5101:1-40-02.2 Medicaid: coverage for children.

(A) This rule describes covered groups for children from birth until the individual reaches age nineteen in accordance with section 1902(a)(10)(A) of the Social Security Act. There is no resource limit for children described in this rule.

(B) Eligibility criteria for newborn children born to medicaid-eligible women. In accordance with section 1902(e)(4) of the Social Security Act (as in effect June 1, 2010), a child shall be automatically eligible, as of the date of birth, and shall remain eligible until the child reaches the age of one, provided the birth mother is eligible for medicaid on the date of the child's birth. This includes, but is not limited to:

(1) A birth mother whose labor and delivery services were furnished prior to the date of application and the services are eligible to be covered by medicaid in accordance with 42 C.F.R. 435.117 (as in effect October 1, 2011), and whose medicaid eligibility is based on retroactive eligibility in accordance with rule 5101:1-38-01.2 of the Administrative Code.

(2) A birth mother receiving alien emergency medical services in accordance with rule 5101:1-41-20 of the Administrative Code.

(3) A birth mother residing in a public institution who is:

(a) In a "suspended for payment but eligible for medicaid" status, and

(b) Within twelve months from the date of application or redetermination.

(4) A birth mother eligible for medicaid who is in the custody of a public children services agency (PCSA) or private children placing agency (PCPA), in receipt of adoption or foster care assistance under Title IV-E, or in receipt of state or federal adoption assistance.

(5) A newborn whose birth mother loses medicaid eligibility after the birth of the newborn.

(6) A newborn child who is no longer a member of the medicaid eligible birth mother's household any time prior to the child reaching the age of one.

(C) Eligibility criteria for children under age nineteen.

(1) If a child is younger than nineteen, unmarried, not pregnant, and living with the child's parent(s), the income of the parent(s) shall be counted.

(2) The net-countable family income shall not exceed:

(a) One hundred fifty per cent of the federal poverty level regardless of creditable insurance coverage, or

(b) Two hundred per cent of the federal poverty level only if the child is not covered by creditable insurance.

(3) A child receiving medical coverage under this covered group shall remain eligible through the end of the month in which he or she turns age nineteen and would have otherwise remained eligible in accordance with rule 5101:1-38-01.8 of the Administrative Code.

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

(1) Not require a face-to-face interview.

(2) For children described in paragraph (B) of this rule:

(a) Accept verbal or written notification of the newborn's birth from any individual or entity reporting the birth.

(b) Verify, in the electronic eligibility system, the birth mother was eligible for and received medicaid on the date of the child's birth;

(c) Approve the child's eligibility for medicaid without delay and without consideration of income;

(d) Not require verification of U.S. citizenship or identity;

(e) Not require an application or a redetermination for the child prior to age one; and

(f) Complete a redetermination when the child reaches the age of one.

Effective: 01/09/2012
R.C. 119.032 review dates: 07/01/2016
Promulgated Under: 111.15
Statutory Authority: 5101.502 , 5101.512 , 5111.01 , 5111.011 , 5111.013
Rule Amplifies: 5101.502 , 5101.512 , 5111.01 , 5111.011 , 5111.013
Prior Effective Dates: 9/3/77, 10/26/78, 5/1/79, 9/21/79, 2/21/80, 6/1/84, 10/1/84 (Emer.), 12/27/84, 1/1/85 (Emer.), 2/15/85 (Emer.), 3/12/85 (Emer.), 4/1/85, 6/10/85 (Emer.), 11/30/85, 1/3/86, 8/1/86 (Emer.), 8/1/86, 9/23/86, 10/3/86, 10/8/86, 2/13/87 (Emer.), 4/25/87, 11/1/87, 1/1/88 (Emer.), 1/1/88, 6/20/88, 1/1/89 (Emer.), 2/6/89, 3/6/89, 3/28/89 (Emer.), 5/1/89 (Emer.), 7/1/89 (Emer.), 7/8/89, 9/23/89, 10/1/89 (Emer.), 12/16/89, 1/1/90 (Emer.), 4/1/90, 4/2/90, 6/22/90, 10/1/90, 4/1/91 (Emer.), 10/1/91, 11/1/91 (Emer.), 1/1/92, 5/1/92, 6/30/92, 9/1/92, 1/1/93 (Emer.), 1/1/93, 3/18/93, 3/1/94 (Emer.), 4/18/94, 6/20/94, 9/1/94, 9/1/95, 10/31/97 (Emer.), 12/31/97 (Emer.), 1/1/98 (Emer.), 1/26/98, 3/9/98, 4/4/98, 10/1/98, 11/1/99 (Emer.), 11/1/99, 11/19/99 (Emer.), 11/19/99, 1/1/00, 2/1/00, 7/1/00, 6/1/02 (Emer.), 8/30/02, 6/1/03, 9/20/03, 7/1/05, 1/1/06, 1/1/08, 7/17/11