Ohio Administrative Code Search

...ribed in this rule. (B) Definitions. (1) "Countable income," for the purpose of this rule, has the same meaning as in rule 5160:1-3-03.2 of the Administrative Code. (2) "Current incurred medical expense" means a medical bill or a portion of a medical bill that: (a) Includes: (i) A medically necessary medical item or service provided to the individual or to the individual's family memb...

...ribed in this rule. (B) Definitions. (1) "Countable income," for the purpose of this rule, has the same meaning as in rule 5160:1-3-03.2 of the Administrative Code. (2) "Current incurred medical expense" means a medical bill or a portion of a medical bill that: (a) Includes: (i) A medically necessary medical item or service provided to the individual or to the individual's family memb...

...(A) In accordance with 42 U.S.C. 1396b(v), this rule describes eligibility criteria for coverage of the treatment of an emergency medical condition for certain individuals who do not meet the medicaid citizenship or satisfactory immigration status requirements described in rule 5160:1-2-11 or 5160:1-2-12 of the Administrative Code. (B) Definition. "Emergency medical condition," for the purpos...

...S) benefit authorized under section 1915(i) of the Social Security Act (as in effect on October 1, 2017). Section 1915(i) of the act allows states the flexibility to provide HCBS to individuals who require less than an institutional level of care (LOC) and who would, therefore, not be eligible for HCBS under the more restrictive criteria of section 1915(c) waivers. The specialized recovery ser...

...S) benefit authorized under section 1915(i) of the Social Security Act (as in effect October 1, 2024). Section 1915(i) allows states the flexibility to provide HCBS to individuals who require less than an institutional level of care (LOC) and who would, therefore, not be eligible for HCBS under the more restrictive criteria of section 1915(c) waivers. The specialized recovery services (SRS) pr...

...itions apply unless otherwise stated. (1) "Labor trafficking" means recruiting, harboring, transporting, or obtaining of a person for labor or services through the use of force, fraud, or intimidation for the purpose of involuntary servitude, debt bondage, or slavery. (2) "Severe form of human trafficking" means sex trafficking or labor trafficking. (3) "Sex trafficking" means recruiting, harbo...

...itions apply unless otherwise stated. (1) "Labor trafficking" means recruiting, harboring, transporting, or obtaining of a person for labor or services through the use of force, fraud, or intimidation for the purpose of involuntary servitude, debt bondage, or slavery. (2) "Severe form of human trafficking" means sex trafficking or labor trafficking. (3) "Sex trafficking" means recruiting, harbo...

...or LTC services, the individual must: (1) Be eligible for medical assistance in accordance with Chapter 5160:1-3, 5160:1-4, 5160:1-5, or 5160:1-6, as applicable; and (2) Meet any non-financial eligibility requirements required for the type of LTC services requested; and (3) Not be subject to a restricted medicaid coverage period, in accordance with rule 5160:1-6-06.5 of the Administrative Code. (C) An individual ...

...or LTC services, the individual must: (1) Be eligible for medical assistance in accordance with Chapter 5160:1-3, 5160:1-4, 5160:1-5, or 5160:1-6, as applicable; and (2) Meet any non-financial eligibility requirements for the type of LTC services requested; and (3) Not be subject to a restricted medicaid coverage period, in accordance with rule 5160:1-6-06.5 of the Administrative Code. (C)...

...itions apply unless otherwise stated. (1) "Baseline date" means the first date the individual both is an institutionalized individual and has applied for medical assistance. An individual only has one baseline date. (2) "Community spouse" (CS) means an individual who is not receiving medicaid payment for long-term care (LTC) services and is married to an institutionalized spouse. (3) "Community spouse resource all...

...ns apply unless otherwise stated. (1) "Baseline date" means the first date the individual both is an institutionalized individual and has applied for medical assistance. An individual only has one baseline date. (2) "Community spouse" (CS) means an individual who is not receiving medicaid payment for long-term care (LTC) services and is married to an institutionalized spouse. (3) "Community...

...ject to the following resource rules: (1) The home equity limit as described in rule 5160:1-6-02.1 of the Administrative Code. (2) Evaluation of any qualified long-term care insurance policy as described in rule 5160:1-6-02.2 of the Administrative Code. (3) Evaluation of any entrance fee when the individual is residing in a continuing care retirement community, life care community, or a philanthropic long-term car...

