Chapter 5161: CHILDREN'S HEALTH INSURANCE PROGRAM

5161.01 Definitions.

(A) As used in the Revised Code, "children's health insurance program" and, when used as an acronym for the children's health insurance program, "CHIP" mean the program of child health assistance authorized by Title XXI of the "Social Security Act," 42 U.S.C. 1397aa et seq. CHIP part I, CHIP part II, and CHIP part III, as authorized by this chapter, are components of CHIP. Any reference in statute enacted by the general assembly to medicaid or the medicaid program also means CHIP to the extent, if any, that CHIP is provided under the medicaid program.

(B) As used in this chapter, "federal poverty line" means the official poverty line defined by the United States office of management and budget based on the most recent data available from the United States bureau of the census and revised by the United States secretary of health and human services pursuant to the "Omnibus Budget Reconciliation Act of 1981," section 673(2), 42 U.S.C. 9902(2).

Added by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

5161.02 [Renumbered from 5101.502] Rules for administration of CHIP.

The medicaid director may adopt rules in accordance with Chapter 119. of the Revised Code as necessary for the efficient administration of the children's health insurance program , including rules that establish all of the following:

(A) The conditions under which the program will pay for health benefits coverage;

(B) The method of the payment;

(C) The amount of payment, or the method by which the amount is to be determined, for each service included in the health benefits coverage.

Renumbered from § 5101.502 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 07-01-2000

5161.05 [Renumbered from 5101.50] Continued operation of federal component.

The medicaid director may continue to operate the component of the children's health insurance program initially authorized by an executive order issued under section 107.17 of the Revised Code as long as federal financial participation is available for the program. If operated, the component shall pay for part or all of the cost of health benefits coverage for uninsured individuals under nineteen years of age with family incomes not exceeding one hundred fifty per cent of the federal poverty line.

Renumbered from § 5101.50 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Amended by 128th General AssemblyFile No.9, HB 1, §101.01, eff. 10/16/2009.

Effective Date: 09-05-2001; 2007 HB119 09-29-2007

5161.06 [Renumbered from 5101.501] CHIP part I.

The component of the children's health insurance program authorized by section 5161.05 of the Revised Code shall be known as CHIP part I.

Renumbered from § 5101.501 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 06-30-1999

5161.10 [Renumbered from 5101.51] State child health plan.

In accordance with federal law governing the children's health insurance program, the medicaid director may submit a state child health plan to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for part or all of the cost of health benefits coverage for uninsured individuals under nineteen years of age with family incomes above one hundred fifty per cent of the federal poverty line but not exceeding two hundred per cent of the federal poverty line. If the director submits the plan, the director shall stipulate in the plan

that the payments will be available only while federal financial participation is available for them.

Renumbered from § 5101.51 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 07-01-2000

5161.11 [Renumbered from 5101.511] CHIP part II.

The component of the children's health insurance program authorized by section 5161.10 of the Revised Code shall be known as CHIP part II.

Renumbered from § 5101.511 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 09-29-1999

5161.12 [Renumbered from 5101.512] Implementation of CHIP part II.

If the medicaid director submits a state child health plan to the United States secretary of health and human services under section 5161.10 of the Revised Code and the secretary approves the plan, the director shall implement CHIP part II in accordance with the plan.

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Renumbered from § 5101.512 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 07-01-2000

5161.15 [Renumbered from 5101.52] Request for waiver to pay costs for certain individuals.

In accordance with federal law governing the children's health insurance program, the medicaid director may submit a request for a federal waiver to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for part or all of the cost of health benefits coverage for individuals under nineteen years of age with family incomes above two hundred per cent of the federal poverty line but not exceeding three hundred per cent of the federal poverty line. If the director submits the waiver request, the director shall stipulate in the request that the payments will be available only while federal financial participation is available for them.

Renumbered from § 5101.52 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 2007 HB119 09-29-2007

5161.16 [Renumbered from 5101.521] CHIP part III.

The component of the children's health insurance program authorized by section 5161.15 of the Revised Code shall be known as CHIP part III.

Renumbered from § 5101.521 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 2007 HB119 09-29-2007

5161.17 [Renumbered from 5101.522] Implementation of CHIP part III.

