5101:1-39-11 Medicaid eligibility for persons living in state institutions for the mentally ill and mentally retarded.

(A) Medicaid eligibility is possible for persons who are residents of state institutions for the mentally ill and mentally retarded if the person meets the eligibility requirements of Chapter 5101:1-39 or 5101:1-40 of the Administrative Code. The CDJFS determines eligibility for medicaid applicants/recipients residing in state institutions and authorizes vendor payments when appropriate. The CDJFS in which the state institution is located has case responsibility with the exception of the temporary absence and inter-county transfer provisions set forth in rules 5101:1-37-02.3 and 5101:1-40-01 of the Administrative Code.

(B) Persons who are under the age of twenty-two or aged sixty-five or over and who reside in state institutions for the mentally ill in areas which are certified as Title XIX facilities are assumed to meet the limiting physical factor requirement of disability.

(C) Persons of any age who reside in state institutions for the mentally retarded in areas which are certified as Title XIX facilities are also assumed to meet the limiting physical factor requirement.

(D) Persons of any age who reside in state institutions for the mentally ill in areas certified as Title XIX intermediate care facilities for the mentally retarded (dual diagnosis units) are assumed to meet the limiting physical factor requirement.

(E) The budget procedure which includes deducting the cost of care in a state institution as a medical expense shall be used for eligibility determination as prescribed in rule 5101:1-39-10.1 of the Administrative Code.

(F) For Title XIX facilities where a vendor payment will be authorized, the cost of care will be the Title XIX vendor rate for that facility.

(G) For persons who live in sections not approved for vendor payment, the cost of care as set by the institution shall be used as a medical deduction.

Eff 9-3-77; 8-1-86 (Emer.); 10-3-86; 10-1-02
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.01 , 5111.011
Rule amplifies: RC 5111.01 , 5111.011
R.C. 119.032 review dates: 5/20/2002 and 10/01/2007