5101:1-5-01 of the Administrative Code.

(3) Exceptions to DMA eligibility:

(a) Individuals who are under sanction provisions in accordance with rule 5101:1-40-07 of the Administrative Code.

(b) Individuals who have quit or refused employment or training within the past thirty days without good cause. He/she is ineligible for DMA for thirty days beginning with the date of the refusal or termination of employment or training.

(c) Individuals or other individuals included in determining the individual’s DMA eligibility who are involved in a strike, as defined in section 5107.10 of the Revised Code.

(d) Individuals who are ineligible for SSI due to a failure to comply with SSI program requirements.

(e) Individuals who have transferred property without receiving fair market value during the two years before application or most recent redetermination of eligibility for DMA.

(f) Individuals who reside in a county home, city infirmary, jail or public institution.

(g) Fugitive felons as defined in section 5101.26 of the Revised Code.

(h) Individuals violating a condition of probation, a community control sanction, parole, or a post-release control sanction imposed under federal or state law.

(D) Eligibility period.

(1) The beginning date of eligibility is the date that the applicant meets all eligibility criteria or the date that a signed completed application is filed, whichever is later.

(2) An eligibility redetermination shall be completed every six months.

(E) Application.

(1) The CDJFS shall use the JFS 07200, “Request for Cash, Food Stamp, and Medical Assistance” (rev. 5/2005) in accordance with rule 5101:1-38-01.2 of the Administrative Code.

(2) The CDJFS shall give the JFS 03606 to the individual, the individual’s legal representative, another person applying on behalf of the individual, or the treating physician(s).

(3) The CDJFS shall follow procedures for medicaid application processing, as outlined in rules 5101:1-38-01 and 5101:1-38-01.2 of the Administrative Code.

(F) CDJFS responsibilities.

(1) At the time of application or redetermination for DMA eligibility, the CDJFS shall also explore medicaid eligibility, including medicaid eligibility under the disability and blindness categories, in accordance with rule 5101:1-39-03 of the Administrative Code.

(a) If an individual has, alleges, or appears to have a physical or mental impairment or combination of impairments that may limit his or her ability to work or an individual is, alleges being or appears to be blind, the CDJFS shall assist the individual in obtaining medical documentation to support the disability or blindness claim, in accordance with rule 5101:1-39-03 of the Administrative Code.

(b) The CDJFS shall utilize administrative funds to assist the individual in receiving an eye examination or medical/psychological examination to determine whether an individual is blind or disabled, in accordance with rule 5101:1-39-03 of the Administrative Code.

(2) As a condition of DMA eligibility, the CDJFS shall require individuals to apply for any disability benefits (as defined in paragraph (B) of this rule) to which they may be entitled.

(3) For individuals who are eligible for the DMA program as of January 1, 2006, the CDJFS at the next redetermination, shall use the DMA eligibility criteria outlined in paragraph (C) of this rule.

(4) For all DMA applications received before January 1, 2006 the CDJFS shall use the DMA rules that were in effect prior to January 1, 2006. At the first redetermination of the assistance group’s eligibility, the CDJFS shall use the DMA rules that are in effect January 1, 2006.

(5) For all applications received on or after January 1, 2006, the CDJFS shall use the eligibility criteria outlined in paragraph (C) of this rule.

(6) At redetermination, the CDJFS shall apply the eligibility criteria as outlined in paragraph (C) of this rule. If the individual does not meet all DMA eligibility criteria, the CDJFS shall terminate the individual’s DMA eligibility.

(7) The DMA beginning date of eligibility shall be authorized as the result of a hearing decision, court order or when the CDJFS determines that DMA was erroneously denied, terminated, or delayed and corrective action is being taken.

(8) The CDJFS shall issue proper notice and hearing rights as outlined in division level designation 5101:6 of the Administrative Code.

(G) The DMA assistance group must meet the reporting and verification requirements as outlined in rule 5101:1-38-02 of the Administrative Code.

(H) All appeals regarding DMA that are still pending in the bureau of hearings prior to January 1, 2006, and any appeals requested on or after January 1, 2006 on a DMA denial or termination issued prior to January 1, 2006, shall be determined in accordance with the DMA eligibility rules in effect on December 31, 2005.

