5101:1-39-02 Medicaid: grandfathering provisions resulting from the implementation of the supplemental security income (SSI) program.

(A) With the implementation of the SSI program in January 1974, various grandfathering provisions were enacted to assure that aged, blind, and disabled persons previously eligible for cash assistance and medicaid under the former programs of aid would not be disadvantaged by the new eligibility conditions under the SSI program.

(B) Under the grandfathering provisions, certain persons who were eligible for medicaid in December 1973 are entitled to continued medicaid eligibility coverage even though they may not meet the medicaid eligibility requirements imposed beginning in January 1974 for the coverage of the aged, blind, and disabled. These groups are as follows:

(1) Individuals who are recipients of mandatory supplement payments administered by the social security administration are automatically eligible for medicaid.

(2) Any individual who was eligible in December 1973 as a dependent spouse as long as the dependent spouse continues to be the spouse of and lives with the former cash assistance recipient of AFA, AFB, or AFD, and if the dependent spouse's needs were considered in determining the amount of assistance payable to the recipient in December 1973. The dependent individual must meet all other requirements for medicaid except limiting physical factor. Only in this situation is the requirement of age, blindness, or disability waived as medicaid eligibility requirements.

(3) Individuals who were eligible for medicaid in December 1973 because they met the definition of blindness or disability in effect under the former programs of AFB or AFD remain eligible for medicaid if the individual meets the criteria listed below:

(a) The individual meets all current requirements for medicaid eligibility except for blindness or disability, and

(b) The individual was eligible for medicaid in December 1973 as blind or disabled, whether or not the individual received cash assistance in December 1973, and

(c) For each consecutive month after December 1973, the individual has continued to meet the December 1973 criteria for blindness or disability, and

(d) For each consecutive month after December 1973, the individual has continued to meet all other eligibility requirements which were in effect December 1973.

(e) Failure to meet any one of the four conditions listed in paragraph (B)(3) of this rule renders the case ineligible under the blind or disabled grandfathering provisions. A case is ineligible when it is found that the recipient fails to meet any one condition.

(f) A blind or disabled grandfathered individual permanently loses his blind or disabled grandfathered status when he fails to meet any December 1973 eligibility requirement for any one month.

(g) Any changes in circumstances requires a redetermination of eligibility based upon all conditions in paragraph (B)(3) of this rule.

(4) Persons who would currently be eligible for SSI or cash assistance except for the amount of increased income resulting from the October 1972 twenty per cent general increase in RSDI are eligible for medicaid if, for the month of August 1972, they met the following criteria:

(a) The individual was eligible for and receiving cash assistance under the ADC, AFA, AFB, or AFD programs, and

(b) The individual received and was entitled to monthly RSDI benefits.

(c) Only the October 1972 RSDI increase is disregarded. Any subsequent increases in RSDI are not disregarded.

(d) Although the amount of the October 1972 RSDI increase is disregarded in determining financial eligibility, the individual must meet all of the current eligibility requirements for medicaid or the ADC eligibility requirements which were in effect on July 16, 1996.

(5) All individuals who were eligible for medicaid in December 1973 because they were inpatients or residents of Title XIX institutions and who would have been eligible for cash assistance if they were not in the institution are entitled to continued medicaid as long as they continue to meet the medicaid eligibility requirements in effect in December 1973 and continue to require institutional care.

Eff 9-3-77; 10-26-78; 5-1-79; 9-21-79; 2-7-80; 10-15-98; 10-1-02
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.01 , 5111.011
Rule amplifies: RC 5111.01 , 5111.011
Replaces: 5101:1-39-47
R.C. 119.032 review dates: 10/01/2007