Lawriter - OAC - 5160:1-3-02.3 Medicaid: coverage for individuals receiving supplemental security income (SSI) benefits.

5160:1-3-02.3 Medicaid: coverage for individuals receiving supplemental security income (SSI) benefits.

(A) This rule describes eligibility for medical assistance for aged, blind or disabled individuals who receive SSI benefits authorized by the social security administration under Title XVI of the Social Security Act (as in effect on October 1, 2017). Eligibility for this category shall be determined for applications for medical assistance filed on or after August 1, 2016.

(B) Eligibility criteria. To be eligible for coverage under this group an individual must be receiving SSI benefits based on the social security administration's determination of eligibility for SSI payments. In addition, certain requirements specific to medical assistance must be met in order for an individual to be eligible under this group. Failure to comply with the following requirements will prevent an individual from being determined eligible under this provision:

(1) Consistent with rule 5160:1-2-10 of the Administrative Code:

(a) An individual must assign to the state of Ohio any rights to medical support and payments for medical care from any third party; and

(b) An individual must cooperate with the child support enforcement agency (CSEA) in establishing the paternity of any child eligible for medical assistance and in obtaining medical support and payments for medical care from any third party, in accordance with 42 C.F.R. 433.147 (as in effect on October 1, 2017); and

(c) An individual must cooperate with the administrative agency in identifying and providing information to assist the state with pursuing any third party who may be liable to pay for care and services; and

(2) An individual who is the beneficiary of a trust must provide documentation of the trust as required by rule 5160:1-3-05.2 of the Administrative Code.

(C) Retroactive coverage is available for this program in accordance with rule 5160:1-2-01 of the Administrative Code, but coverage under this rule shall not begin prior to August 1, 2016, and shall not provide reimbursement of services rendered prior to August 1, 2016.

Replaces: 5160:1-3- 02.3


Effective: 4/1/2018
Five Year Review (FYR) Dates: 04/01/2023
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 08/01/2016