(I) DMA covered services are outlined in rules 5101:3-23-01 and 5101:3-23-02 of the Administrative Code.

Replaces: 5101:1-42-01

Effective: 01/01/2006

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

Promulgated Under: 111.15

Statutory Authority: 5115.10, 5115.12, 5115.13, 5115.14

Rule Amplifies: 5115.10, 5115.11, 5115.12, 5115.13, 5115.14, 5115.20, 5115.22, 206.66.42 Am. Sub. HB 66.

Prior Effective Dates: 7/1/2003 (Emer.), 9/5/2003

5101:1-42-02 Medicaid: alien emergency medical assistance (AEMA). [Rescinded]

Rescinded eff 3-1-05

5101:1-42-30 Children's buy-in program: eligibility.

(A) This rule establishes eligibility requirements and limitations for the children’s buy-in (CBI) program for an individual under nineteen years of age with countable family income of more than three hundred per cent of the federal poverty level (FPL) and who has not had creditable coverage for at least six consecutive months before enrolling in the CBI program. The CBI program shall operate under the following limits:

(1) The CBI program is established as a state-funded health care program for which coverage under the program may be purchased by any eligible individual through the payment of premiums.

(2) An individual’s eligibility under the CBI program shall not be subject to federal regulations or statutes governing medicaid or the state children’s health insurance program (SCHIP).

(3) An individual purchasing coverage under the CBI program shall be eligible for coverage only on a prospective basis. Retroactive coverage is not available under the CBI program.

(4) Within limits set by this rule, the CBI program shall offer health care coverage to any eligible individual as set forth in paragraph (C) of this rule.

(5) The administrative agency may suspend application and enrollment under the CBI program at any time and may disenroll any individual as necessary and appropriate for the administration of the program.

(a) Coverage under the CBI program is not an entitlement.

(b) If the administrative agency suspends application or enrollment under the CBI program, the administrative agency will issue a written statement at the point of application and will provide an opportunity for any interested individual to request notification of a future opportunity to apply.

(B) Definitions.

(1) “Administrative agency”, for the purpose of this rule, means the Ohio department of job and family services (ODJFS) or its designee.

(2) “Countable family income”, for the purpose of this rule, means the amount of family income that determines an individual’s eligibility and premium for the CBI program. Countable family income is determined by adding all of a family’s gross unearned income to gross earned income. There shall be no disregards or exemptions in determining countable family income, except earnings for full-time students under age nineteen are not considered countable family income.

(3) “Creditable coverage”, for the purpose of this rule, means:

(a) Health care coverage as defined in 42 U.S.C. 300gg(c)(1) as in effect as of the effective date of this rule.

(i) Creditable coverage includes, but is not limited to, coverage under a group health plan, either group or individual health insurance, the federal employee health benefit program, and a public health plan.

(ii) Creditable coverage does not mean coverage consisting solely of expected benefits, including but not limited to coverage only for accidents, disability income insurance, liability insurance, supplemental policies to liability insurance, worker’s compensation insurance, automobile medical payment insurance, credit-only insurance, coverage for on-site medical clinics, or limited-scope dental, vision, or long-term care insurance.

(b) Creditable coverage does not include coverage under the program for medically handicapped children.

(4) “Family”, for the purpose of this rule, includes the following persons who live in the same household as the individual for whom access to coverage under the CBI program is sought or received:

(a) The individual;

(b) The biological, adoptive, step parents, and legal guardians of the individual;

(d) Minor dependent children of persons listed in paragraph (B)(4)(a), (B)(4)(b), or (B)(4)(c) of this rule.

(5) “Individual”, for the purpose of this rule, means a person who is applying for, or receiving, coverage under the CBI program and any biological, adoptive, or step parent or legal guardian acting on his or her behalf.

(6) “Premium” means a monthly payment required under section 5101.5213 of the Revised Code.

(7) “Program for medically handicapped children” means the program established under sections 3701.021 to 3701.0210 of the Revised Code and administered by the Ohio department of health.

