(A) Individuals aged sixty or older (and their spouses) who are disabled as described in paragraph (B) of this rule and who live with others, may be permitted separate assistance group (AG) status even if they do not purchase food and prepare meals separately from the others. However, this exception is limited to those situations where the income of the individuals with whom the elderly, disabled person resides does not exceed one hundred sixty-five per cent of the poverty level, as discussed in paragraph (C) of this rule, and the elderly individual is unable to purchase food and prepare his or her own meals. If an individual meets these criteria, he and his spouse may be granted separate AG status, even if the spouse does not meet all the criteria. In summary, individuals wishing to be separate AGs, must be all of the following:
(1) Elderly (aged sixty or over).
(2) Disabled (see paragraph (B) of this rule).
(3) Unable to purchase food and prepare meals.
(4) Living with others whose income does not exceed the amounts specified in appendix D of rule 5101:4-4-11 of the Administrative Code entitled"Separate Assistance Group Income Standards - Elderly and Disabled AGs Only."
(B) Disability defined
An individual who is sixty years of age or older and suffers from a disability considered permanent under the Social Security Act of 1935, as amended or suffers from a nondisease-related, severe, permanent disability may be eligible for separate AG status. Note: "Disability" as defined in this rule is not the same as "disabled member" as found in rule 5101:4-1-03 of the Administrative Code. The key factor in determining whether or not disability would qualify an individual for separate AG status under this provision is an inability to purchase and prepare meals.
(1) Verification of disability
In the majority of cases, an individual with a disability considered permanent under the Social Security Act can be assumed to be incapable of purchasing and preparing meals. However, because disability under the Social Security Act as well as other disability programs is based on inability to work, county agencies shall not automatically assume the disability constitutes inability to purchase and/or prepare meals. If it is obvious to the county agency that the person could not purchase and prepare his or her own meals as easily as a nondisabled person, separate AG status shall be granted, provided that the requirements of paragraph (C) of this rule have been met, and the nature of the disability is documented in the case file.
However, when the inability to purchase and prepare meals is not obvious to the county agency, the county agency shall request the individual to provide a statement from a physician that he or she is unable to purchase and prepare his or her own meals. County agencies shall also use an applicant's doctor's statement for determining what constitutes a nondisease-related, severe, permanent disability. If the county agency is unable to determine whether the elderly person meets the disability requirements, the individual shall not be granted separate AG status.
(2) The following is a list developed by the social security administration, revised periodically, which may be used by the county agency to determine what impairments constitute permanent disability for Social Security Act disability purposes. (County agencies will be notified by ODJFS of periodic updates.)
(a) Permanent loss of use of both hands, both feet, or one hand and one foot.
(b) Amputation of the leg at the hip.
(c) Amputation of the leg or foot because of diabetes mellitus or peripheral vascular diseases.
(d) Total deafness, not correctable by surgery or a hearing aid.
(e) Statutory blindness, except if due to cataracts or detached retina.
(f) IQ of fifty-nine or less, established after attaining age sixteen.
(g) Spinal cord or nerve root lesions resulting in paraplegia or quadriplegia.
(h) Multiple sclerosis in which there is damage of the nervous system because of scattered areas of inflammation which recurs and has progressed to varied interference with the function of the nervous system, including severe muscle weakness, paralysis, and vision and speech defects.
(i) Muscular dystrophy with irreversible wasting of the muscles with a significant effect on the ability to use the arms or legs.
(j) Impaired renal function due to chronic renal disease (documented by persistent adverse objective findings) resulting in severely reduced function which may require disalysis or kidney transplant.
(k) Amputation of a limb, if currently age fifty-five or older.
(l) Chronic liver disease with esophageal varices resulting in massive hemorrhage or requiring a shunt operation.
(m) Psychiatric impairments which have required institutionalization in a licensed mental hospital for the past two years without releases that would indicate improvement.
(n) Age fifty-nine and over with any of the following conditions:
(i) - Arthritis of major weight-bearing joint.
(ii) - Arthritis of one major joint in each of the upper extremities.
(iii) - Disorders of the spine.
(iv) - Organic loss of speech.
(v) - Chronic obstructive airway disease.
(vi) - Defuse pulmonary fibrosis.
(vii) - Other restrictive ventilatory disorders.
(viii) - Arteriosclerosis obliterans or thromboangitis.
(ix) - Diabetes mellitus.
(x) - Scleroderma or progressive systemic sclerosis.
(xi) - Central nervous system vascular accident.
(xii) - Parkinsonian syndrome.
(xiii) - Cerebral palsy.
(xiv) - Amyotrophic lateral sclerosis.
(xv) - Anterior poliomyelitis.
(xvi) - Subacute combined cord degeneration.
(xvii) - Degenerative disease.
(xviii) - Syringomyelia.
(xix) - Chronic venous insufficiency.
(xx) - Tabes dorsalis.
(o) Age fifty-five and over with two substantiated myocardial infarctions.
(C) Income of others
After an elderly individual has been determined disabled in accordance with paragraph (B) of this rule, the gross income of the others with whom the elderly, disabled individual resides must be considered, as if the others were applying for participation. The income of the elderly, disabled person and his or her spouse is not included in the calculation, nor are the elderly/disabled person and his or her spouse to be considered AG members for this purpose. The gross monthly income of the others shall be compared to the "Separate Assistance Group Income Standards - Elderly and Disabled AGs Only" as found in appendix D of rule 5101:4-4-11 of the Administrative Code. If the gross income of the others with whom the elderly, disabled person resides is within the limits of, appendix D of rule 5101:4-4-11 of the Administrative Code the AG shall be granted separate AG status. Elderly, disabled individuals as described in paragraph (A) of this rule who wish to be a separate AG shall be responsible for obtaining the cooperation of the individuals with whom they reside in providing necessary income information to the county agency. Income of the others with whom the elderly individuals live shall be verified as if the others were also applying for program participation, as discussed in rule 5101:4-2-09 of the Administrative Code.
(D) Shared expenses
Once separate AG status has been established, county agencies shall prorate any expenses shared by the elderly AG and the others with whom the elderly AG resides and attribute allowable expenses to determine income deduction amounts as described in rule 5101:4-4-23 of the Administrative Code, to whomever incurs the expense.
(E) Elderly and disabled individuals ineligible for separate status
Elderly, disabled individuals who do not meet the requirements of paragraph (A) or (B) of this rule shall be considered ineligible for separate AG status. The individuals shall become members of the total AG with whom they reside, and shall have AG status based upon the group of individuals who customarily purchase and prepare meals together for home consumption.
R.C. 119.032 review dates: 10/08/2008 and 01/01/2014
Promulgated Under: 111.15
Statutory Authority: 5101.54
Rule Amplifies: 329.04, 329.042, 5101.54
Prior Effective Dates: 6/1/83; 9/24/83; 12/31/84 (Emer.); 4/1/85; 10/1/95 (Emer.); 12/15/95; 2/1/99; 2/1/04