Rule 173-42-03 | PASSPORT program (medicaid-funded component): enrollment and reassessment of individuals.
(A) Initial contact: An individual may contact either ODM's administrative agency or ODA's designee to apply for the medicaid-funded component of the PASSPORT program. The two agencies coordinate processing applications for enrollment as follows:
(1) If the individual makes initial contact with ODM's administrative agency, then ODM's administrative agency shall help the individual apply and process the applications for medicaid (unless already enrolled in medicaid) and the medicaid-funded component of the PASSPORT program. If ODM's administrative agency notifies ODA's designee that the individual meets all financial eligibility requirements, then ODA's designee shall initiate contact with the individual to conduct an assessment by telephone, video conference, or in person to determine if the individual meets all non-financial eligibility requirements in rule 5160-31-03 of the Administrative Code.
(2) If the individual makes initial contact with ODA's designee, then ODA's designee shall help the individual apply for medicaid (unless already enrolled in medicaid) and the medicaid-funded component of the PASSPORT program and conduct an assessment by telephone, video conference, or in person to determine if the individual meets all non-financial eligibility requirements in rule 5160-31-03 of the Administrative Code.
(3) After the individual applies for the medicaid-funded component of the PASSPORT program, ODA or its designee shall notify the individual of the existence of the state-funded component of the PASSPORT program in Chapter 173-40 of the Administrative Code and offer the individual an opportunity to apply for enrollment in the state-funded component of the program.
(B) Denial: If ODM's administrative agency or ODA's designee determines the individual does not meet all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, then the following responsibilities apply:
(1) If ODM's administrative agency determines the individual does not meet all financial eligibility requirements, it shall notify ODA's designee and notify the individual of the denied application and appeal rights under section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code.
(2) If ODA's designee determines the individual does not meet all non-financial eligibility requirements, it shall notify the individual of the denied application and appeal rights under section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code.
(C) Enrollment: If ODM's administrative agency or ODA's designee determines the individual meets all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, then ODA's designee shall notify the individual that the individual meets all eligibility requirements and enroll the individual according to paragraph (C)(1) or (C)(2) of this rule.
(1) Available slot: ODA's designee shall enroll the individual in the program without placing the individual on the unified waiting list, if all the following conditions exist:
(a) A waiver slot in the medicaid-funded component of the PASSPORT program is available.
(b) The individual continues to meet the eligibility requirements for the program.
(c) The individual continues to want to enroll in the program.
(2) No available slot: If a waiver slot is not available in the medicaid-funded component of the PASSPORT program, ODA's designee may enroll the individual when a waiver slot becomes available by one of the following two means:
(a) Unified waiting list: If an individual meets all the non-financial eligibility requirements, but a slot is not available in the PASSPORT program, ODA's designee shall place the individual on the unified waiting list according to rule 173-44-04 of the Administrative Code, unless the individual qualifies for the home first component of the PASSPORT program, as addressed in paragraph (C)(2)(b) of this rule.
(b) Home first: If an individual meets all requirements for the home first component of the PASSPORT program in section 173.521 of the Revised Code, ODA's designee shall enroll the individual before enrolling any individual from the unified waiting list.
(D) Reassessment: ODA's designee shall reassess each individual enrolled in the medicaid-funded component of the PASSPORT program no less often than one time before each anniversary date of enrollment. After ODA's designee conducts each reassessment, if the individual continues to qualify for the medicaid-funded component of the program, the individual may decide if the individual wishes to remain in the program by signing an ODA-approved enrollment agreement as a condition of continued enrollment. During an emergency declared by the governor or a federal public health emergency, ODA's designee may collect the individual's handwritten or electronic signature on the enrollment agreement on a date later than the date the individual agrees to continue in the program, but no later than the next reassessment of the individual.
(E) An authorized representative may represent an individual in the enrollment and reassessment processes.
Last updated January 2, 2024 at 8:40 AM
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