5101:3-1-15 Medicaid card.

(A) All eligible medicaid consumers are issued a medicaid card as evidence of eligibility to be used when requesting medical services. Medicaid consumers who are enrolled in a managed care plan (MCP) are issued a MCP identification card from the managed care plan in place of a medicaid card. The medicaid card is valid for a period of one month only, and should be examined by the provider on each occasion that a service is requested to ensure that the consumer is currently eligible. The Ohio department of job and family services (ODJFS) will not pay for services rendered to ineligible consumers. If the eligible consumer does not have a medicaid card in his/her possession, the provider should contact the county department of job and family services (CDJFS) to verify eligibility.

(B) The medicaid card lists consumers eligible for medicaid, indicating the twelve-digit Ohio medicaid billing number for each member of the case. Medicaid providers are required to take reasonable steps to check the identity of the consumer for whom services are being provided.

(C) The medicaid card also supplies information identifying any third-party insurance coverage known to ODJFS. Requirements regarding third party insurance coverage are described in rule 5101:3-1-08 of the Administrative Code.

(D) In addition to the medicaid card, ODJFS also issues the following medical cards:

(1) “Ohio Disability Assistance” card. Certain individuals who are ineligible for medicaid may be eligible for the state and county funded disability medical assistance (DMA) program as defined in Chapter 5101:3-23 of the Administrative Code.

(2) “Ohio Disability Assistance Restricted Status” card. Consumers covered under this program are eligible for services provided under the DMA program with certain program restrictions as defined in Chapter 5101:3-23 of the Administrative Code.

(3) “Healthy Start Healthy Families Medicaid” card. This card is used by families who qualify for medicaid coverage under income eligibility guidelines established by the federal government as defined in Chapter 5101:1-40 of the Administrative Code.

(4) “PACT Medicaid” card. This card is used by consumers enrolled in the department’s primary alternative care and treatment (PACT) program as defined in Chapter 5101:3-20 of the Administrative Code.

(5) “Ohio Qualified Medicare Beneficiary” (QMB) card, Medicaid benefits for QMBs are limited to payments toward medicare cost-sharing expenses. Requirements regarding QMB coverage are described in rule 5101:3-1-05 of the Administrative Code.

(6) “Expedited Medicaid Limited Coverage” card. Expedited medicaid provides eligible pregnant women with outpatient medical coverage, as described in rule 5101:1-40-60 of the Administrative Code, while they wait for the CDJFS to complete the eligibility determination process that may permit them to receive coverage through other programs such as medicaid for the aged, blind or disabled, healthy start medicaid, or healthy families medicaid.

Effective: 12/18/2006

R.C. 119.032 review dates: 09/01/2006 and 12/01/2011

Promulgated Under: 119.03

Statutory Authority: 5111.02

Rule Amplifies: 5111.01, 5111.02

Prior Effective Dates: 4/7/77, 7/1/80, 10/1/87, 5/30/02