5101:1-40-02.4 Medicaid: coverage for individuals at least age nineteen and younger than age twenty-one.

(A) This rule describes medicaid eligibility for individuals at least age nineteen and younger than age twenty-one, as described in 42 C.F.R. 435.222 and sections 1902(a)(10)(A)(ii) and 1905(a)(i) of the Social Security Act (as in effect April 1, 2011). This covered group is also known as "Ribicoff children." There is no resource limit for this covered group.

(B) Eligibility criteria for individuals at least age nineteen and younger than twenty-one.

(1) The individual must be at least nineteen and younger than twenty-one.

(2) Income.

(a) The individual's or family's net countable income must not exceed the current Ohio works first (OWF) payment standard for the appropriate family size.

(b) If the individual lives alone or with someone who is not the individual's parent or spouse, only the individual's net countable income is used in the eligibility determination.

(c) If the individual is living with a parent or spouse, the individual's countable income and the parent's or spouse's allocation of income, as described in Chapter 5101:1-40 of the Administrative Code, is used in the eligibility determination.

(3) Family size.

(a) When the individual is living with parent(s) or a spouse, the family size includes the parent(s) or spouse.

(b) When the individual is living with dependent siblings and parent(s), the family size includes the dependent siblings.

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

(1) Total all gross countable income.

(2) Subtract the following disregards, if appropriate:

(a) The first ninety dollars of monthly earned income.

(b) Thirty dollars and one-third of the remaining earned income.

(i) The thirty dollar disregard is limited to twelve months.

(ii) The one-third disregard is limited to the first four consecutive months.

(c) The first fifty dollars of child support received, if applicable.

(3) Compare the net countable income to the current OWF payment standard for the appropriate family size.

(a) If the net countable income is equal to or less than the OWF payment standard, eligibility exist.

(b) If the net countable income is greater than the OWF payment standard, eligibility does not exist.

Replaces: 5101:1-40- 25.1

Effective: 10/03/2011
R.C. 119.032 review dates: 10/01/2016
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.011
Rule Amplifies: 5111.01 , 5111.011
Prior Effective Dates: 8/1/86 (Emer), 10/3/86, 3/1/94 (Emer), 4/18/94, 7/1/00, 1/1/06