If the medicaid director submits a waiver request to the United States secretary of health and human services under section 5161.15 of the Revised Code and the secretary grants the waiver, the director shall implement CHIP part III in accordance with the waiver.

Renumbered from § 5101.522 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 2007 HB119 09-29-2007

5161.20 [Renumbered from 5101.524] Health benefits coverage.

In accordance with the "Social Security Act," section 2101, 42 U.S.C. 1397aa, the children's health insurance program shall provide payments for obtaining health benefits coverage through any of the following:

(A) Obtaining coverage that meets the requirements the "Social Security Act," section 2103, of 42 U.S.C. 1397cc ;

(B) Providing benefits under the medicaid program ;

(C) A combination of divisions (A) and (B) of this section.

Renumbered from § 5101.524 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 2007 HB119 09-29-2007

5161.22 [Renumbered from 5101.516] Imposing restrictions where federal financial participation for CHIP parts II or III insufficient.

If the medicaid director determines that federal financial participation for CHIP part II, part III, or both parts is insufficient to pay for part or all of the costs of health benefits coverage for all the individuals the director anticipates are eligible for the part or parts, the director may refuse to accept new applications for the part or parts or may make the eligibility requirements more restrictive for the part or parts.

Renumbered from § 5101.516 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 07-01-2000

5161.24 [Renumbered from 5101.517] Cost-sharing by individual receiving health assistance under CHIP part II.

To the extent permitted by the "Social Security Act," section 2103(e), 42 U.S.C. 1397cc(e), the medicaid director may require an individual seeking to enroll, or who is enrolled, in CHIP part II to pay a premium, deductible, coinsurance payment, or other cost-sharing expense.

Renumbered from § 5101.517 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 07-01-2000

5161.25 [Renumbered from 5101.527] Premium payments.

To the extent permitted by the "Social Security Act," section 2103(e), 42 U.S.C. 1397cc(e), the medicaid director shall require an individual seeking to enroll, or who is enrolled, in CHIP part III to pay the following as a term of enrollment:

(A) A premium of not less than forty dollars per month for a family with one individual seeking to enroll, or who is enrolled, in the part;

(B) A premium of not less than eighty dollars per month for a family with two individuals seeking to enroll, or who is enrolled, in the part;

(C) A premium of not less than one hundred twenty dollars per month for a family with three or more individuals seeking to enroll, or who are enrolled, in the part.

Renumbered from § 5101.527 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 2007 HB119 09-29-2007

5161.27 [Renumbered from 5101.519] Application for medicaid.

A completed application for medicaid shall be treated as an application for the children's health insurance program if the application is for an assistance group that includes a child under nineteen years of age and is denied.

Renumbered from § 5101.519 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 09-29-1999

5161.30 [Renumbered from 5101.513] Contract to perform administrative duties.

The medicaid director may contract with a government entity or person to perform the director's administrative duties regarding CHIP part I, part II, part III, two of the parts, or all three parts, other than the duty to submit a state child health plan to the United States secretary of health and human services under section 5161.10 of the Revised Code, the duty to submit a waiver request under section 5161.15 of the Revised Code, and the duty to adopt rules under section 5161.02 of the Revised Code.

Renumbered from § 5101.513 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Effective Date: 07-01-2000

5161.35 [Renumbered from 5101.5110] Waiver request to provide health assistance to certain individuals.

(A) The medicaid director may submit a waiver request to the United States secretary of health and human services to provide health assistance to any individual who meets all of the following requirements:

(1) Is the parent of a child who is under nineteen years of age , resides with the parent, and is enrolled in the children's health insurance program part I or II or the medicaid program ;

(2) Is uninsured;

(3) Has a family income that does not exceed one hundred per cent of the federal poverty line.

(B) A waiver request the director submits under division (A) of this section may seek federal funds allotted to the state under the "Social Security Act," section 2104, 42 U.S.C. 1397dd, that are not otherwise used to fund the children's health insurance program parts I and II.

Renumbered from § 5101.5110 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

Amended by 128th General AssemblyFile No.9, HB 1, §101.01, eff. 10/16/2009.

Effective Date: 09-05-2001