...ers (CPI-U) in accordance with section 5163.32 of the Revised Code. (C) An individual shall not be eligible for LTC services if the individual's equity interest in his or her home, as defined in rule 5160:1-3-05.13 of the Administrative Code, exceeds the home equity limit. (D) The home equity limit does not apply to an individual if any of the following persons are lawfully residing in the individual's home: (1) T...

...(CPI-U) in accordance with section 5163.32 of the Revised Code. (C) An individual shall not be eligible for LTC services when the individual's equity interest in the home, as defined in rule 5160:1-3-05.13 of the Administrative Code, exceeds the home equity limit. (D) The home equity limit does not apply to an individual when any of the following persons are lawfully residing in the individual's...

...ip (QLTCP) program. (B) Definitions. (1) "Estate recovery" means the program set forth in rule 5160:1-2-07 of the Administrative Code. (2) "Qualified long-term care partnership" (QLTCP) means the program established under section 5164.86 of the Revised Code, under which an individual's assets or resources are disregarded in eligibility determinations and at estate recovery in the amount of ...

...ip (QLTCP) program. (B) Definitions. (1) "Estate recovery" means the program set forth in rule 5160:1-2-07 of the Administrative Code. (2) "Qualified long-term care partnership" (QLTCP) means the program established under section 5164.86 of the Revised Code, under which an individual's assets or resources are disregarded in eligibility determinations and at estate recovery in the amount of ...

...re facility (LTCF). (B) Definitions. (1) "Continuing care retirement communities" and "life care communities" mean housing communities that provide different types of care based on each resident's need over time. CCRCs and life care communities may range from independent living in an apartment to assisted living to full-time care in a nursing facility. Residents may move from one setting to another, based on their ...

...e facility (PLTCF). (B) Definitions. (1) "CCRCs" and "life care communities" mean housing communities that provide different categories of care based on each resident's need over time. CCRCs and life care communities may range from independent living in an apartment, to assisted living, to full-time care in a nursing facility. Residents may move from one setting to another, based on their needs,...

... payment for long-term care services. (1) An individual ineligible for base eligibility due to excess income shall have his or her income eligibility determined using the special income level (SIL), in accordance with rule 5160:1-6-03.1 of the Administrative Code. (2) If an individual's countable income is greater than the SIL, as determined in rule 5160:1-6-03.1 of the Administrative Code, the individual may estab...

...eet the resource requirements in rules 5160:1-3-05.1 and 5160:1-6-04 of the Administrative Code, as applicable, before his or her application for medical assistance can be approved. (D) Only an individual who has been institutionalized for a continuous period of institutionalization, as defined in rule 5160:1-6-01.1 of the Administrative Code, may have his or her income eligibility determined usi...

...eet the resource requirements in rules 5160:1-3-05.1 and 5160:1-6-04 of the Administrative Code, as applicable, before his or her application for medical assistance can be approved. (D) Only an individual who has been institutionalized for a continuous period of institutionalization, as defined in rule 5160:1-6-01.1 of the Administrative Code, may have his or her income eligibility determined usi...

...eet the resource requirements in rules 5160:1-3-05.1 and 5160:1-6-04 of the Administrative Code, as applicable, before his or her application for medical assistance can be approved. (D) Only an individual who has been institutionalized for a continuous period of institutionalization, as defined in rule 5160:1-6-01.1 of the Administrative Code, may have his or her income eligibility determined usi...

...-term care services. (B) Definitions (1) "Beneficiary" is defined in rule 5160:1-3-05.2 of the Administrative Code. (2) "Grantor" is defined in rule 5160:1-3-05.2 of the Administrative Code. (3) "Individual" is defined in rule 5160:1-6-01.1 of the Administrative Code. (4) "Irrevocable trust" is defined in rule 5160:1-3-05.2 of the Administrative Code. (5) "Primary beneficiary" means the...

...rces deeming provisions in Chapter 5160:1-3 of the Administrative Code do not apply. (B) This rule only applies to the financial eligibility determination of the IS, who is: (1) Requesting long-term care (LTC) payment of services, as described in rule 5160:1-6-01.1 of the Administrative Code, in a medical institution, or home and community-based services (HCBS) waiver, or program of all-inclusiv...

...rces deeming provisions in Chapter 5160:1-3 of the Administrative Code do not apply. (B) This rule only applies to the financial eligibility determination of the IS, who is: (1) Requesting long-term care (LTC) payment of services, as described in rule 5160:1-6-01 of the Administrative Code, in a medical institution, home and community-based services (HCBS) waiver, or program of all-inclusive car...