Rule 5160:1-2-14 | Medicaid: continuous eligibility for children younger than age nineteen.
(A) This rule describes the twelve-month period of continuous eligibility for a child younger than age nineteen, and the conditions under which the child's coverage ends during the twelve-month period, as described in section 1902(e)(12) of the Social Security Act (as in effect October 1, 2019).
(B) Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months if the child was found to be eligible for a category of medical assistance other than:
(1) Presumptive eligibility as described in Chapter 5160:1-1 or Chapter 5160:1-2 of the Administrative Code;
(3) Refugee medical assistance as described in rule 5160:1-5-05 of the Administrative Code.
(1) A child's twelve-month period of continuous eligibility begins:
(b) Without regard to any months of retroactive eligibility.
(2) The child's coverage shall be terminated during the continuous eligibility period only:
(a) Upon oral or written request of the child (if the child is at least eighteen years old) or the child's representative; or
(b) When the child:
(i) No longer resides in the state of Ohio; or
(D) Patient liability, or premium. A patient liability or premium calculated for a child in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code shall not increase during the child's continuous coverage period. Any decrease in a child's patient liability or premium results in a new maximum amount, which will not increase for the remainder of the child's continuous coverage period.
(E) Regardless of a child's status under this rule, payment for services shall not be made if payment is prohibited under rule 5160:1-1-05 of the Administrative Code.