5101:1-37-65 MAGI-based medicaid: coverage for a parent or caretaker relative residing with a child.

(A) This rule describes eligibilty for parents and caretaker relatives residing with children as described in 42 C.F.R. 435.110 (as in effect on April 1, 2013) for applications for medical assistance filed on or after January 1, 2014.

(B) Eligibility criteria for coverage because an individual is a parent or caretaker relative residing with a child.

(1) The individual must be residing with a dependent child under the age of eighteen. An individual is considered to be residing with the child even if the child is temporarily absent with the intent to return home.

(2) The individual must be the child's parent or caretaker relative, or a spouse residing with the child's parent or caretaker relative.

(3) An individual must not be subject to an OWF sanction, unless the individual has agreed to comply with the work activity. The sanctioned individual shall regain medicaid eligibility beginning on the first day of the month in which the individual agrees to comply with the work activity.

(4) The individual's household income must not exceed ninety per cent of the federal poverty level for the family size.

(C) Transitional medical assistance (TMA) or extended medical assistance (EMA).

(1) To be eligible for TMA or EMA an individual must have:

(a) Been eligible for and enrolled in medicaid:

(i) For at least three of the six months immediately preceding the loss of eligibility.

(ii) As a parent or caretaker relative, or as the minor child of a parent or caretaker relative, eligible under paragraph (B) of this rule.

(b) Become ineligible for medicaid under this rule as a result of an increase in:

(i) Earned income, to be eligible for TMA. Verification of increased income is not required and can be self-declared.

(ii) Increased collection of spousal support, to be eligible for EMA. Verification of increased income is not required and can be self-declared.

(2) Duration of eligibility.

(a) A parent or caretaker relative is eligible for:

(i) Four months of EMA beginning the month immediately following the last month the individual had income below the threshold for coverage as a parent or caretaker relative. Any months of medicaid received in error due to unreported income are counted as months of EMA.

(ii) Twelve months of TMA beginning the month immediately following the last month the individual had income below the threshold for coverage as a parent or caretaker relative. Any months of medicaid received in error due to unreported income are counted as months of TMA.

(b) A child remains eligible under rule 5101:1-37-63 of the Administrative Code for a continuous period of twelve months. At the end of that twelve-month period, the child becomes eligible for any remaining months of TMA or EMA for which the parent or caretaker relative is eligible, ending in the same month as TMA or EMA ends for the parent or caretaker relative.

(3) Resuming interrupted spans of eligibility. If an individual whose span of TMA was interrupted because the individual became eligible for coverage under paragraph (B) of this rule subsequently loses eligiblity under paragraph (B) of this rule due to an increase in earned income, the individual is eligible for any remaining months or the original TMA span.

(4) Repeated spans of eligibility. There is no limit to the number of times an individual may receive coverage under TMA or EMA, provided that the individual meets all of the relevant criteria for the coverage each time.

(D) Administrative agency responsibilities. The administrative agency must:

(1) Calculate a parent's or caretaker relative's family size and household income as described in rule 5101:1-37-61 of the Administrative Code.

(2) Consider an individual's eligibility for TMA or EMA as part of the redetermination and pre-termination review processes described in rule 5101:1-37-51 of the Administrative Code.

(a) Verify in the electronic eligibility system the individual was receiving medicaid in previous months. Approve TMA or EMA if an individual meets the requirements in paragraph (C) of this rule;

(b) Deny or terminate TMA or EMA when:

(i) There is no longer a child residing with the parent or caretaker relative, or

(ii) All individuals become eligible for another medicaid covered group.

Effective: 10/01/2013
R.C. 119.032 review dates: 10/01/2018
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.011
Rule Amplifies: 5111.01 , 5111.011