(C) Eligibility criteria. An individual is eligible to purchase coverage under the CBI program if the individual meets the following requirements. The individual who is to be covered under the CBI program:

(1) Is younger than nineteen years of age;

(2) Is an Ohio resident;

(3) Is a United States citizen;

(4) Has countable family income more than three hundred per cent of the FPL for the appropriate family size as determined in paragraph (B)(4) of this rule;

(5) With the exception of medicaid, has been without creditable coverage for at least six consecutive months immediately preceding the date of application;

(6) Is not eligible for medicaid;

(7) Pays the premium. Partial payment of a premium shall not constitute payment of the premium; and

(8) Meets any one of the following conditions:

(a) Is unable to obtain creditable coverage due to a pre-existing condition of the individual;

(b) Lost the only creditable coverage available to the individual because the individual has exhausted a lifetime benefit limitation;

(c) The premium for the only creditable coverage available to the individual is more than two hundred per cent of the premium set forth in paragraph(D) of this rule; or

(d) Participates in the program for medically handicapped children.

(D) Premiums. The premium for each individual purchasing coverage under the CBI program shall be calculated by the administrative agency based on a percentage of an actuarial determination of the cost of CBI program coverage. The percentage of the actuarial determination of the cost of CBI program coverage the individual shall pay is as follows:

(1) If countable family income is more than three hundred per cent and no more than four hundred per cent of the FPL, the monthly premium shall be fifty per cent of the actuarially determined cost.

(2) If countable family income is more than four hundred per cent and no more than five hundred per cent of the FPL, the monthly premium shall be seventy-five per cent of the actuarially determined cost.

(3) If countable family income is more than five hundred per cent of the FPL, the premium cost for each individual shall be the full amount of the actuarially determined cost.

(E) Responsibilities of the individual.

(1) An individual shall complete an application in the form and manner prescribed by the administrative agency. A single application may be used for more than one individual in a family applying to purchase coverage under the CBI program. The individual shall:

(a) Provide information including, but not limited to, age, income, family size, and health care coverage;

(b) Self-declare information required for the application; and

(2) An individual shall report changes affecting the individual’s eligibility under the criteria listed in paragraph (C) of this rule or the amount of the individual’s premium.

(3) An individual shall provide information to complete the redetermination as required by the administrative agency.

(4) An individual shall affirm under penalty of perjury the information provided to the administrative agency is complete and correct.

(5) An individual shall notify the administrative agency of the individual’s intent to discontinue purchase of CBI coverage no less than thirty days prior to the date of discontinuation in accordance with procedures established by the administrative agency.

(F) Administrative agency responsibilities.

(1) The administrative agency shall notify an individual of any action that may affect an individual’s initial and continued eligibility to purchase coverage under the CBI program or the amount of the individual’s premium, and shall provide the individual with instructions for submission of a request for reconsideration to the administrative agency.

(2) The administrative agency shall notify an individual of a determination or redetermination of eligibility to purchase coverage under the CBI program.

(a) If an individual is eligible to purchase coverage under the CBI program, the notice shall include the following information:

(i) Name of any individual eligible to purchase coverage under the CBI program;

(ii) Premium amount;

(iii) Instructions for making premium payments and the initial premium payment due date;

(iv) The beginning coverage date, conditional upon the payment in full of the first premium; and

(v) Instructions for submission of a request for reconsideration.

(b) If an individual is not eligible to purchase coverage under the CBI program, the notice shall include the following information:

(i) Name of any ineligible individual;

(ii) Reasons for ineligibility; and

(iii) Instructions for submission of a request for reconsideration.

(3) The administrative agency may require that an individual purchasing coverage under the CBI program verify information provided during the application or redetermination process.

(4) The administrative agency may annually require that an individual purchasing coverage under the CBI program complete an eligibility redetermination.

(5) The administrative agency shall terminate eligibility under the CBI program if any one of the following occur:

(a) The individual no longer meets the eligibility requirements set forth in paragraph (C) of this rule;

(b) Premiums are not paid in full on behalf of the individual for two consecutive months;

(c) The administrative agency determines that misrepresentations were made during the application or redetermination process;

(d) The administrative agency determines that the individual failed to report changes that would affect the individual’s eligibility in the CBI program or the amount of the individual’s premium; or

(e) The individual notifies the administrative agency of the individual’s intent to discontinue purchase of CBI coverage pursuant to paragraph (E)(5) of this rule.

(6) The administrative agency shall apply all premium payments to the first month of enrollment for which any amount of premium is past due.

(7) If an individual’s eligibility under the CBI program is terminated due to non-payment of premiums for two consecutive months, the administrative agency shall:

(a) Notify an individual about his or her eligibility status and potential for loss of coverage due to non-payment of premiums and shall provide the individual with instructions for submission of a request for reconsideration to the administrative agency.

(b) Terminate coverage under the CBI program until all unpaid premiums are paid in full and shall not resume coverage until the individual reapplies and establishes eligibility to purchase coverage under the CBI program.

(8) Pursuant to section 131.02 of the Revised Code, the administrative agency shall pursue recovery of unpaid premiums unless the individual notifies the administrative agency of the intent to discontinue purchase of coverage under the CBI program pursuant to paragraph (E)(5) of this rule.

(G) Request for reconsideration.

(1) Individual responsibilities.

(a) An individual may request a reconsideration of any notice issued under authority of this rule. An individual shall file a written request with the administrative agency no more than fifteen calendar days after the date of the issuance of any notice. The request shall include the following:

(i) Any argument or explanation of the individual’s reason for dispute;

(ii) Any fact to support the individual’s argument or explanation; and

(iii) Any documentary evidence supporting the individual’s position.

(b) The individual shall submit along with the reconsideration request a copy of the notice that is the subject of the dispute.

(2) Administrative agency responsibilities.

(a) The administrative agency shall review the request for reconsideration, the evidence submitted with the request, and all arguments in support of that request. The administrative agency may ask for additional information or clarification from the individual.

(b) The administrative agency shall issue a decision responding to the request for reconsideration.

(3) Decisions related to denials or terminations of eligibility under the CBI program shall not provide for coverage under the CBI program prior to the date of issuance of the decision.

(4) The administrative agency decision shall be final.

Effective: 06/06/2008

R.C. 119.032 review dates: 06/01/2013

Promulgated Under: 119.03

Statutory Authority: 5101.5215

Rule Amplifies: 5101.5211 to 5101.5216

Prior Effective Dates: 04/01/08 (Emer.)

5101:1-42-90 Refugee medical assistance (RMA).

(A) RMA is a time-limited medical assistance program, funded through the office of refugee resettlement (ORR), that provides a medical screening through contracted refugee health screening providers, and other medical services to an individual who is not a United States (U.S.) citizen, is not eligible for medicaid and who meets the other eligibility requirements of this rule.

(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 determining eligibility for a medical assistance program.

(2) “Countable family income” means the family’s earned and unearned income after allowable deductions, exemptions, and exclusions as defined in rules 5101:1-40-20.1 to 5101:1-40-22 of the Administrative Code. Countable income does not include any cash assistance payments, in-kind services or shelter provided by a sponsor or local resettlement agency.

(3) “Derivative T visa” means either a T-2, T-3, T-4, or T-5 visa issued to certain family members of victims of a severe form of trafficking who may be eligible for RMA benefits if the visa holder meets refugee program eligibility requirements.

(4) “Family”, for the purpose of this rule, means an individual, the individual’s spouse, and dependent children.

(5) “Individual”, for the purpose of this rule, means an applicant for or a recipient of RMA or refugee cash assistance (RCA) who is not a U.S. citizen and who meets one of the following definitions of immigration status under the Immigration and Nationality Act (INA) (as of May 1, 2009), as verified by documentation issued by the U.S. department of state, U.S. department of homeland security, or U.S. department of justice:

(a) Paroled as a refugee or asylee under section 212(d)(5) of the INA (as of May 1, 2009).

(b) Admitted to the U.S. as a refugee under section 207 of the INA (as of May 1, 2009).

(d) Cuban and Haitian entrants in accordance with requirements in 45 C.F.R. part 401 (as of May 1, 2009).

(e) Certain Amerasians from Vietnam who are admitted to the U.S. as immigrants pursuant to section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act of 1988 (as contained in section 101(e) of Public Law 100-202, and amended by the 9th proviso under migration and refugee assistance in title II of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1989, Public Law 100-461, as amended).

(f) Victims of a severe form of trafficking as identified in 22 U.S.C. 7105(b)(1) (as of May 1, 2009) and certain family members, as identified in the Trafficking Victims Protection Reauthorization Act of 2003 (TVPRA) (Pub. L. No. 108-193). Victims of a severe form of trafficking are awarded a certification letter from ORR and are potentially eligible for RMA as described in 28 C.F.R. 1100.33 (as of May 1, 2009). Certain family members are awarded “Derivative T” visas and are potentially eligible for RMA.

(g) Admitted as an Afghan or Iraqi special immigrant under section 101(a)(27) of the INA (as of May 1, 2009).

(6) “Resources” means cash, personal property, and real property an individual has an ownership interest in and the legal ability to access in order to convert to cash.

(7) “RMA need standard” means one hundred per cent of the federal poverty level (FPL) based on family size.

(8) “Spenddown” is a process described in rule 5101:1-39-10 of the Administrative Code.

(1) The individual shall be neither:

(a) Eligible for medicaid; nor

(b) A full-time student in an institution of higher education, except where such enrollment is approved by the state, or its designee, as part of an individual employability plan as described in rules 5101:1-2-40 to 5101:1-2-40.5 of the Administrative Code.

(2) The individual meets the income requirements for RMA when:

(a) The individual’s countable family income is no more than the RMA need standard, or

(b) The individual whose family income is more than the RMA need standard spends down countable family income to the RMA need standard.

(3) Initial and ongoing eligibility for RMA is based on the applicant’s income on the date of application.

(4) Resources are exempt for RMA.

(D) Eligibility period. An individual who meets the eligibility requirements of this rule may receive RMA for a time-limited period not to exceed eight months from the individual’s date of entry or from the date status is granted, as listed on the individual’s U.S. citizenship and immigration services’ (USCIS) documentation.

(E) Individual responsibilities. The individual shall:

(1) Provide:

(a) USCIS documentation of alien status;

(b) The name of the resettlement agency, if any, that resettled the individual; and

(c) The information necessary to establish eligibility, cooperate in the verification process, and report changes in accordance with rule 5101:1-38-02 of the Administrative Code.

(2) Spend down to the RMA need standard if the individual’s income exceeds the RMA need standard; and

(3) Cooperate in providing verification of any third-party liability or coverage of medical expenses as defined in Chapter 5101:1-38 of the Administrative Code.

(F) Administrative agency responsibilities. The administrative agency shall:

(1) Accept an application, or electronic equivalent, for “cash assistance, food assistance, and medical assistance” as an application for RMA;

(2) Not require an individual to apply for or receive RCA;

(3) Not require a face-to-face interview;

(4) Use actual countable family income for the month of application. Do not average income prospectively in determining income eligibility for RMA;

(5) Determine medicaid eligibility, as described in Chapters 5101:1-37 to 5101:1-42 of the Administrative Code, prior to determining eligibility for RMA;

(6) Call the trafficking verification line to confirm the validity of the certification letter or letter for children and to notify ORR of the benefits for which the individual has applied;

(7) Make eligible an individual who receives RCA and who meets the eligibility requirements of this rule;

(8) Obtain third-party liability information from an individual who has other health insurance;

(9) Explore retroactive eligibility for RMA, as defined in Chapter 5101:1-38 of the Administrative Code. Retroactive eligibility cannot begin prior to the individual’s date of entry or from the date status is granted;

(10) Transfer the individual to RMA if medicaid eligibility is terminated due to an increase in income. A new eligibility determination is not required through the remainder of the RMA eligibility period; and

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

Replaces: 5101:1-2-40.1

Effective: 05/07/2009

R.C. 119.032 review dates: 05/01/2014

Promulgated Under: 111.15

Statutory Authority: 5101.02, 5101.49

Rule Amplifies: 5101.02, 5101.49

Prior Effective Dates: 7/1/76; 12/31/77; 11/22/81; 10/21/82; 11/1/82; 2/9/84 (Temp); 5/1/84; 7/1/84; 7/2/84; 7/2/84; 10/1/84 (Emer.); 12/27/84; 1/1/85 (Emer.); 4/1/85; 8/1/86 (Emer.); 10/3/86; 7/1/88; 1/1/89 (Emer.); 4/1/89; 11/1/89; 1/1/90 (Emer.); 4/1/90; 10/1/91 (Emer.); 12/20/91; 4/1/92; 10/1/93 (Emer.); 12/21/92; 9/1/94; 10/1/95; 1/1/96; 5/1/97; 7/1/98; 7/1/00; 10/8/00; 10/1/02